us_core_test_kit 0.1.0

checksums.yaml

@@ -0,0 +1,7 @@
+---
+SHA256:
+  metadata.gz: 644cf64081633bedeba02c71adaa6cb0debec2e0cca70ee40d5e276d217f07fc
+  data.tar.gz: bff7199b6260687374c27b93f6d7bb52acf0bfdbeaf529c0a3bb85f24096e437
+SHA512:
+  metadata.gz: fabccf53360c88e97bb71a75f9b01e28617df437c7a7074eca324b2ccf1087aab8d5ffbdcac87d9e5436a6d1df7fcd58435511acb50766bd9a7bdef8cb666b9f
+  data.tar.gz: 88db4166c8bafe88d1fa54570a48227db10275ffe85c82d3c9cb4cce9d0a4d58d580d6fd2fb87cfcfb6bd34f1138aecf7096d5ad010a1540fc02e2c8fb6d83e6

data/LICENSE

@@ -0,0 +1,201 @@
+                                 Apache License
+                           Version 2.0, January 2004
+                        http://www.apache.org/licenses/
+
+   TERMS AND CONDITIONS FOR USE, REPRODUCTION, AND DISTRIBUTION
+
+   1. Definitions.
+
+      "License" shall mean the terms and conditions for use, reproduction,
+      and distribution as defined by Sections 1 through 9 of this document.
+
+      "Licensor" shall mean the copyright owner or entity authorized by
+      the copyright owner that is granting the License.
+
+      "Legal Entity" shall mean the union of the acting entity and all
+      other entities that control, are controlled by, or are under common
+      control with that entity. For the purposes of this definition,
+      "control" means (i) the power, direct or indirect, to cause the
+      direction or management of such entity, whether by contract or
+      otherwise, or (ii) ownership of fifty percent (50%) or more of the
+      outstanding shares, or (iii) beneficial ownership of such entity.
+
+      "You" (or "Your") shall mean an individual or Legal Entity
+      exercising permissions granted by this License.
+
+      "Source" form shall mean the preferred form for making modifications,
+      including but not limited to software source code, documentation
+      source, and configuration files.
+
+      "Object" form shall mean any form resulting from mechanical
+      transformation or translation of a Source form, including but
+      not limited to compiled object code, generated documentation,
+      and conversions to other media types.
+
+      "Work" shall mean the work of authorship, whether in Source or
+      Object form, made available under the License, as indicated by a
+      copyright notice that is included in or attached to the work
+      (an example is provided in the Appendix below).
+
+      "Derivative Works" shall mean any work, whether in Source or Object
+      form, that is based on (or derived from) the Work and for which the
+      editorial revisions, annotations, elaborations, or other modifications
+      represent, as a whole, an original work of authorship. For the purposes
+      of this License, Derivative Works shall not include works that remain
+      separable from, or merely link (or bind by name) to the interfaces of,
+      the Work and Derivative Works thereof.
+
+      "Contribution" shall mean any work of authorship, including
+      the original version of the Work and any modifications or additions
+      to that Work or Derivative Works thereof, that is intentionally
+      submitted to Licensor for inclusion in the Work by the copyright owner
+      or by an individual or Legal Entity authorized to submit on behalf of
+      the copyright owner. For the purposes of this definition, "submitted"
+      means any form of electronic, verbal, or written communication sent
+      to the Licensor or its representatives, including but not limited to
+      communication on electronic mailing lists, source code control systems,
+      and issue tracking systems that are managed by, or on behalf of, the
+      Licensor for the purpose of discussing and improving the Work, but
+      excluding communication that is conspicuously marked or otherwise
+      designated in writing by the copyright owner as "Not a Contribution."
+
+      "Contributor" shall mean Licensor and any individual or Legal Entity
+      on behalf of whom a Contribution has been received by Licensor and
+      subsequently incorporated within the Work.
+
+   2. Grant of Copyright License. Subject to the terms and conditions of
+      this License, each Contributor hereby grants to You a perpetual,
+      worldwide, non-exclusive, no-charge, royalty-free, irrevocable
+      copyright license to reproduce, prepare Derivative Works of,
+      publicly display, publicly perform, sublicense, and distribute the
+      Work and such Derivative Works in Source or Object form.
+
+   3. Grant of Patent License. Subject to the terms and conditions of
+      this License, each Contributor hereby grants to You a perpetual,
+      worldwide, non-exclusive, no-charge, royalty-free, irrevocable
+      (except as stated in this section) patent license to make, have made,
+      use, offer to sell, sell, import, and otherwise transfer the Work,
+      where such license applies only to those patent claims licensable
+      by such Contributor that are necessarily infringed by their
+      Contribution(s) alone or by combination of their Contribution(s)
+      with the Work to which such Contribution(s) was submitted. If You
+      institute patent litigation against any entity (including a
+      cross-claim or counterclaim in a lawsuit) alleging that the Work
+      or a Contribution incorporated within the Work constitutes direct
+      or contributory patent infringement, then any patent licenses
+      granted to You under this License for that Work shall terminate
+      as of the date such litigation is filed.
+
+   4. Redistribution. You may reproduce and distribute copies of the
+      Work or Derivative Works thereof in any medium, with or without
+      modifications, and in Source or Object form, provided that You
+      meet the following conditions:
+
+      (a) You must give any other recipients of the Work or
+          Derivative Works a copy of this License; and
+
+      (b) You must cause any modified files to carry prominent notices
