TX5: send-documents

Transaction Overview

The send-documents transaction is used to send one or more maternal health documents to support pregnancy notification, birth-services referral, antepartum information sharing, and continuity of care across settings.

The canonical transaction code is send-documents. TX5 is a local editorial label assigned by the cc-maternal-health-birth Use Case Guide for readability and navigation; it is not the interoperable transaction identifier. The canonical transaction code is intended to remain stable and reusable across use cases.

The transaction’s payload and metadata can be packaged using XDM or FHIR packaging.

The transaction is designed to support the following payloads:

• Pregnancy Notification and Risk Assessment

• Pregnancy Notification

• Pregnancy Risk Assessment

SMTP/MIME Message Header

The following SMTP/MIME message-header metadata supports early message routing and processing, use-case awareness, reusable transaction identification, Payload Metadata representation, Direct final-destination delivery notification, and optional workflow-status return.

Message-header layering. x-direct-useCase identifies the use-case context known to the sender; x-direct-transaction identifies the reusable exchange behavior; and x-direct-metadataTypeCode identifies how Payload Metadata is represented. Message Delivery confirms arrival of the Message at its Final Destination. Workflow Status provides the stronger assurance that the Payload reached its intended workflow. Both responses use the Direct address supplied in Disposition-Notification-To.

Final Destination is intentionally implementation-dependent. Depending on the receiving architecture and edge protocol, successful delivery may be established through SMTP, an IMAP/mailbox arrangement, XDR, a custom API, or another supported receiving interface. A successful Final Destination Delivery Notification does not establish that the Payload was parsed, matched, routed, accepted, or delivered into its intended business workflow.

Conf.	Header element	Fixed value / constraint	Implementation guidance
R	Content-Type	multipart/mixed	Outer message content type.
R	x-direct-metadata-payload-versionIdentifier	1	Metadata and payload framework version identifier.
R	x-direct-useCase	cc-maternal-health-birth	Identifies the use-case context known to the sender. It is not an exclusive internal-routing instruction; the Receiver Actor may apply received information to other authorized workflows for which it is relevant.
R	x-direct-metadataTypeCode	urn:dt-org:dsm:map:SMTP+XD:1.0	Identifies the Payload Metadata representation. This value indicates that XD metadata/XDM package processing applies; Subject is not used as an XDM processing signal.
O	x-direct-purpose	TREATMENT	Purpose of use.
O	Subject	No fixed value specified	Human-readable subject line. SHALL NOT be relied upon as the machine-processable indication that the message carries XD/XDM metadata.
O	Disposition-Notification-Options	X-DIRECT-FINAL-DESTINATION-DELIVERY=optional,true	Include when Direct Final Destination Delivery Notification is requested.
RE/R2	Disposition-Notification-To	Sender-designated Direct address	Return address for a requested MDN and for requested TX8 Workflow Status. SHALL be populated when x-direct-workflow-status-requested=true and when final-destination delivery notification is requested.
R	x-direct-transaction	send-documents	Canonical, stable reusable transaction code. SHALL carry the canonical transaction identity, not the local editorial TX number.
O	x-direct-workflow-status-requested	true | false; absent = false	When true, requests TX8 send-workflow-status after the Payload reaches, or fails to reach, its intended workflow. The response is sent to Disposition-Notification-To.

Note that messages carrying XDM metadata packaging additional are required to include

R		Some sort of XDM 1.0 value	Required label for messaging carrying XDM packages.

XD Metadata Guidance

XD is the fully specified representation of Payload Metadata for this transaction. The requirements in this section define the package-level and payload-object metadata semantics used as the source requirements for alternative metadata representations.

The following SMTP/MIME message-header metadata supports reporting, routing, correlation, and use-case-aware processing of TX1 messages using the XDM Packaging syntax and structure.

Payload Packaging Structure

The Direct message SHALL use multipart/mixed packaging.

