medcomdk · SGA-MedCom · Jan 13, 2026 · Nov 17, 2025 · Nov 18, 2025 · Nov 18, 2025
diff --git a/_build.bat b/_build.bat
@@ -89,7 +89,7 @@ echo ---------------------------------------------------------------
 echo.
 
 echo Please select an option:
-echo 1. Download or upload publisher
+echo 1. Download or update publisher
 echo 2. Build IG
 echo 3. Build IG - no sushi
 echo 4. Build IG - force no TX server

diff --git a/input/fsh/MedComCoreCareTeam.fsh b/input/fsh/MedComCoreCareTeam.fsh
@@ -8,7 +8,7 @@ Description: "Careteam participating in the care of a patient"
 * text.status MS
 * text.div MS
 * name 1.. MS
-* managingOrganization 0..1 MS 
+* managingOrganization 1..1 MS 
 * managingOrganization only Reference(MedComCoreOrganization) 
 * managingOrganization ^type.aggregation = #bundled
 * insert ProducerShallPutInNarrative(id)

diff --git a/input/fsh/MedComCoreContactExtension.fsh b/input/fsh/MedComCoreContactExtension.fsh
@@ -10,7 +10,9 @@ Description: "Extension that contains the contact information"
 * valueContactPoint.value ^short = "Shall contain a relevant telephone number."
 * valueContactPoint.system = #phone
 * valueContactPoint.system MS
-
+* insert ProducerShallPutInNarrative(valueContactPoint.system)
+* insert ProducerShallPutInNarrative(valueContactPoint.value)
+* insert ProducerShallPutInNarrative(valueContactPoint.use)
 
 Invariant: medcom-core-contact
 Description: "The telephone number may include + and numbers from 0-9"

diff --git a/input/fsh/MedComCoreDiagnosticRepport.fsh b/input/fsh/MedComCoreDiagnosticRepport.fsh
@@ -3,6 +3,11 @@ Parent: DiagnosticReport
 Id: medcom-core-diagnosticreport
 Title: "MedComCoreDiagnosticReport"
 Description: "Report containing all observation results."
+* id MS
+* text MS
+* text ^short = "The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle."
+* text.status MS
+* text.div MS
 * identifier 1..1 MS 
 * identifier.value 1..1 MS 
 * identifier.value obeys medcom-uuidv4
@@ -13,7 +18,7 @@ Description: "Report containing all observation results."
 * code MS
 * code from $DiagnosticReportCode
 * subject 1..1 MS
-* subject only Reference(MedComCorePatient) 
+* subject only Reference(DkCorePatient) 
 * subject ^type.aggregation = #bundled
 * issued 1..1 MS
 * result MS

diff --git a/input/fsh/MedComCoreEncounter.fsh b/input/fsh/MedComCoreEncounter.fsh
@@ -23,7 +23,7 @@ Description: "An interaction between a patient/citizen and healthcare provider(s
 * episodeOfCare[lpr3identifier].identifier only Lpr3Identifier
 * episodeOfCare[lpr3identifier].identifier ^definition = "Shall contain the id of the episode of care reported to the Danish National Patient Registry if known"
 * subject 1.. MS
-* subject only Reference(MedComCorePatient)
+* subject only Reference(DkCorePatient)
 * subject ^type.aggregation = #bundled
 * account ..0
 * serviceProvider only Reference(MedComCoreOrganization)

diff --git a/input/fsh/MedComCoreMedia.fsh b/input/fsh/MedComCoreMedia.fsh
@@ -3,6 +3,11 @@ Parent: Media
 Id: medcom-core-media
 Title: "MedComMedia"
 Description: "Profile to capture relevant images,audio, video and document as part of the healthcare process"
+* id MS
+* text MS
+* text ^short = "The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle."
+* text.status MS
+* text.div MS
 * status MS
 * identifier 1..1 MS
 * identifier only MedComAssignedIdentifier