+          stating that You changed the files; and
+
+      (c) You must retain, in the Source form of any Derivative Works
+          that You distribute, all copyright, patent, trademark, and
+          attribution notices from the Source form of the Work,
+          excluding those notices that do not pertain to any part of
+          the Derivative Works; and
+
+      (d) If the Work includes a "NOTICE" text file as part of its
+          distribution, then any Derivative Works that You distribute must
+          include a readable copy of the attribution notices contained
+          within such NOTICE file, excluding those notices that do not
+          pertain to any part of the Derivative Works, in at least one
+          of the following places: within a NOTICE text file distributed
+          as part of the Derivative Works; within the Source form or
+          documentation, if provided along with the Derivative Works; or,
+          within a display generated by the Derivative Works, if and
+          wherever such third-party notices normally appear. The contents
+          of the NOTICE file are for informational purposes only and
+          do not modify the License. You may add Your own attribution
+          notices within Derivative Works that You distribute, alongside
+          or as an addendum to the NOTICE text from the Work, provided
+          that such additional attribution notices cannot be construed
+          as modifying the License.
+
+      You may add Your own copyright statement to Your modifications and
+      may provide additional or different license terms and conditions
+      for use, reproduction, or distribution of Your modifications, or
+      for any such Derivative Works as a whole, provided Your use,
+      reproduction, and distribution of the Work otherwise complies with
+      the conditions stated in this License.
+
+   5. Submission of Contributions. Unless You explicitly state otherwise,
+      any Contribution intentionally submitted for inclusion in the Work
+      by You to the Licensor shall be under the terms and conditions of
+      this License, without any additional terms or conditions.
+      Notwithstanding the above, nothing herein shall supersede or modify
+      the terms of any separate license agreement you may have executed
+      with Licensor regarding such Contributions.
+
+   6. Trademarks. This License does not grant permission to use the trade
+      names, trademarks, service marks, or product names of the Licensor,
+      except as required for reasonable and customary use in describing the
+      origin of the Work and reproducing the content of the NOTICE file.
+
+   7. Disclaimer of Warranty. Unless required by applicable law or
+      agreed to in writing, Licensor provides the Work (and each
+      Contributor provides its Contributions) on an "AS IS" BASIS,
+      WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or
+      implied, including, without limitation, any warranties or conditions
+      of TITLE, NON-INFRINGEMENT, MERCHANTABILITY, or FITNESS FOR A
+      PARTICULAR PURPOSE. You are solely responsible for determining the
+      appropriateness of using or redistributing the Work and assume any
+      risks associated with Your exercise of permissions under this License.
+
+   8. Limitation of Liability. In no event and under no legal theory,
+      whether in tort (including negligence), contract, or otherwise,
+      unless required by applicable law (such as deliberate and grossly
+      negligent acts) or agreed to in writing, shall any Contributor be
+      liable to You for damages, including any direct, indirect, special,
+      incidental, or consequential damages of any character arising as a
+      result of this License or out of the use or inability to use the
+      Work (including but not limited to damages for loss of goodwill,
+      work stoppage, computer failure or malfunction, or any and all
+      other commercial damages or losses), even if such Contributor
+      has been advised of the possibility of such damages.
+
+   9. Accepting Warranty or Additional Liability. While redistributing
+      the Work or Derivative Works thereof, You may choose to offer,
+      and charge a fee for, acceptance of support, warranty, indemnity,
+      or other liability obligations and/or rights consistent with this
+      License. However, in accepting such obligations, You may act only
+      on Your own behalf and on Your sole responsibility, not on behalf
+      of any other Contributor, and only if You agree to indemnify,
+      defend, and hold each Contributor harmless for any liability
+      incurred by, or claims asserted against, such Contributor by reason
+      of your accepting any such warranty or additional liability.
+
+   END OF TERMS AND CONDITIONS
+
+   APPENDIX: How to apply the Apache License to your work.
+
+      To apply the Apache License to your work, attach the following
+      boilerplate notice, with the fields enclosed by brackets "{}"
+      replaced with your own identifying information. (Don't include
+      the brackets!)  The text should be enclosed in the appropriate
+      comment syntax for the file format. We also recommend that a
+      file or class name and description of purpose be included on the
+      same "printed page" as the copyright notice for easier
+      identification within third-party archives.
+
+   Copyright {yyyy} {name of copyright owner}
+
+   Licensed under the Apache License, Version 2.0 (the "License");
+   you may not use this file except in compliance with the License.
+   You may obtain a copy of the License at
+
+       http://www.apache.org/licenses/LICENSE-2.0
+
+   Unless required by applicable law or agreed to in writing, software
+   distributed under the License is distributed on an "AS IS" BASIS,
+   WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
+   See the License for the specific language governing permissions and
+   limitations under the License.

