DICOM PS3.20 2021d - Imaging Reports using HL7 Clinical Document Architecture

5.2.5 Element/Attribute Conformance (Current)
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### 5.2.5 Element/Attribute Conformance

Each element/attribute has a conformance verb (keyword) in addition to the cardinality constraint.

The keywords SHALL, SHOULD, MAY, SHOULD NOT, SHALL NOT, and NEED NOT in this document are to be interpreted as described in ISO/IEC Directives, Part 2, Annex H "Verbal forms for the expression of provisions":

- SHALL: an absolute requirement

- SHALL NOT: an absolute prohibition against inclusion

- SHOULD/SHOULD NOT: a best practice or recommendation. There may be valid reasons to ignore a recommendation, but the full implications must be understood and carefully weighed before choosing to not adhere to the best practice.

- MAY/NEED NOT: truly optional; can be included or omitted at the discretion of the content creator with no conformance implications

The keyword SHALL is associated with a minimum cardinality of at least 1; other keywords have a minimum cardinality of 0. If an element is required by SHALL, but is not known (and would otherwise be omitted without the SHALL requirement), it must be represented by a nullFlavor. SHALL allows the use of nullFlavor unless the requirement is on an attribute (nullFlavor does not apply to attributes), or the use of nullFlavor is explicitly precluded (see Section 5.2.7 Value Conformance and Section 5.3.2 Null Flavor).

Within the template, the keyword COND (conditional) may be present. In this case, the specification of the condition, and the conformance verbs associated with the condition being true or false, are described below the table in a paragraph flagged with the COND keyword.

In an open template, additional elements and attributes allowed by the CDA Specification are not precluded by template constraints, unless there are applicable SHALL NOT template specifications.

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DICOM PS3.20 2021d - Imaging Reports using HL7 Clinical Document Architecture