It SHALL contain a human-readable healthcare communication and an XDM ZIP package containing the machine-processable notification and an identical human-readable communication conveying the essential notification information.

Conf.	MIME part	Content	MIME type
R	MIME Part 1	Human-readable healthcare communication	text/plain
O	MIME Part 1 alternative	HTML healthcare communication	text/html
R	MIME Part 2	XDM ZIP package	application/zip
R	XDM SubmissionSet	XDM SubmissionSet
R	Contained XDM document 1	HL7 CDA Document	Application/xml+cda
O	Contained XDM document 2	HL7 CDA Document	Application/xml+cda

MIME Part 1 – Human Readable Communication

The human readable communication summarizes the metadata provided for each document included in the payload.

For text representation, this information is presented in a simple table. For html representation, it is presented in the same format as supported by the stylesheet for rendering available document metadata.

MIME Part 2 – Structured Data Package

MIME Part 2 holds the structured data package which includes both machine processable and human readable information combined.

Conf.	Metadata element	Value / constraint	Notes
R	Content-Type	application/zip	The second outer MIME part is the XDM package.
R	Content-Transfer-Encoding	base64	Required for the binary ZIP package.
R	Content-ID	System-assigned	Populate a MIME Content-ID.
R	Content-Disposition	attachment; filename="xdm.zip"	Fixed value from the workbook.

SubmissionSet

Conf.	Metadata element	Value / source	Use-case guidance
R	uniqueId	System-assigned	Added by the system.
R	availabilityStatus	urn:oasis:names:tc:ebxml-regrep:StatusType:Approved	Fixed status.
R	submissionTime	System-generated submission time	No additional use-case constraint.
R	intendedRecipient	Direct address selected for the recipient	The telecommunication component SHALL contain the registered Direct address corresponding to the SMTP RCPT TO recipient.
RE/R2	patientId	ClinicalDocument/recordTarget/id or a patient identifier known to the intended recipient	May be obtained from a known-patient-identifier source; the workbook notes that it may not always be known.
O	sourcePatientInfo	Patient demographics from the notification, including PID-derived name and related data	Populate from the source patient information used for matching.
R	sourcePatientId	Patient identifier from PID / source system	Represents the identifier known to the sender.
R	author	Sending author/person and represented organization; include the Direct address in telecom	The SubmissionSet author identifies who is sending the package, not necessarily the clinical author.
R	sourceId	Identifier for the SubmissionSet author	The workbook suggests that the Direct address may be suitable for this workflow.
R	purpose	send-documents	Canonical transaction code used as the transaction purpose. SHALL match x-direct-transaction.
RE/R2	contentTypeCode	send-documents	Canonical transaction code. SHALL match x-direct-transaction and identify the reusable transaction represented by this package. The local editorial TX number is not carried as interoperable metadata.
O	title	cc-maternal-health-birth:send-disharge-notification:	Use the display name associated with the selected event code.
O	description	Human-readable description of the notification	Workbook maps this concept to ClinicalDocument/sdtc:text; for an HL7 V2 notification, populate an equivalent concise description.
O	referenceIdList	urn:dt-org:dsm:map:2025:pregnancy	Pregnancy Context Instance Identifier.
O	referenceIdList	urn:dt-org:dsm:map:2026:visit	Visit Context Instance Identifier.
O	referenceIdList	urn:dt-org:dsm:map:2026:request	Request Context Instance Identifier, when applicable.
O	limitedMetadata	No fixed value specified	Use as defined by the base XDM/XDR specification.
R	entryUUID	System-assigned UUID	SubmissionSet registry object identifier for each attachment.
O	slot/@name	List of UUIDs for documents contained in the SubmissionSet	Populate when the selected packaging approach uses this extension.

Document Entry – HL7 CDA Minimally Structured Document

The first DocumentEntry contians the HL7 CDA Document.

