FHIR & Data Standards

The FHIR R4 profiles and terminology standards every shared record must follow.

All health records exchanged over ABDM are FHIR R4 documents conforming to the NRCeS FHIR Implementation Guide for ABDM (developed by C-DAC Pune as the national FHIR resource centre).

Implementation guide: nrces.in/ndhm — profiles, code systems, and example bundles for every HI type.

Document bundles

Each shared record is a FHIR Bundle of type document. The first entry must be a Composition resource. The Composition.type identifies the record category.

You can share records in 2 forms:

A simple FHIR bundle with a PDF or image attachment.
A structured FHIR bundle with coded health information.

HI type	Document type	Typical contents
`OPConsultation`	OP Consult Record	Examinations, procedures, medicines, and clinical advice.
`Prescription`	Prescription Record	Medication advice and `MedicationRequest` entries.
`DiagnosticReport`	Diagnostic Report Record	Radiology reports, lab reports, and `Observation` results.
`DischargeSummary`	Discharge Summary Record	Admission details, procedures, medicines, and care plan.
`ImmunizationRecord`	Immunization Record	Vaccines, certificates, and next-dose advice.
`WellnessRecord`	Wellness Record	Vitals, examination data, and wellness data.
`HealthDocumentRecord`	Health Document Record	Scans, PDFs, and unstructured documents.
`Invoice`	Invoice Record	Billing entries and invoice documents.

Minimum structure

Skeleton of an ABDM FHIR document bundle

{
  "resourceType": "Bundle",
  "type": "document",
  "identifier": { "system": "https://your-hmis.example", "value": "bundle-uuid" },
  "timestamp": "2025-01-15T11:00:00+05:30",
  "entry": [
    { "resource": { "resourceType": "Composition", "status": "final", "...": "..." } },
    { "resource": { "resourceType": "Patient", "...": "..." } },
    { "resource": { "resourceType": "Practitioner", "...": "..." } },
    { "resource": { "resourceType": "Organization", "...": "..." } },
    { "resource": { "resourceType": "MedicationRequest", "...": "..." } }
  ]
}

Bundle rules that trip integrators up:

Set Bundle.type to document.
Put Composition first in Bundle.entry.
Keep each Bundle.id unique for traceability.
Set Bundle.timestamp to the document issue time.
Use Bundle.identifier to trace the document in your system.
Include every entry referenced from the Composition.
Use resolvable logical references such as Patient/1.
Do not use absolute URLs for references.
Patient resource should carry ABHA identifiers.
Practitioner should carry HPR IDs.
Organization should carry the HFR facility ID.
Signatures may need Bundle.signature. Check current certification rules for your track.

Composition rules

The Composition is the clinical document header. It gives context, sections, and attestation. It does not contain all clinical data by itself.

Field	Rule
`title`	Provide a broad human-readable document title.
`type`	Use the ABDM SNOMED CT code for the document type.
`subject`	Reference the patient resource and include a display value.
`author`	Reference the practitioner or organization that authored the record.
`encounter`	Reference the visit or clinical encounter, when available.
`attester`	Reference the practitioner or organization that attested the document.
`section.entry`	Reference only the top-level clinical resources in that section.

For production, set the organization identifier system to the ABDM facility registry. For sandbox, set it to the ABDM sandbox facility registry.

Terminologies

Standard	Use
SNOMED CT	Diagnoses, findings, procedures (free national licence via NRCeS)
LOINC	Lab observations
ICD-10/11	Morbidity coding, insurance
UCUM	Units of measure

Validate before certification

Validate your bundles against the NRCeS profiles with the official FHIR validator (the NRCeS site hosts the ABDM package). Certification includes bundle conformance checks per HI type you declare.

Validate a bundle with the FHIR validator

java -jar validator_cli.jar sample-bundle.json -ig https://nrces.in/ndhm/fhir/r4

Unstructured data

Real-world systems have PDFs and scans. Wrap them as HealthDocumentRecord bundles using DocumentReference with base64 attachment content — don't skip sharing them just because they aren't coded FHIR.

Sources

ABDM Proposed Simplified Milestone 2 (DOCX→MD, 2026-08)

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