FHIR Artifacts > Structure Definition: ServiceRequest Profile

Structure Definition: ServiceRequest Profile

Canonical URL:http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-ServiceRequest

Simplifier project page: ServiceRequest

Derived from: ServiceRequest (CA:eReC)

Base FHIR: ServiceRequest

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work

Differential View

profileS1..
referenceS
identifierS
DARC..1
DART..1
codingSBinding
CopiedParticipants
serviceProviderPreferenceSExtension(Complex)
useS
systemS1..
codeS1..
displayS1..
basedOnReference(EReferralServiceRequest)
replacesReference(EReferralServiceRequest)
requisition
priorityS
systemS1..Fixed Value
codeS1..Binding
displayS1..
system1..
code1..
display1..
subjectReference(EReferralPatient)
authoredOn
serviceRequestDelegateSExtension(Complex)
performerIdentifierS..1Extension(Identifier)
systemS1..
codeS1..
displayS1..
textS
supportingInfoReference(EReferralAllergyIntolerance | EReferralCommunication | EReferralCondition | EReferralConsent | EReferralDocumentReference | EReferralFamilyMemberHistory | EReferralMedicationStatement | EReferralProcedure | EReferralQuestionnaireResponse | Resource)
authorReferenceReference(EReferralOrganization | EReferralPatient | EReferralPractitioner)
authorStringstring
text

Hybrid View

profileS1..
referenceS
identifierS
DARC..1
DART..1
codingSBinding
CopiedParticipants
serviceProviderPreferenceSExtension(Complex)
useS
systemS1..
codeS1..
displayS1..
basedOnReference(EReferralServiceRequest)
replacesReference(EReferralServiceRequest)
requisition
priorityS
systemS1..Fixed Value
codeS1..Binding
displayS1..
system1..
code1..
display1..
subjectReference(EReferralPatient)
authoredOn
serviceRequestDelegateSExtension(Complex)
performerIdentifierS..1Extension(Identifier)
systemS1..
codeS1..
displayS1..
textS
supportingInfoReference(EReferralAllergyIntolerance | EReferralCommunication | EReferralCondition | EReferralConsent | EReferralDocumentReference | EReferralFamilyMemberHistory | EReferralMedicationStatement | EReferralProcedure | EReferralQuestionnaireResponse | Resource)
authorReferenceReference(EReferralOrganization | EReferralPatient | EReferralPractitioner)
authorStringstring
text

Snapshot View

profileS1..
referenceS
identifierS
DARC..1
DART..1
codingSBinding
CopiedParticipants
serviceProviderPreferenceSExtension(Complex)
useS
systemS1..
codeS1..
displayS1..
basedOnReference(EReferralServiceRequest)
replacesReference(EReferralServiceRequest)
requisition
priorityS
systemS1..Fixed Value
codeS1..Binding
displayS1..
system1..
code1..
display1..
subjectReference(EReferralPatient)
authoredOn
serviceRequestDelegateSExtension(Complex)
performerIdentifierS..1Extension(Identifier)
systemS1..
codeS1..
displayS1..
textS
supportingInfoReference(EReferralAllergyIntolerance | EReferralCommunication | EReferralCondition | EReferralConsent | EReferralDocumentReference | EReferralFamilyMemberHistory | EReferralMedicationStatement | EReferralProcedure | EReferralQuestionnaireResponse | Resource)
authorReferenceReference(EReferralOrganization | EReferralPatient | EReferralPractitioner)
authorStringstring
text