data/lib/us_core_test_kit/custom_groups/capability_statement/conformance_support_test.rb

@@ -0,0 +1,41 @@
+module USCoreTestKit
+  class ConformanceSupportTest < Inferno::Test
+    id :us_core_311_conformance_support
+    title 'FHIR Server supports the conformance interaction'
+    description %(
+      The conformance 'whole system' interaction provides a method to get the
+      CapabilityStatement for the FHIR server. This test checks that the
+      server responds to a `GET` request at the following endpoint:
+
+      ```
+      GET [base]/metadata
+      ```
+
+      This test checks the following SHALL requirement:
+
+      > Applications SHALL return a resource that describes the functionality
+        of the server end-point.
+
+      [http://hl7.org/fhir/R4/http.html#capabilities](http://hl7.org/fhir/R4/http.html#capabilities)
+
+      It does this by checking that the server responds with an HTTP OK 200
+      status code and that the body of the response contains a valid
+      [CapabilityStatement
+      resource](http://hl7.org/fhir/R4/capabilitystatement.html). This test
+      does not inspect the content of the CapabilityStatement to see if it
+      contains the required information. It only checks to see if the RESTful
+      interaction is supported and returns a valid CapabilityStatement
+      resource.
+    )
+    makes_request :capability_statement
+
+    run do
+      fhir_client.set_no_auth
+      fhir_get_capability_statement(name: :capability_statement)
+
+      assert_response_status(200)
+      assert_resource_type(:capability_statement)
+      assert_valid_resource
+    end
+  end
+end

data/lib/us_core_test_kit/custom_groups/capability_statement/fhir_version_test.rb

