PatientReferral (ServiceRequest) | I | | ServiceRequest | There are no (further) constraints on this element Element idShort description A request for a service to be performed Alternate names diagnostic request, referral, referral request, transfer of care request Definition A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.
Data type ServiceRequest Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty() - dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() - dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() - dom-6: A resource should have narrative for robust management
text.`div`.exists() - dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty() - prr-1: orderDetail SHALL only be present if code is present
orderDetail.empty() or code.exists()
Mappings- rim: Entity. Role, or Act
- workflow: Request
- v2: ORC
- rim: Act[moodCode<=INT]
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Data type string |
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idShort description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Data type Meta Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idServiceRequest.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Data type uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idShort description Language of the resource content Definition The base language in which the resource is written.
Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Data type code Binding CommonLanguages (preferred)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
text | | 0..1 | Narrative | There are no (further) constraints on this element Element idShort description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Data type Narrative Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- rim: N/A
- rim: Act.text?
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contained | | 0..* | Resource | There are no (further) constraints on this element Element idShort description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Data type Resource Mappings- rim: Entity. Role, or Act
- rim: N/A
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idServiceRequest.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
identifier | Σ | 1..1 | Identifier | There are no (further) constraints on this element Element idServiceRequest.identifier Short description Identifiers assigned to this order Definition Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.
Comments The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.
Data type Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
- servd: Identifier
- workflow: Request.identifier
- w5: FiveWs.identifier
- v2: ORC.2, ORC.3, RF1-6 / RF1-11,
- rim: .identifier
- quick: ClinicalStatement.identifier
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instantiatesCanonical | Σ | 0..0 | canonical(ActivityDefinition | PlanDefinition) | There are no (further) constraints on this element Element idServiceRequest.instantiatesCanonical Short description Instantiates FHIR protocol or definition Definition The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Comments Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Data type canonical(ActivityDefinition | PlanDefinition) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Request.instantiatesCanonical
- v2: Varies by domain
- rim: .outboundRelationship[typeCode=DEFN].target
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instantiatesUri | Σ | 0..0 | uri | There are no (further) constraints on this element Element idServiceRequest.instantiatesUri Short description Instantiates external protocol or definition Definition The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Comments This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Data type uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Request.instantiatesUri
- v2: Varies by domain
- rim: .outboundRelationship[typeCode=DEFN].target
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basedOn | Σ I | 0..0 | Reference(CarePlan | ServiceRequest | MedicationRequest) | There are no (further) constraints on this element Element idShort description What request fulfills Alternate names fulfills Definition Plan/proposal/order fulfilled by this request.
Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Data type Reference(CarePlan | ServiceRequest | MedicationRequest) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.basedOn
- v2: ORC.8 (plus others)
- rim: .outboundRelationship[typeCode=FLFS].target
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replaces | Σ I | 0..0 | Reference(ServiceRequest) | There are no (further) constraints on this element Element idShort description What request replaces Alternate names supersedes, prior, renewed order Definition The request takes the place of the referenced completed or terminated request(s).
Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Data type Reference(ServiceRequest) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.replaces
- v2: Handled by message location of ORC (ORC.1=RO or RU)
- rim: .outboundRelationship[typeCode=RPLC].target
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requisition | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idServiceRequest.requisition Short description Composite Request ID Alternate names grouperId, groupIdentifier Definition A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.
Requirements Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.
Comments Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
Data type Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
- servd: Identifier
- workflow: Request.groupIdentifier
- v2: ORC.4
- rim: .inboundRelationship(typeCode=COMP].source[moodCode=INT].identifier
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status | Σ ?! | 1..1 | codeBindingFixed Value | Element idShort description draft | active | on-hold | revoked | completed | entered-in-error | unknown Definition Comments The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.
Data type code Binding The status of a service order.
RequestStatus (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value Mappings- rim: n/a
- workflow: Request.status
- w5: FiveWs.status
- v2: ORC.5,RF1-1
- rim: .status
- quick: Action.currentStatus
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intent | Σ ?! | 1..1 | codeBindingFixed Value | Element idShort description proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Definition Whether the request is a proposal, plan, an original order or a reflex order.
Comments This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
Data type code Binding The kind of service request.
RequestIntent (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value Mappings- rim: n/a
- workflow: Request.intent
- w5: FiveWs.class
- v2: N/A
- rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
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category | Σ | 1..1 | CodeableConceptFixed Value | Element idShort description Classification of service Definition A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").
Requirements Used for filtering what service request are retrieved and displayed.
Comments There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.
Data type CodeableConcept Binding Classification of the requested service.
ServiceRequestCategoryCodes (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- w5: FiveWs.class
- v2: RF1-5
- rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="INT"].code
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priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idShort description routine | urgent | asap | stat Definition Indicates how quickly the ServiceRequest should be addressed with respect to other requests.
Comments Note that FHIR strings SHALL NOT exceed 1MB in size
Meaning when missing If missing, this task should be performed with normal priority
Data type code Binding Identifies the level of importance to be assigned to actioning the request.