diff --git a/input/fsh/MedComCoreObservation.fsh b/input/fsh/MedComCoreObservation.fsh
@@ -1,22 +1,34 @@
+
+
 Profile: MedComCoreObservation
 Parent: DkCoreObservation
 Id: medcom-core-observation
 Title: "MedComCoreObservation"
-Description: "Observation profile intended to be used in MedComHomeCareObservation and MedCom's Laboratory standards."
-* identifier 1..1 MS 
-* identifier.value 1..1 MS 
-* identifier.value obeys medcom-uuidv4
-* identifier ^short = "The Observation identifier" 
+Description: "Observation profile."
+* id MS
+* text MS
+* text ^short = "The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle."
+* text.status MS
+* text.div MS
 * status 1..1 MS
 * status from $ObsStatusCodes
 * status ^short = "registered | partial | preliminary | final | corrected | cancelled | entered-in-error" 
-* effectiveDateTime MS 
-* effectiveDateTime ^short = "The date and time the sample was taken (Danish: prøvetegningstidspunkt)."
+* effective[x] ^short = "The date and time of the observation."
 * code MS
-* code.coding.code MS
-* code.coding.system MS
 * subject 1..1 MS
-* subject only Reference(MedComCorePatient)
+* subject only Reference(DkCorePatient)
 * subject ^type.aggregation = #bundled
-* note MS
-* note ^short = "A comment on the individual result (Danish: Analysekommentar)"
+* performer 1.. MS
+* performer only Reference(MedComCoreOrganization or MedComCorePractitioner or MedComCorePractitionerRole or MedComCoreCareTeam or DkCorePatient or DkCoreRelatedPerson)
+* extension contains
+    $MedComObsExtValueAttachment named valueAttachment 0..*
+
+/* // --- R5 valueAttachment via official cross-version extension ---
+* extension contains
+    $obsExtValueAttachment named valueAttachmentR5 0..*
+* extension[valueAttachmentR5].value[x] only Attachment */
+
+* insert ProducerShallPutInNarrative(id)
+* insert ProducerShallPutInNarrative(status)
+* insert ProducerShallPutInNarrative(subject)
+* insert ProducerShallPutInNarrative(performer)
diff --git a/input/fsh/MedComCoreOrganization.fsh b/input/fsh/MedComCoreOrganization.fsh
@@ -2,14 +2,17 @@ Profile: MedComCoreOrganization
 Parent: DkCoreOrganization
 Id: medcom-core-organization
 Description: "A formally recognized organizations within danish healthcare, registered with a SOR identifier issued by The Danish Health Data Authority"
-* id MS
+* id 1.. MS
 * text MS
 * text ^short = "The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle."
 * text.status MS
 * text.div MS
+* identifier MS
 * identifier[SOR-ID] ^short = "Sundhedsvæsenets Organisationsregister (SOR) identifier" 
 * identifier[SOR-ID] 1..
-* identifier[SOR-ID] MS SU
+* identifier[SOR-ID] MS
+* identifier[SOR-ID].system MS
+* identifier[SOR-ID].value MS
 * name MS
 * name ^definition = "Name of the organization. Shall be present if known by the sender."
 * insert ProducerShallPutInNarrative(id)

diff --git a/input/fsh/MedComCorePatient.fsh b/input/fsh/MedComCorePatient.fsh
@@ -34,9 +34,12 @@ Description: "Patient/citizen resource to use as subject in MedCom communication
 * managingOrganization ^definition = "Organization that is the custodian of the patient record. This can e.g. be the sender of a message or responsable for the patients treatment. One of these organizations will always be included in the bundle, why this element is not mandatory to include."
 * identifier and name and telecom and address MS
 * insert ProducerShallPutInNarrative(id)
-* insert ProducerShallPutInNarrative(identifier[cpr])
-* insert ProducerShallPutInNarrative(identifier[x-ecpr])
-* insert ProducerShallPutInNarrative(identifier[d-ecpr])
+* insert ProducerShallPutInNarrative(identifier[cpr].value)
+* insert ProducerShallPutInNarrative(identifier[cpr].system)
+* insert ProducerShallPutInNarrative(identifier[x-ecpr].value)
+* insert ProducerShallPutInNarrative(identifier[x-ecpr].system)
+* insert ProducerShallPutInNarrative(identifier[d-ecpr].value)
+* insert ProducerShallPutInNarrative(identifier[d-ecpr].system)
 * insert ProducerShallPutInNarrative(name[official].family)
 * insert ProducerShallPutInNarrative(name[official].given)
 * insert ProducerShallPutInNarrative(telecom)

diff --git a/input/fsh/MedComCorePractitioner.fsh b/input/fsh/MedComCorePractitioner.fsh
@@ -8,8 +8,11 @@ Description: "Practitioner resource is used to describe a healthcare professiona
 * text.status MS
 * text.div MS
 * name MS
+* name.given MS
+* name.family MS
 * insert ProducerShallPutInNarrative(id)
-* insert ProducerShallPutInNarrative(name)
+* insert ProducerShallPutInNarrative(name.given)
+* insert ProducerShallPutInNarrative(name.family)
 