@@ -0,0 +1,15 @@
+module USCoreTestKit
+  class FHIRVersionTest < Inferno::Test
+    id :us_core_311_fhir_version
+    title 'Server is using FHIR R4'
+    description %(
+        This test inspects the CapabilityStatement returned by the server to
+        verify that the server is using FHIR R4.
+      )
+
+    run do
+      server_version = fhir_client.detect_version.to_s.upcase
+      assert server_version == 'R4', "Server is using FHIR version #{server_version} rather than R4"
+    end
+  end
+end

data/lib/us_core_test_kit/custom_groups/capability_statement/json_support_test.rb

@@ -0,0 +1,40 @@
+module USCoreTestKit
+  class JSONSupportTest < Inferno::Test
+    id :us_core_311_json_support
+    title 'FHIR server capability states JSON support'
+    description %(
+      FHIR provides multiple [representation
+      formats](https://www.hl7.org/fhir/formats.html) for resources, including
+      JSON and XML. US Core profiles require servers to use the [JSON
+      representation](https://www.hl7.org/fhir/json.html):
+
+      [```The US Core Server **SHALL** Support json source formats for all US
+      Core
+      interactions.```](http://hl7.org/fhir/us/core/CapabilityStatement-us-core-server.html#behavior)
+
+      The FHIR conformance interaction require servers to describe which
+      formats are available for clients to use. The server must explicitly
+      state that JSON is supported. This is located in the [format
+      element](https://www.hl7.org/fhir/capabilitystatement-definitions.html#CapabilityStatement.format)
+      of the CapabilityStatement Resource.
+
+      This test checks that one of the following values are located in the
+      format field.
+
+      * json
+      * application/json
+      * application/fhir+json
+    )
+    uses_request :capability_statement
+
+    run do
+      assert_resource_type(:capability_statement)
+
+      json_formats = ['json', 'application/json', 'application/fhir+json']
+      server_formats = resource.format
+
+      assert server_formats.any? { |format| json_formats.include? format },
+              'CapabilityStatement does not state support for JSON'
+    end
+  end
+end

data/lib/us_core_test_kit/custom_groups/capability_statement/profile_support_test.rb

@@ -0,0 +1,90 @@
+module USCoreTestKit
+  class ProfileSupportTest < Inferno::Test
+    id :us_core_311_profile_support
+    title 'Capability Statement lists support for required US Core Profiles'
+    description %(
+      The US Core Implementation Guide states:
+
+      ```
+      The US Core Server SHALL:
+      1. Support the US Core Patient resource profile.
+      2. Support at least one additional resource profile from the list of US
+          Core Profiles.
+      ```
+    )
+    uses_request :capability_statement
+
+    PROFILES = {
+      'AllergyIntolerance' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance'].freeze,
+      'CarePlan' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan'].freeze,
+      'CareTeam' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam'].freeze,
+      'Condition' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition'].freeze,
+      'Device' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device'].freeze,
+      'DiagnosticReport' => [
+        'http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab',
+        'http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note'
+      ].freeze,
+      'DocumentReference' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference'].freeze,
+      'Encounter' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter'].freeze,
+      'Goal' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal'].freeze,
+      'Immunization' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization'].freeze,
+      'Location' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-location'].freeze,
+      'Medication' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication'].freeze,
+      'MedicationRequest' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest'].freeze,
+      'Observation' => [
+        'http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab',
+        'http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age',
+        'http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height',
+        'http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry',
+        'http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus',
+        'http://hl7.org/fhir/StructureDefinition/bp',
+        'http://hl7.org/fhir/StructureDefinition/bodyheight',
+        'http://hl7.org/fhir/StructureDefinition/bodyweight',
+        'http://hl7.org/fhir/StructureDefinition/heartrate',
+        'http://hl7.org/fhir/StructureDefinition/resprate',
+        'http://hl7.org/fhir/StructureDefinition/bodytemp',
+        'http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile'
+      ].freeze,
+      'Organization' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization'].freeze,
+      'Patient' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient'].freeze,
+      'Practitioner' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner'].freeze,
+      'PractitionerRole' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole'].freeze,
+      'Procedure' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure'].freeze,
+      'Provenance' => ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance'].freeze
+    }.freeze
+
+    run do
+      assert_resource_type(:capability_statement)
+      capability_statement = resource
+
+      supported_resources =
+        capability_statement.rest
+          &.each_with_object([]) do |rest, resources|
+            rest.resource.each { |resource| resources << resource.type }
+          end.uniq
+      supported_profiles =
+        capability_statement.rest
+          &.flat_map(&:resource)
+          &.flat_map { |resource| resource.supportedProfile + [resource.profile] }
+          &.compact || []
+      supported_profiles.map! { |profile_url| profile_url.split('|').first }
+
+      assert supported_resources.include?('Patient'), 'US Core Patient profile not supported'
+
+      other_resources = PROFILES.keys.reject { |resource_type| resource_type == 'Patient' }
+      other_resources_supported = other_resources.any? { |resource| supported_resources.include? resource }
+      assert other_resources_supported, 'No US Core resources other than Patient are supported'
+
+      PROFILES.each do |resource_type, profiles|
+        next unless supported_resources.include? resource_type
+
+        profiles.each do |profile|
+          warning do
+            assert supported_profiles&.include?(profile),
+                    "CapabilityStatement does not claim support for US Core #{resource_type} profile: #{profile}"
+          end
+        end
+      end
+    end
+  end
+end