Conf.	Metadata element	Value / source	Use-case guidance
R	entryUUID	System-assigned	Registry entry identifier.
R/X	URI	System-assigned package URI	As required by the selected XDM option.
R	uniqueId	System-assigned	Globally unique identifier for this payload instance.
R	mimeType	Application/xml+cda	Fixed MIME type.
RE/R2	formatCode	No fixed value specified	Use an applicable HL7 V2 notification format code when established.
RE/R2	languageCode	Language of human-readable content	Populate when known.
RE/R2	classCode	send-documents	Canonical transaction classification. SHALL match x-direct-transaction and SubmissionSet.contentTypeCode. DocumentEntry.typeCode separately identifies the specific payload object or clinical/event type.
RE/R2	typeCode
O	title	Identical to SubmissionSet.title	Keep title consistent across the package.
O	referenceIdList	Applicable subset of the SubmissionSet context identifiers	The individual document may have a narrower context.
RE/R2	patientId	Patient identifier known to the receiver	Use the same patient identity strategy as the SubmissionSet.
RE/R2	sourcePatientId	From PID	Source patient identifier.
RE/R2	sourcePatientInfo	From PID	Source patient demographics.
RE/R2	creationTime	From EVN	Use the event time represented in the notification.
RE/R2	author	Treating facility name from PV1 or the location where represented	Identifies the treating facility responsible for the event.
R	author.role	TF (Treating Facility)	Fixed author role.
O	author.specialty	No additional use-case constraint	Populate if available.
O	serviceStartTime	Event/encounter start time when known	Populate from the HL7 V2 event/visit data.
O	serviceStopTime	Event/encounter stop time when known	Populate when applicable.
RE/R2	practiceSettingCode	Code describing the clinical practice setting	Populate from available event/facility data.
RE/R2	confidentialityCode	Applicable confidentiality code	Populate consistently with organizational policy.
RE/R2	healthcareFacilityTypeCode	Code describing the treating facility	Populate from the facility/location represented in the event.
O	limitedMetadata	No fixed value specified	Use as defined in the base profile.
R	objectType	urn:oasis:names:tc:ebxml-regrep:ObjectType:RegistryObject:ExtrinsicObject	Fixed XDS object type.
O	Slot/@name	Available extensions	Use only extensions permitted by the base profile.
R/O	hash	Calculated document hash	Follow the base XDM/XDR option requirements.
R/O	size	Document size in bytes	Follow the base XDM/XDR option requirements.

FHIR Metadata Guidance

When FHIR is used to represent Payload Metadata, implementers SHALL apply the same metadata requirements, coding, and semantics specified in the XD Metadata Guidance, using Appendix C - Mapping XD Metadata to FHIR Resources. SubmissionSet metadata is represented in a FHIR List Resource, and corresponding XD DocumentEntry metadata is represented in FHIR DocumentReference Resources referenced by the List. This is an alternative representation of the same Payload Metadata, not a different metadata model.

Context IG Metadata Guidance

TBD - Context IG Metadata Guidance. Guidance for representing this transaction's Payload Metadata using the DirectTrust Context IG specification will be added following completion of the current major Context IG redesign.

Technical Actor Functional Requirements

Actor	Requirement category	Normative requirement
Content Creator	Payload creation	SHALL create the payload content required by send-documents and preserve the responsible Information Source and applicable clinical/workflow provenance.
Message Sender	Transmission	SHALL package and transmit the Direct message using the message-header, Payload Metadata, and packaging constraints defined for this transaction.
Message Receiver	Receipt	SHALL receive and validate the Direct message and make the Payload and Payload Metadata available to the Content Consumer.
Content Consumer	Processing	SHALL process the Payload according to the supported transaction behavior and applicable local workflow.
Receiver Actor	Workflow status	When x-direct-workflow-status-requested=true, SHALL initiate TX8 after determining whether the Payload reached its intended workflow and SHALL send TX8 to Disposition-Notification-To.