Copy of 'GP Connect Data Model | FHIR STU3 Representation'

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ReferralRequest.meta

ReferralRequest.meta.profile

ReferralRequest.extension:ReferralRequestMethod

ReferralRequest.identifier

ReferralRequest.identifier.system

ReferralRequest.identifier.value

ReferralRequest.basedOn

ReferralRequest.replaces

ReferralRequest.groupIdentifier.assigner

ReferralRequest.status

unknown

ReferralRequest.intent

order

ReferralRequest.priority

ReferralRequest.subject

ReferralRequest.context

ReferralRequest.authoredOn

ReferralRequest.requester

ReferralRequest.requester.agent

ReferralRequest.requester.onBehalfOf

ReferralRequest.recipient

ReferralRequest.reasonCode

ReferralRequest.reasonReference

ReferralRequest.description

ReferralRequest.supportingInfo

ReferralRequest.note

ReferralRequest.note.author[x]

unknown

order

Reference

Canonical URI: https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ReferralRequest-1

The canonical URI is the stable FHIR identifier for this profile and is not currently available as a browsable web page.

Related links

CareConnect-ReferralRequest-1

CareConnect-GPC-ReferralRequest-1

id

Usage

Optional

Guidance

The id is the logical identifier for the CareConnect-GPC-ReferralRequest-1 profile.

Example

<id value="5837b927-e939-4aa1-8b19-5442b8a567ba" />

meta.versionId

Usage

Optional

Guidance

The population of the meta.versionId element could be useful if sending an adendum of something previously sent to help the consumer (receiver) in understanding there is a "newer" version.

Example

<meta>
    <versionId value="1" />
</meta>

meta.lastUpdated

Usage

Optional

Guidance

The meta.lastUpdated element could be useful alongside the meta.versionIdelement could be useful if sending an adendum of something previously sent to help the consumer (receiver) in understanding there is a "newer" version.

Example

<meta>
    <lastUpdated value="2022-10-28T08:06:00+00:00" />
</meta>

meta.profile

Usage

Mandatory

Guidance

The meta.profile contains a fixed value of the URL for the CareConnect-GPC-ReferralRequest-1 profile.

Example

<meta>
    <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ReferralRequest-1" />
</meta>

meta.security

Usage

Optional

Guidance

The security label(s) applicable to the resource.

See Resources not to be disclosed to a patient for more details on how to populate the element.

Example

<meta>
    <security>
        <system value="http://hl7.org/fhir/v3/ActCode"/>
        <code value="NOPAT"/>
        <display value="no disclosure to patient, family or caregivers without attending provider's authorization"/>
    </security>
</meta>

meta.tag

Usage

Optional

Guidance

A use-case for the meta.tag element within GP Connect has not been defined.

Example

<meta>
    <tag>
        <coding>
            <system value="http://hl7.org/fhir/common-tags" />
            <code value="actionable" />
            <display value="Actionable" />
        </coding>
    </tag>
</meta>

identifier

Usage

Optional

Guidance

The identifier MUST be populated with a globally unique and persistent identifier (that is, it doesn’t change between requests and therefore stored with the source data). This MUST be scoped by a provider specific namespace for the identifier.

Where consuming systems are integrating data from this resource to their local system, they MUST also persist this identifier at the same time.

If the referral was made via the e-Referral Service and a Unique Booking Reference Number (UBRN) exists for the referral, then it MUST be included as an identifier. The system identifier for this is https://fhir.nhs.uk/Id/ubr-number.

Example

<identifier>
    <system value="https://foo.bar/id/referral-request" />
    <value value="fef26348-ccd1-440b-940e-ba1ec058cf21" />
</identifier>

definition

Usage

Optional

Guidance

A use-case for the definition element within GP Connect has not been defined.

Example

<definition>
    <reference value="plan-definition--00192ast" />
</definition>

basedOn

Usage

Optional

Guidance

Indicates any plans or prior referrals that this referral is intended to fulfill.

Example

<basedOn>
    <reference value="careplan--procedure-request--referral-request--00123f72" />
</basedOn>

replaces

Usage

Optional

Guidance

A use-case for the replaces element within GP Connect has not been defined as terminated referrals are not in scope (thus cannot be referenced).

Any association to a prior, completed referral can be made via the basedOn element.

Example

<replaces>
    <reference value="careplan--procedure-request--referral-request--0071dj" />
</replaces>

groupIdentifier

Usage

Optional

Guidance

A use-case for the groupIdentifier element within GP Connect has not been defined.

