Construct a FHIR transaction Bundle of type 'transaction' containing the required MHD resources: a List resource representing the SubmissionSet, a DocumentReference resource for each document, optionally a List resource for a Folder, and a Binary or DocumentReference.content.attachment for the document content itself.
Populate the SubmissionSet List with required metadata: sourceId (the submitting organization OID), submissionTime, and references to the included DocumentReference entries.
Populate each DocumentReference with required MHD metadata: patient, date, type, category, content (attachment with contentType and either data or url), and context (encounter or period) as applicable — verify required elements against the current IHE MHD IG.
Set Bundle.entry.request.method to POST for new resources and include appropriate fullUrl values using temporary UUIDs for cross-resource references within the Bundle.
POST the transaction Bundle to the Document Recipient actor's FHIR endpoint (typically [base]/ for a transaction Bundle) and evaluate the returned transaction-response Bundle.
Check each entry in the response Bundle for status codes; a successful submission will show 201 Created for each entry; any 4xx or 5xx indicates a submission error requiring correction.
Known gotchas
MHD ITI-65 requires specific List profiles for SubmissionSet and Folder — using a generic FHIR List without the required MHD extensions and codes will cause conformance failures.
Binary resources containing document content can be large; some implementations prefer a URL reference in DocumentReference.content.attachment.url pointing to a separately uploaded Binary rather than inline base64.
The MHD IG has evolved across versions (MHD v3.x, v4.x); confirm which version the Document Recipient actor implements before building your Bundle structure.
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp