Structured Documents as defined by an HL7 standard may be stored on DICOM Interchange Media, and may be referenced from within DICOM SOP Instances (including the DICOMDIR Media Storage Directory).

An Encapsulated CDA is referenced from the Media Storage Directory like any other DICOM SOP Instance.

An HL7 Structured Document is an aggregate multimedia object, consisting of a base XML-encoded document, plus zero or more multimedia components (e.g., graphics) that are considered an integral part of the object. The multimedia components shall be encoded in-line in the encapsulated XML document unless they are references to other DICOM SOP Instances contained on the media.