Motion to apply the following updates: Add to DiagnosticReport boundaries: A DiagnosticReport has overlapping characteristics with DocumentReference.  The DiagnosticReport is appropriate to reflect a set of discrete results (Observations) and associated contextual details for a specific report, and within those results any further structure within the Observation instances, while a DocumentReference typically reflects a non-FHIR object that is not a FHIR Document (e.g., an existing C-CDA document), a scan of a drivers license, or narrative note.  There is some overlap potential such as a scan of a CBC report that can either be referenced by way of a DocumentReference, or included in a DiagnosticReport as a representedForm together with the structured, discrete data.  Specific implementation guides would further clarify when one approach is more appropriate than another. Modify DocumentReference boundary paragraph: This resource captures data that might not be in FHIR format. The document can be any object (e.g. file), and is not limited to the formal HL7 definitions of  Document . This resource may be a report with unstructured text or report that is not expressed in a DiagnosticReport.   The DiagnosticReport is appropriate to reflect a set of discrete results (Observations) and associated contextual details for a specific report, and within those results any further structure within the Observation instances.   This   The DocumentReference   { }resource may be an  Observation  whose value is audio, video or image data. This resource is the preferred representation of such forms of information as it exposes the metadata relevant for interpreting the information.  There is some overlap potential such as a scan of a CBC report that can either be referenced by way of a DocumentReference, or included in a DiagnosticReport as a representedForm together with the structured, discrete data.  Specific implementation guides would further clarify when one approach is more appropriate than another.