 Instance: e9eacb62-666b-11ed-9022-0242ac120002
 InstanceOf: MedComCorePractitioner

diff --git a/input/fsh/MedComCorePractitionerRole.fsh b/input/fsh/MedComCorePractitionerRole.fsh
@@ -1,5 +1,5 @@
 Profile: MedComCorePractitionerRole
-Parent: PractitionerRole
+Parent: DkCorePractitionerRole
 Id: medcom-core-practitionerrole
 Description: "PractitionerRole resource used to describe the role of a healthcare professional or another actor involved in  citizen or patient care."
 * id MS
@@ -8,27 +8,34 @@ Description: "PractitionerRole resource used to describe the role of a healthcar
 * text.status MS
 * text.div MS
 * practitioner only Reference(MedComCorePractitioner) 
-* practitioner MS
-* code MS
+* practitioner 1.. MS
+* code 1.. MS
 * code from $PractitionerRoles (example)
 * code.coding MS
 * code.text MS
-* organization MS
+* organization 1.. MS
 * organization only Reference(MedComCoreOrganization) 
 * organization ^type.aggregation = #bundled
+* obeys medcom-core-practitionerrole-code-xor-text
 * insert ProducerShallPutInNarrative(id)
 * insert ProducerShallPutInNarrative(practitioner)
 * insert ProducerShallPutInNarrative(organization)
 * insert ProducerShallPutInNarrative(code.coding)
 * insert ProducerShallPutInNarrative(code.text)
 
 
+Invariant: medcom-core-practitionerrole-code-xor-text
+Description: "There shall exist a practitioner role code or text."
+Severity: #error
+Expression: "code.coding.code.exists() xor code.text.exists()"
+
 Instance: 6057686e-666c-11ed-9022-0242ac120002
 InstanceOf: MedComCorePractitionerRole
 Title: "Example of a PractitionerRole"
 Description: "Example of a practitioner role with a code and reference to a practitioner"
 * code = $PractitionerRole#afdelingslaege
 * practitioner = Reference(e9eacb62-666b-11ed-9022-0242ac120002)
+* organization = Reference(12ee0dde-a672-462f-820d-5efe832d73c9)
 
 
 //Practitioner rolle
@@ -37,4 +44,5 @@ InstanceOf: MedComCorePractitionerRole
 Title: "PractitionerRole with a role and reference to a practitioner"
 Description: "PractitionerRole with a role and reference to a practitioner"
 * practitioner = Reference(e9eacb62-666b-11ed-9022-0242ac120002)
-* code = $PractitionerRole#sygeplejerske
+* code = $PractitionerRole#sygeplejerske
+* organization = Reference(12ee0dde-a672-462f-820d-5efe832d73c9)
diff --git a/input/fsh/MedComObservationValueAttachmentExtension.fsh b/input/fsh/MedComObservationValueAttachmentExtension.fsh
@@ -0,0 +1,19 @@
+Profile: MedComObservationValueAttachmentExtension
+Parent: Extension
+Id: medcom-observation-value-attachment-extension
+Title: "MedCom Observation ValueAttachment Extension"
+Description: "Generic extension for Observation value as Attachment type."
+
+// Canonical URL for extensionen
+* ^url = "http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension"
+* ^status = #active
+
+// Hvor extensionen må bruges
+* ^context[0].type = #element
+* ^context[0].expression = "Observation"
+* ^context[+].type = #element
+* ^context[=].expression = "Observation.extension"
+* . ^short = "Observation value as attachment."
+* url 1..1
+* url = "http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension" (exactly)
+* value[x] only Attachment
diff --git a/input/fsh/aliases.fsh b/input/fsh/aliases.fsh
@@ -14,4 +14,9 @@ Alias: $DiagnosticReportCodeSystem = http://medcomfhir.dk/ig/terminology/CodeSys
 Alias: $DiagnosticReportCode = http://medcomfhir.dk/ig/terminology/ValueSet/MedComDiagnosticReportCodesValueset
 Alias: $mediastatus = http://hl7.org/fhir/event-status
 Alias: $ProducenID = http://medcomfhir.dk/ig/terminology/CodeSystem/MedComProducentID  
-Alias: $obligation = http://hl7.org/fhir/StructureDefinition/obligation
+Alias: $obligation = http://hl7.org/fhir/StructureDefinition/obligation
+
+// ValueAttachment R5 extension used in Observation
+Alias: $obsExtValueAttachment = http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
+
+Alias: $MedComObsExtValueAttachment = http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
diff --git a/input/pagecontent/StructureDefinition-medcom-core-careteam-intro.md b/input/pagecontent/StructureDefinition-medcom-core-careteam-intro.md
@@ -1,5 +1,5 @@
 ### Scope and usage 
 
-This profile describes a MedComCoreCareTeam. A CareTeam is one or more professionals who plan to participate in the coordination and delivery of care for a patient or citizen. A MedComCoreCareTeam shall include a name and it may include a reference to an MedComCoreOrganization or MedComMessagingOrganization, as the managing organisation for the careteam.
+This profile describes a MedComCoreCareTeam. A CareTeam is one or more professionals who plan to participate in the coordination and delivery of care for a patient or citizen. A MedComCoreCareTeam **SHALL** include a name and it may include a reference to an Organization, as the managing organisation for the careteam.
 
-Please refer to the tab "Snapshot Table(Must support)" below for the definition of the required content of a MedComCoreOrganization.
+Please refer to the tab "Snapshot Table" below for the definition of the required content of a MedComCoreOrganization.
diff --git a/input/pagecontent/StructureDefinition-medcom-core-diagnosticreport-intro.md b/input/pagecontent/StructureDefinition-medcom-core-diagnosticreport-intro.md
@@ -1,7 +1,5 @@
->Note: This profile is developed to be part of a production trial of the communication between the general practitioner and municipal acute care team.
-
 #### Scope and usage
-This profile is intended to be uses in  MedCom HomeCareObservation and MedCom's Laboratory standards. 
+This profile is intended to be uses as a diagnostic report in MedCom standards. 
 
 #### Attachments 
 In MedComCoreDiagnosticReport it is allowed to include attachments. When sending an attachment diagnosticReport.media shall be used. The DiagnosticReport.media.link reference to MedComCoreMedia resource where the atachment shall be added. 

diff --git a/input/pagecontent/StructureDefinition-medcom-core-encounter-intro.md b/input/pagecontent/StructureDefinition-medcom-core-encounter-intro.md
@@ -2,13 +2,13 @@
 
 This profile describes the MedComCoreEncounter. An encounter describes the interaction between a patient and one or more healthcare providers for the purpose of providing healthcare services or assessing the health status of a patient. An encounter can take place in an ambulatory, an emergency, at the citizen's home, virtually and so on. 
 
-The base expectations when describing an encounter in a Danish context is to include the subject of the encounter which shall be a [MedComCorePatient](https://medcomfhir.dk/ig/core/StructureDefinition-medcom-core-patient.html) as well as a status and class, which are described below. For some specific purposes, such as [HospitalNotification](https://medcomfhir.dk/ig/hospitalnotification/), there is a need for a specialization of the MedComCoreEncounter. In these cases, it will be explicitly described which encounter to use and which changed are applied. 
+The base expectations when describing an encounter in a Danish context is to include the subject of the encounter as well as a status and class, which are described below.
 
-Please refer to the tab "Snapshot Table(Must support)" below for the definition of the required content of a MedComCoreEncounter. 
+Please refer to the tab "Snapshot Table" below for the definition of the required content of a MedComCoreEncounter. 
 
 #### Status and class
 
-A status and class shall be included MedComCoreEncounter. 
+A status and class **SHALL** be included in a MedComCoreEncounter. 
 
 The status refers to the current state of the encounter. This will most often change due to the nature an encounter, as it will pass through many statuses which follows the workflow of the encounter. A status can be 'in-progress' describing that the patient is present or the meeting has begun, or 'finished' describing that the encounter is finished.
 
@@ -22,4 +22,4 @@ The EpisodeOfCare identifier is used to technically connect several encounters c
 
 It is both possible to use a [Landspatientregisteret](https://www.esundhed.dk/Registre/Landspatientregisteret)-identifier (called LPR3-identifier) and a locally defined identifier as the EpisodeOfCare-identifier. 
 