RequestPriority (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Request.priority
- w5: FiveWs.grade
- v2: TQ1.9, RF1-2
- rim: .priorityCode
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doNotPerform | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element idServiceRequest.doNotPerform Short description True if service/procedure should not be performed Definition Set this to true if the record is saying that the service/procedure should NOT be performed.
Requirements Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.
Comments In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.
Meaning when missing If missing, the request is a positive request e.g. "do perform"
Data type boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Request.doNotPerform
- rim: .actionNegationInd
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code | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idShort description What is being requested/ordered Alternate names service requested Definition A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.
Comments Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.
Data type CodeableConcept Binding Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available here.
ProcedureCodes(SNOMEDCT) (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- workflow: Request.code
- w5: FiveWs.what[x]
- v2: PR1-3 / OBR-4 (varies by domain)
- rim: .code
- quick: Procedure.procedureCode
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orderDetail | Σ I | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idServiceRequest.orderDetail Short description Additional order information Alternate names detailed instructions Definition Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.
Comments For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.
Data type CodeableConcept Binding Codified order entry details which are based on order context.
ServiceRequestOrderDetailsCodes (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: NTE
- rim: .code
- quick: Procedure.procedureCode
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quantity[x] | Σ | 0..1 | | There are no (further) constraints on this element Element idServiceRequest.quantity[x] Short description Service amount Definition An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).
Requirements When ordering a service the number of service items may need to be specified separately from the the service item.
Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: NTE
- rim: .quantity
|
quantityQuantity | | | Quantity | There are no (further) constraints on this element Data type Quantity |
quantityRatio | | | Ratio | There are no (further) constraints on this element Data type Ratio |
quantityRange | | | Range | There are no (further) constraints on this element Data type Range |
subject | Σ I | 1..1 | Reference(BGHMCPatient) | Element idShort description The patient being referred Definition This is a reference to a Patient resource.
Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Data type Reference(BGHMCPatient) Allowed aggregation: contained, referenced Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.subject
- w5: FiveWs.subject[x]
- v2: PID
- rim: .participation[typeCode=SBJ].role
- quick: ClinicalStatement.subject
- w5: FiveWs.subject
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encounter | Σ I | 1..1 | Reference(Encounter) | There are no (further) constraints on this element Element idShort description Encounter in which the request was created Alternate names context Definition An encounter that provides additional information about the healthcare context in which this request is made.
Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Data type Reference(Encounter) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.encounter
- w5: FiveWs.context
- v2: PV1
- rim: .inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
- quick: ClinicalStatement.encounter
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occurrence[x] | Σ | 0..1 | | There are no (further) constraints on this element Element idServiceRequest.occurrence[x] Short description When service should occur Alternate names schedule Definition The date/time at which the requested service should occur.
Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Request.occurrence[x]
- w5: FiveWs.planned
- v2: TQ1/TQ2, OBR-7/OBR-8
- rim: .effectiveTime
- quick: Procedure.procedureSchedule
|
occurrenceDateTime | | | dateTime | There are no (further) constraints on this element Data type dateTime |
occurrencePeriod | | | Period | There are no (further) constraints on this element Data type Period |
occurrenceTiming | | | Timing | There are no (further) constraints on this element Data type Timing |
asNeeded[x] | Σ | 0..1 | | There are no (further) constraints on this element Element idServiceRequest.asNeeded[x] Short description Preconditions for service Definition If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.
Binding A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.
SNOMEDCTMedicationAsNeededReasonCodes (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- rim: boolean: precondition.negationInd (inversed - so negationInd = true means asNeeded=false CodeableConcept: precondition.observationEventCriterion[code="Assertion"].value
- quick: Proposal.prnReason.reason
|
asNeededBoolean | | | boolean | There are no (further) constraints on this element Data type boolean |
asNeededCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data type CodeableConcept |
authoredOn | Σ | 1..1 | dateTime | Element idServiceRequest.authoredOn Short description Date of the referral Alternate names orderedOn Definition When the request transitioned to being actionable.
Data type dateTime Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Request.authoredOn
- w5: FiveWs.recorded
- v2: ORC.9, RF1-7 / RF1-9
- rim: .participation[typeCode=AUT].time
- quick: Proposal.proposedAtTime
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requester | Σ I | 1..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | There are no (further) constraints on this element Element idShort description Who/what is requesting service Alternate names author, orderer Definition The individual who initiated the request and has responsibility for its activation.
Comments This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.
Data type Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.requester
- w5: FiveWs.author
- v2: ORC.12, PRT
- rim: .participation[typeCode=AUT].role
- quick: ClinicalStatement.statementAuthor
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id | | 0..1 | string | There are no (further) constraints on this element Element idServiceRequest.requester.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Data type string Mappings |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idServiceRequest.requester.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
reference | Σ I | 1..1 | string | There are no (further) constraints on this element Element idServiceRequest.requester.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
type | Σ | 1..1 | uriBindingFixed Value | Element idServiceRequest.requester.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Data type uri Binding Aa resource (or, for logical models, the URI of the logical model).