data/lib/us_core_test_kit/custom_groups/capability_statement_group.rb

@@ -0,0 +1,64 @@
+require 'tls_test_kit'
+require_relative 'capability_statement/conformance_support_test'
+require_relative 'capability_statement/fhir_version_test'
+require_relative 'capability_statement/json_support_test'
+require_relative 'capability_statement/profile_support_test'
+
+module USCoreTestKit
+  class CapabilityStatementGroup < Inferno::TestGroup
+    id :us_core_311_capability_statement
+    title 'Capability Statement'
+    short_description 'Retrieve information about supported server functionality using the FHIR capabilties interaction.'
+    description %(
+      # Background
+      The #{title} Sequence tests a FHIR server's ability to formally describe
+      features supported by the API by using the [Capability
+      Statement](https://www.hl7.org/fhir/capabilitystatement.html) resource.
+      The features described in the Capability Statement must be consistent with
+      the required capabilities of a US Core server. The Capability Statement
+      must also advertise the location of the required SMART on FHIR endpoints
+      that enable authenticated access to the FHIR server resources.
+
+      The Capability Statement resource allows clients to determine which
+      resources are supported by a FHIR Server. Not all servers are expected to
+      implement all possible queries and data elements described in the US Core
+      API. For example, the US Core Implementation Guide requires that the
+      Patient resource and only one additional resource profile from the US Core
+      Profiles.
+
+      # Test Methodology
+
+      This test sequence accesses the server endpoint at `/metadata` using a
+      `GET` request. It parses the Capability Statement and verifies that:
+
+      * The endpoint is secured by an appropriate cryptographic protocol
+      * The resource matches the expected FHIR version defined by the tests
+      * The resource is a valid FHIR resource
+      * The server claims support for JSON encoding of resources
+      * The server claims support for the Patient resource and one other
+        resource
+
+      It collects the following information that is saved in the testing session
+      for use by later tests:
+
+      * List of resources supported
+      * List of queries parameters supported
+    )
+    run_as_group
+
+    test from: :tls_version_test,
+         id: :standalone_auth_tls,
+         title: 'FHIR server secured by transport layer security',
+         description: %(
+           Systems **SHALL** use TLS version 1.2 or higher for all transmissions
+           not taking place over a secure network connection.
+         ),
+         config: {
+           options: {  minimum_allowed_version: OpenSSL::SSL::TLS1_2_VERSION }
+         }
+    test from: :us_core_311_conformance_support
+    test from: :us_core_311_fhir_version
+    test from: :us_core_311_json_support
+    test from: :us_core_311_profile_support
+  end
+end

data/lib/us_core_test_kit/custom_groups/clinical_notes_guidance_group.rb

@@ -0,0 +1,208 @@
+# coding: utf-8
+require_relative '../search_test'
+
+module USCoreTestKit
+  class ClinicalNotesGuidanceGroup < Inferno::TestGroup
+    id :us_core_311_clinical_notes_guidance
+    title 'Clinical Notes Guidance'
+    short_description 'Verify DiagnosticReport and DocumentReference resources support the US Core Clinical Notes Guidance.'
+    description %(
+      The #{title} Sequence tests DiagnosticReport and DocumentReference
+      resources associated with the provided patient. The resources returned
+      will be checked for consistency against the [US Core Clinical Notes
+      Guidance](https://www.hl7.org/fhir/us/core/clinical-notes-guidance.html)
+
+      In this set of tests, Inferno serves as a FHIR client that attempts to
+      access the different types of Clinical Notes specified in the guidance.
+      The provided patient needs to have the following five common clinical
+      notes as DocumentReference resources:
+
+      * Consultation Note (11488-4)
+      * Discharge Summary (18842-5)
+      * History & Physical Note (34117-2)
+      * Procedures Note (28570-0)
+      * Progress Note (11506-3)
+
+      The provided patient also needs to have the following three common
+      diagnostic reports as DiagnosticReport resources:
+
+      * Cardiology (LP29708-2)
+      * Pathology (LP7839-6)
+      * Radiology (LP29684-5)
+
+      In order to enable consistent access to scanned narrative-only clinical
+      reports, the US Core server shall expose these reports through both
+      DiagnosticReport and DocumentReference by representing the same attachment
+      url.
+    )
+    run_as_group
+
+    test do
+      include SearchTest
+
+      id :us_core_311_clinical_note_types
+      title 'Server demonstrates support for the required DocumentReference types and DiagnosticReport categories.'
+      description %(
+        [The US Core Clinical Notes
+        Guidance](https://www.hl7.org/fhir/us/core/clinical-notes-guidance.html)
+        states that systems SHALL support the following five "Common Clinical
+        Notes":
+
+        * Consultation Note (11488-4)
+        * Discharge Summary (18842-5)
+        * History & Physical Note (34117-2)
+        * Procedures Note (28570-0)
+        * Progress Note (11506-3)
+
+        and three DiagnosticReport categories:
+
+        * Cardiology (LP29708-2)
+        * Pathology (LP7839-6)
+        * Radiology (LP29684-5)
+      )
+      input :patient_ids,
+            title: 'Patient IDs',
+            description: 'Comma separated list of patient IDs that in sum contain all MUST SUPPORT elements'
+
+      REQUIRED_TYPES = ['11488-4', '18842-5', '34117-2', '28570-0', '11506-3'].freeze
+      REQUIRED_CATEGORIES = ['LP29708-2', 'LP7839-6', 'LP29684-5'].freeze
+
+      def document_reference_types_found(patient_id)
+        search_params = { patient: patient_id }
+        status_values = ['current,superseded,entered-in-error']
+
+        search_and_check_response(search_params, 'DocumentReference')
+
+        if response[:status] == 400
+          perform_search_with_status(
+            params,
+            patient_id,
+            status_search_values: status_values,
+            resource_type: 'DocumentReference'
+          )
+        end
+
+        resources = fetch_all_bundled_resources(resource_type: 'DocumentReference')
+                      .select { |resource| resource.resourceType == 'DocumentReference' }
+
+        scratch[:document_reference_attachments] ||= {}
+        scratch[:document_reference_attachments][patient_id] ||= {}
+        attachments = scratch[:document_reference_attachments][patient_id]
+
+        codes_found =
+          resources.flat_map do |resource|
+            resource.content
+              &.select { |content| !attachments.key? content.attachment&.url}
+              &.each { |content| attachments[content.attachment.url] = resource.id }
+
+            resource.type&.coding&.map { |coding| coding.code }
+          end
+
+        codes_found.compact.uniq
+      end
+
+      def diagnostic_report_categories_found(patient_id)