-Whether a LPR3-identifier or a locally defined identifier is used, it shall be an UUID. The LPR3-identifier shall obey a rule stating that the UUID shall be of version 5, [here more information about the LPR3-identifier can be found](https://scandihealth.github.io/lpr3-docs/). Using a locally defined identifier, a system for the identifier shall be added. 
+Whether a LPR3-identifier or a locally defined identifier is used, it **SHALL** be an UUID. The LPR3-identifier **SHALL** obey a rule stating that the UUID **SHALL** be of version 5, [here more information about the LPR3-identifier can be found](https://scandihealth.github.io/lpr3-docs/). Using a locally defined identifier, a system for the identifier **SHALL** be added. 
diff --git a/input/pagecontent/StructureDefinition-medcom-core-media-intro.md b/input/pagecontent/StructureDefinition-medcom-core-media-intro.md
@@ -1,5 +1,3 @@
->Note: This profile is developed to be part of a production trial of the communication between the general practitioner and municipal acute care team.
-
 ### Scope and use
 This profile is a MedCom Core profile for media and is intended to represent relevant attachments for a variety cases including: 
 * laboratory observations
@@ -8,15 +6,7 @@ This profile is a MedCom Core profile for media and is intended to represent rel
 Only an attachment of the permitted formats must be included. 
 [Click here to see the permitted formats of an attachment](https://medcomfhir.dk/ig/terminology/ValueSet-medcom-core-attachmentMimeTypes.html)
 
-<!-- Only an attachment of the following formats must be included: 
-
-* Adobe Portable Document Format (PDF)
-* Graphics Interchange Format (gif)
-* JPEG Image
-* Portable Network Graphics (PNG)
-* Tag Image File Format (tiff) -->
-
-The attached file shall be base64-encoded and added to the element MedComCoreMedia.content.data
-If the attached file is sent, it is a requirement that the ID and title of the attached file shall be sent.
-The ID of the attachment shall be expressed using Media.identifier element.
-The Media.content.titel element shall be used to express the titel of the attachment.
+The attached file **SHALL** be base64-encoded and added to the element MedComCoreMedia.content.data
+If the attached file is sent, it is a requirement that the ID and title of the attached file **SHALL** be sent.
+The ID of the attachment **SHALL** be expressed using Media.identifier element.
+The Media.content.titel element **SHALL** be used to express the titel of the attachment.
diff --git a/input/pagecontent/StructureDefinition-medcom-core-observation-intro.md b/input/pagecontent/StructureDefinition-medcom-core-observation-intro.md
@@ -1,20 +1,20 @@
->Note: This profile is developed to be part of a production trial of the communication between the general practitioner and municipal acute care team.
-
 ### Scope and use
-This profile is a MedCom Core profile for observations and is intended to represent observations for a variety cases including: 
+This profile is a MedCom Core profile for observations and is intended to represent observations for a variety cases including for example: 
 * laboratory observations
-* observations performed by a municipal acute care team  
+* observations performed by a municipal acute care team
+* EKG study data
 
 #### Status
-The MedComCoreObservation resource require an indication of the observation status. To indicate the observation status a code from ValueSet defined by MedCom shall be used. <a href="http://medcomfhir.dk/ig/terminology/ValueSet-medcom-core-observation-status.html"> Click here se the status codes.</a> 
-
+The MedComCoreObservation resource require an indication of the observation status. To indicate the observation status, a code from this valueSet defined by MedCom **MUST** be used. <a href="http://medcomfhir.dk/ig/terminology/ValueSet-medcom-core-observation-status.html"> Click here se the status codes.</a> 
 
 #### Codes
-In a Observation resource, codes from CodeSystems are used to describe what is observed in the elements Observation.code.coding. In the element Observation.code.coding six CodeSystem are specified.
+In an Observation resource, codes from CodeSystems are used to describe what is observed in the elements Observation.code.coding. In the element Observation.code.coding six possible CodeSystem are specified.
 * NPU codes are the most used codes in Danmark to express analysis performed at the laboratory. 
 * LOINC codes is an international Codsystem for health measurements, observations, and documents. LOINC codes are less stricted then NPU codes. 
 * IEEE codes are internationaly codes for devices and can be used to express an original observation from a device. 
 * SKS codes are classifications for use in documenting patients and healthcare services.SKS have a few observation codes in use, most are found in the ‘R’ Hierarchy - see e.g. https://medinfo.dk/sks/brows.php.
 * MedCom codes are Danish codes, that have been necessary in Danish interoperability projects through time and are used to express analysis performed at the laboratory. 
 * SNOMED CT codes are the world's most comprehensive clinical terminology.SNOMED CT is often used as a reference terminology, to give a common language of retrieval for data that have originally been defined or coded in some other way
 
+#### Use of the valueAttachment Extension
+This profile contains a FHIR extension designed to hold an attachment encoded in Base64. The `valueAttachment` element is implemented as an extension because the base `value[x]` element does not support the `Attachment` type. The extension can also capture essential metadata for the attachment.