ResourceType (extensible)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value Mappings |
identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idServiceRequest.requester.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.
When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference
Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Data type Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
- servd: Identifier
- rim: .identifier
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display | Σ | 1..1 | string | There are no (further) constraints on this element Element idServiceRequest.requester.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
performerType | Σ | 0..0 | CodeableConcept | There are no (further) constraints on this element Element idServiceRequest.performerType Short description Performer role Alternate names specialty Definition Desired type of performer for doing the requested service.
Comments This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.
Data type CodeableConcept Binding Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
ParticipantRoles (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- workflow: Request.performerType
- w5: FiveWs.actor
- v2: PRT, RF!-3
- rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code
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performer | Σ I | 1..1 | Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) | There are no (further) constraints on this element Element idShort description Requested performer Alternate names request recipient Definition The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.
Comments If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).
Data type Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.performer
- w5: FiveWs.actor
- v2: PRT, Practitioner: PRD-2/PRD-7 where PRD-3 = RT; Organization: PRD-10 where PRD-3 = RT
- rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
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locationCode | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idServiceRequest.locationCode Short description Requested location Definition The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.
Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Data type CodeableConcept Binding A location type where services are delivered.
v3.ServiceDeliveryLocationRoleType (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- w5: FiveWs.actor
- rim: .participation[typeCode=LOC].role[scoper.determinerCode=KIND].code
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locationReference | Σ I | 0..* | Reference(Location) | There are no (further) constraints on this element Element idServiceRequest.locationReference Short description Requested location Definition A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.
Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Data type Reference(Location) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- w5: FiveWs.actor
- rim: .participation[typeCode=LOC].role[scoper.determinerCode=INSTANCE]
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reasonCode | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idServiceRequest.reasonCode Short description Explanation/Justification for procedure or service Definition An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo .
Comments This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.
Data type CodeableConcept Binding Diagnosis or problem codes justifying the reason for requesting the service investigation.
ProcedureReasonCodes (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- workflow: Request.reasonCode
- w5: FiveWs.why[x]
- v2: ORC.16, RF1-10
- rim: .reasonCode
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reasonReference | Σ I | 1..1 | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | There are no (further) constraints on this element Element idServiceRequest.reasonReference Short description Explanation/Justification for service or service Definition Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo .
Comments This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode . When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.
Data type Reference(Condition | Observation | DiagnosticReport | DocumentReference) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.reasonReference
- w5: FiveWs.why[x]
- v2: ORC.16
- rim: .outboundRelationship[typeCode=RSON].target
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insurance | I | 0..0 | Reference(Coverage | ClaimResponse) | There are no (further) constraints on this element Element idShort description Associated insurance coverage Definition Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.
Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Data type Reference(Coverage | ClaimResponse) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.insurance
- v2: IN1/IN2
- rim: .outboundRelationship[typeCode=COVBY].target
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supportingInfo | I | 0..* | Reference(ReferralMedicalCondition) | Element idServiceRequest.supportingInfo Short description Medical condition info Alternate names Ask at order entry question, AOE Definition Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.
Comments To represent information about how the services are to be delivered use the instructions element.
Data type Reference(ReferralMedicalCondition) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.supportingInfo
- v2: Accompanying segments
- rim: .outboundRelationship[typeCode=PERT].target
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specimen | Σ I | 0..* | Reference(Specimen) | There are no (further) constraints on this element Element idShort description Procedure Samples Definition One or more specimens that the laboratory procedure will use.
Comments Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.
Data type Reference(Specimen) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2: SPM
- rim: .participation[typeCode=SPC].role
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bodySite | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idShort description Location on Body Alternate names location Definition Anatomic location where the procedure should be performed. This is the target site.
Requirements Knowing where the procedure is performed is important for tracking if multiple sites are possible.
Comments Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure.
Data type CodeableConcept Binding Codes describing anatomical locations. May include laterality.
SNOMEDCTBodyStructures (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: SPM
- rim: targetSiteCode
- quick: Procedure.targetBodySite
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note | | 0..* | Annotation | There are no (further) constraints on this element Element idShort description Comments Definition Any other notes and comments made about the service request. For example, internal billing notes.
Comments For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Data type Annotation Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: N/A
- rim: Act
- workflow: Request.note
- v2: NTE
- rim: .inboundRelationship(typeCode=SUBJ].source[classCode=ANNGEN, moodCode=EVN].value[xsi:type=ST]
- quick: ClinicalStatement.additionalText
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patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element idServiceRequest.patientInstruction Short description Patient or consumer-oriented instructions Definition Instructions in terms that are understood by the patient or consumer.
Comments Note that FHIR strings SHALL NOT exceed 1MB in size
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: NTE
- rim: .text
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relevantHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idServiceRequest.relevantHistory Short description Request provenance Definition Key events in the history of the request.
Comments This might not include provenances for all versions of the request – only those deemed “relevant” or important.
This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude
All Provenances should have some historical version of this Request as their subject.
Data type Reference(Provenance) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Request.relevantHistory
- v2: N/A
- rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]
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