+        search_params = { patient: patient_id }
+        status_values = ['registered,partial,preliminary,final,amended,corrected,appended,cancelled,entered-in-error,unknown']
+
+        search_and_check_response(search_params, 'DiagnosticReport')
+
+        if response[:status] == 400
+          perform_search_with_status(
+            params,
+            patient_id,
+            status_search_values: status_values,
+            resource_type: 'DiagnosticReport'
+          )
+        end
+
+        resources = fetch_all_bundled_resources(resource_type: 'DiagnosticReport')
+                      .select { |resource| resource.resourceType == 'DiagnosticReport' }
+
+        scratch[:diagnostic_report_attachments] ||= {}
+        scratch[:diagnostic_report_attachments][patient_id] ||= {}
+        attachments = scratch[:diagnostic_report_attachments][patient_id]
+
+        codes_found =
+          resources.flat_map do |resource|
+            resource.presentedForm
+              &.select { |attachment| !attachments.key? attachment&.url}
+              &.each { |attachment| attachments[attachment.url] = resource.id }
+
+            resource.category&.flat_map { |category| category.coding&.map { |coding| coding.code } }
+          end
+
+        codes_found.compact.uniq
+      end
+
+      run do
+        missing_types = REQUIRED_TYPES.dup
+        missing_categories = REQUIRED_CATEGORIES.dup
+
+        patient_id_list.each do |patient_id|
+          missing_types -= document_reference_types_found(patient_id)
+          missing_categories -= diagnostic_report_categories_found(patient_id)
+        end
+
+        pass if missing_types.empty? && missing_categories.empty?
+
+        message = 'Could not find these '
+
+        if missing_types.present?
+          message += "DocumentReference types: #{missing_types.join(', ')}"
+          message += ' and ' if missing_categories.present?
+        end
+
+        if missing_categories.present?
+          message += "DiagnosticReport categories #{missing_categories.join(', ')}."
+        end
+
+        skip message
+      end
+    end
+
+    test do
+      id :us_core_311_clinical_note_attachments
+      title 'DiagnosticReport and DocumentReference reference the same attachment'
+      description %(
+        All presentedForms urls referenced in DiagnosticReports shall have
+        corresponding content attachment urls referenced in DocumentReference.
+
+        There is no single best practice for representing a scanned, or
+        narrative-only report due to the overlapping scope of the underlying
+        resources and variability in system implementation. Reports may be
+        represented by either a DocumentReference or a DiagnosticReport. To
+        require Clients query both DocumentReference and DiagnosticReport to get
+        all the information for a patient is potentially dangerous if a client
+        doesn’t understand or follow this requirement.
+
+        To simplify the requirement, US Core IG requires servers implement the
+        duplicate reference to allow a client to find a Pathology report, or
+        other Diagnostic Reports, in either Resource.
+      )
+
+      run do
+        skip_if scratch[:document_reference_attachments].blank?,
+                "No DocumentReference attachments found"
+        skip_if scratch[:diagnostic_report_attachments].blank?,
+                "No DiagnosticReport attachments found"
+
+        unmatched_attachment_messages =
+          scratch[:diagnostic_report_attachments].flat_map do |patient_id, report_attachments|
+            unmatched_urls = report_attachments.keys
+
+            if scratch[:document_reference_attachments].key? patient_id
+              unmatched_urls -= scratch[:document_reference_attachments][patient_id].keys
+            end
+
+            unmatched_urls.map do |url|
+              "#{url} in DiagnosticReport/#{report_attachments[patient_id][url]} for Patient #{patient_id}"
+            end
+          end
+
+        assert unmatched_attachment_messages.empty?,
+               "Attachments #{unmatched_attachment_messages.join(', ')} are not referenced in any DocumentReference"
+      end
+    end
+  end
+end