Example

<identifier>
    <system value="https://foo.bar/id/referral-request/group" />
    <value value="ea01541c-dbe0-4b23-b492-b7d5f2c45d3a" />
</identifier>

status

Usage

Mandatory

Guidance

A default value of unknown SHOULD be used for open or complete referrals as generally the status of referrals is not consistently maintained in a GP patient record. A status of cancelled MAY be used where the GP System has directly cancelled a referral, for example cancelled via eRS. Referrals entered in error MUST NOT be included.

Code System Request Status

Example

<status value="unknown" />

intent

Usage

Mandatory

Guidance

The status element is a mandatory one within FHIR and while it can be populated with any value from the available code system, it is expected that must use-cases within GP Connect will be order.

Code System Request Intent

Example

<status value="order" />

type

Usage

Optional

Guidance

A use-case for the type element has not been defined for GP Connect; however, it is expected that reasonCode element can be used to represent a referral code using SNOMED CT.

Example

<type>
    <coding>
        <system value="http://snomed.info/sct" />
        <code value="397721007" />
        <display value="Referral by Accident and Emergency (procedure)" />
        <snomedCT>
            <url value="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid" />
            <extension>
            <valueId value="397721007" />
                <descriptionId value="397721007" />
                <descriptionDisplay value="Referral by Accident and Emergency (procedure)" />
            </extesion>
        </snomedCT>
    </coding>
    <text value="Referral by Accident and Emergency (procedure)" />
</type>

priority

Usage

Optional

Guidance

A mapping is applied to the priority codes to align it to the e-Referral Service priority types. This MUST be populated where the source system has a referral priority which matches the e-Referral Service priority codes or can be mapped to those priority codes. If there is a priority code for the referral but it is incompatible with the e-Referral Service priorities, this element MUST be excluded and the priority MUST be supplied in the note element.

Example

<priority value="stat" />

serviceRequested

Usage

Optional

Guidance

This MUST NOT be populated with the source system’s main code for the referral, which MUST be returned in the reasonCode element. This MAY be populated if the GP clinical system also holds a distinct entry for the type of service requested.

Example

<serviceRequested>
    <coding>
        <system value="http://snomed.info/sct" />
        <code value="394597005" />
        <display value="Histopathology" />
        <snomedCT>
            <url value="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid" />
            <extension>
            <valueId value="394597005" />
                <descriptionId value="394597005" />
                <descriptionDisplay value="Histopathology" />
            </extesion>
        </snomedCT>
    </coding>
    <text value="Histopathology" />
</serviceRequested>

subject

Usage

Mandatory

Guidance

The subject element will contain a reference to the Patient that the ReferralRequest is regarding. This can either be as a reference within the payload, or using the reference.identifier.

Example

<subject>
    <extension>
        <url value="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1" />
        <valueCodeableConcept>
            <coding>
                <system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1" />
                <code value="01" />
                <display value="Number present and verified" />
            </coding>
            <!-- text optional as already stipulated within the codeable concept -->
            <text value="Number present and verified" />
        </valueCodeableConcept>
    </extension>
    <system value="https://fhir.nhs.uk/Id/nhs-number" />
    <value value="4857773456" />
</subject>

context

Usage

Required

Guidance

A reference to the Consultation (Encounter or Episode of Care) within which the referral was recorded.

Example

<context>
    <reference value="encounter-933d0c70-3bd9-400b-82b5-d717ec593824" />
</context>

occurrence[x]

Usage

Optional

Guidance

A use-case for the occurrence[x] element within GP Connect has not been defined.

Example

<occurrenceDateTime value="2022-12-13T13:33:00Z" />

authoredOn

Usage

Required

Guidance

The main date for the referral as entered by the end user in accordance with the following guidance.

All GP clinical systems have a user selection date field against a referral. Providers MUST populate the authoredOn element with the user entered referral date.

Consumers should be aware that the date may have slightly different meaning according to the GP clinical system and local practice for recording referrals.

Example

<authoredOn value="2022-12-05T11:10:00Z" />

requester.agent

Usage

Required

Guidance

The preferred agent is the practitioner responsible for the decision to refer the patient. If the referral is not attributed to a practitioner, then any of the other resource options MAY be used as most appropriate. If the referral does not clearly identify responsibility for the referral decision or action, this MUST be the user who recorded the referral.

Example

<requester>
    <agent>
        <identifier>
            <system value="https://fhir.hl7.org.uk/Id/gmc-number" />
            <value value="000000000" />
            <display value="Test GP" />
        </identifier>
    </agent>
</requester>

requester.onBehalfOf

Usage

Required

Guidance

This MUST be populated if the requester.agent is a practitioner and the Organization associated with the referenced Practitioner is not the GP practice responsible for the referral. This element SHOULD be absent if the requester.agent is not a practitioner. This element MAY be populated or absent where the GP practice responsible for the referral is the same organisation as associated with requester.agent practitioner via the practitioner role.

Example

<requester>
    <onBehalfOf>
        <identifier>
            <system value="https://fhir.hl7.org.uk/Id/gmc-number" />
            <value value="012340000" />
            <display value="Test Practitioner" />
        </identifier>
    </onBehalfOf>
</requester>

specialty

Usage

Optional

Guidance

This MUST NOT be populated with the source system’s main code for the referral, which MUST be returned in the reasonCode element. This MAY be populated if the GP clinical system holds a distinct entry for the clinical or practitioner specialty requested by the referral.

Example

<specialty>
    <coding>
        <system value="http://hl7.org/fhir/practitioner-specialty" />
        <code value="cardio" />
        <display value="Cardiologist" />
        <snomedCT>
            <url value="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid" />
            <extension>
            <valueId value="cardio" />
                <descriptionId value="cardio" />
                <descriptionDisplay value="Cardiologist" />
            </extesion>
        </snomedCT>
    </coding>
    <text value="Cardiologist" />
</specialty>

recipient

Usage

Required

Guidance

The recipient element can be used to indicate which practitioner and / or organisation the patient has been referred to, providing that it has been recorded in a suitable coded format.

If the referral recipient details are in a form which cannot be returned as a referenced resource, the details should be populated in the note element as key value pairs.

Example

<recipient>
    <reference>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/ods-organization-code" />
            <value value="Q72" />
            <display value="NHS ENGLAND NORTH EAST AND YORKSHIRE (YORKSHIRE AND HUMBER) (Q72)" />
        </identifier>
    </reference>
</recipient>

OR

<note>
    <author>
        <reference value="practitioner-948392" />
    </author>
    <time value="2022-10-13T16:59:00Z" />
    <text>
        Practitioner: Dr Make-you-well
        Organisation: An example organisation
    </text>
</note>

reasonCode

Usage

Required

Guidance

The reasonCode element can be populated with the source system’s main coded entry for the referral.

Additional, coded or text entries which are clearly captured as reasons for referral may also be included.

Example

<reasonCode>
    <coding>
        <system value="http://snomed.info/sct" />
        <code value="195967001" />
        <display value="Asthma (disorder)" />
    </coding>
</reasonCode>

reasonReference

Usage

Optional

Guidance

A referral may have a linked problem which represents the reason for the referral.

Where the inforamtion is available, referencing the problem that teh referral is regarding may be useful.

Example

<reasonReference>
    <reference value="problem-header-condition--00f39ds" />
</reasonReference>

description

Usage

Required

Guidance

The description element can be populated with the free text description associated with the referral.

Example

<description value="Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut rutrum." />

supportingInfo

Usage

Required

Guidance

Reference to the referral letter(s) and any other supporting documents or resources which are not covered by other more specific elements, for instance this could include reference to linked observations or test results.

This does not apply to a linked problem. The problem MUST be included in the bundle and reference to the referralRequest. The referralRequest MUST NOT reference to the problem.

Example

<supportingInfo>
    <reference value="observation-001sdk345" />
</supportingInfo>

note

Usage

Required

Guidance

Any additional information recorded against the referral which is not accommodated by other elements. This could include additional categorisation of the referral or notes recorded against the referral after it has been made such as details of progress or outcomes.

Example

<note>
    <author>
        <reference value="practitioner-948392" />
    </author>
    <time value="2022-10-13T16:59:00Z" />
    <text>
        Free text... R4 of the FHIR standard supports GitHub Flavoured Markdown (GFM).
    </text>
</note>

relevantHistory

Usage

Optional

Guidance

A use-case for the relevantHistory element within GP Connect has not been defined.

Example

<reasonReference>
    <reference value="provenance--00y1pa2" />
</reasonReference>

extension(ReferralRequestMethod)

Usage

Optional

Guidance

The method used to send or receive a Referral Request.

Example

<extension url="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-ReferralRequestMethod-1">
    <valueCodeableConcept>
      <coding>
        <system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-ReferralRequestMethod-1" />
        <code value="2" />
        <display value="Phone" />
      </coding>
    </valueCodeableConcept>
  </extension>

Elements elements not in use

The following elements MUST NOT be populated:

definition

This is not required by GP Conne

replaces

Terminated referrals are not in scope so cannot be referenced. Any association to a prior, completed referral can be made via the basedOn element.

groupIdentifier

This is not required by GP Connect.

type

Thie element has not been defined for GP COnnect use. The reasonCode element MUST be used for the SNOMED CT coded referral code.

occurrence

reasonReference

A referral may have a linked problem which represents the reason for the referral. This is required information where it exists, but the problem MUST be included to the referralRequest. The referralRequest MUST NOT reference to the problem.

relevantHistory