Table View

ServiceRequest..
ServiceRequest.meta1..
ServiceRequest.meta.profile1..
ServiceRequest.extension:PatientPresentLocation..1
ServiceRequest.extension:PatientPresentLocation.value[x]..
ServiceRequest.extension:PatientPresentLocation.value[x].reference..
ServiceRequest.extension:PatientPresentLocation.value[x].identifier..
ServiceRequest.extension:DARC..1
ServiceRequest.extension:DART..1
ServiceRequest.extension:RoutingOptions..
ServiceRequest.extension:RoutingOptions.value[x]..
ServiceRequest.extension:RoutingOptions.value[x].coding..
ServiceRequest.extension:CopiedParticipants..
ServiceRequest.extension:serviceProviderPreferenceExtension..
ServiceRequest.identifier..
ServiceRequest.identifier.use..
ServiceRequest.identifier.type..
ServiceRequest.identifier.type.coding..
ServiceRequest.identifier.type.coding.system1..
ServiceRequest.identifier.type.coding.code1..
ServiceRequest.identifier.type.coding.display1..
ServiceRequest.basedOnReference(EReferralServiceRequest)..
ServiceRequest.replacesReference(EReferralServiceRequest)..
ServiceRequest.requisition..
ServiceRequest.priority..
ServiceRequest.code..
ServiceRequest.code.coding..
ServiceRequest.code.coding.system1..
ServiceRequest.code.coding.code1..
ServiceRequest.code.coding.display1..
ServiceRequest.orderDetail..
ServiceRequest.orderDetail.coding..
ServiceRequest.orderDetail.coding.system1..
ServiceRequest.orderDetail.coding.code1..
ServiceRequest.orderDetail.coding.display1..
ServiceRequest.subjectReference(EReferralPatient)..
ServiceRequest.authoredOn..
ServiceRequest.requesterReference(EReferralPatient | EReferralPractitionerRole)..
ServiceRequest.requester.extension:serviceRequestDelegateExtension..
ServiceRequest.performerReference(EReferralHealthcareService | EReferralPractitionerRole)..
ServiceRequest.performer.extension:performerIdentifierExtension..1
ServiceRequest.reasonCode..
ServiceRequest.reasonCode.coding..
ServiceRequest.reasonCode.coding.system1..
ServiceRequest.reasonCode.coding.code1..
ServiceRequest.reasonCode.coding.display1..
ServiceRequest.reasonCode.text..
ServiceRequest.supportingInfoReference(EReferralAllergyIntolerance | EReferralCommunication | EReferralCondition | EReferralConsent | EReferralDocumentReference | EReferralFamilyMemberHistory | EReferralMedicationStatement | EReferralProcedure | EReferralQuestionnaireResponse | Resource)..
ServiceRequest.note..
ServiceRequest.note.author[x]Reference(EReferralOrganization | EReferralPatient | EReferralPractitioner) | string..
ServiceRequest.note.text..

JSON View

{
"resourceType": "StructureDefinition",
"id": "ca-on-eReferral-profile-ServiceRequest",
"url": "http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-ServiceRequest",
"version": "1.1.0",
"name": "EReferralServiceRequest",
"title": "ServiceRequest",
"status": "draft",
"description": "ServiceRequest is the main resource use to send all referral related information to the destination system.",
"fhirVersion": "4.0.1",
"kind": "resource",
"abstract": false,
"type": "ServiceRequest",
"baseDefinition": "http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-ServiceRequest",
"derivation": "constraint",
"differential": {
"element": [
{
"id": "ServiceRequest.meta",
"path": "ServiceRequest.meta",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.meta.profile",
"path": "ServiceRequest.meta.profile",
"comment": "#### **_` FOR eREFERRAL USAGE: The meta.profile = http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-ServiceRequest|1.1.0 `_**\n\nIt is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.extension:PatientPresentLocation",
"path": "ServiceRequest.extension",
"sliceName": "PatientPresentLocation",
"max": "1"
},
{
"id": "ServiceRequest.extension:PatientPresentLocation.value[x]",
"path": "ServiceRequest.extension.value[x]",
"mustSupport": true
},
{
"id": "ServiceRequest.extension:PatientPresentLocation.value[x].reference",
"path": "ServiceRequest.extension.value[x].reference",
"mustSupport": true
},
{
"id": "ServiceRequest.extension:PatientPresentLocation.value[x].identifier",
"path": "ServiceRequest.extension.value[x].identifier",
"mustSupport": true
},
{
"id": "ServiceRequest.extension:DARC",
"path": "ServiceRequest.extension",
"sliceName": "DARC",
"max": "1"
},
{
"id": "ServiceRequest.extension:DART",
"path": "ServiceRequest.extension",
"sliceName": "DART",
"max": "1"
},
{
"id": "ServiceRequest.extension:RoutingOptions",
"path": "ServiceRequest.extension",
"sliceName": "RoutingOptions"
},
{
"id": "ServiceRequest.extension:RoutingOptions.value[x]",
"path": "ServiceRequest.extension.value[x]",
"mustSupport": true
},
{
"id": "ServiceRequest.extension:RoutingOptions.value[x].coding",
"path": "ServiceRequest.extension.value[x].coding",
"mustSupport": true,
"binding": {
"strength": "extensible",
"valueSet": "http://ehealthontario.ca/fhir/ValueSet/ereferral-source-types"
}
},
{
"id": "ServiceRequest.extension:CopiedParticipants",
"path": "ServiceRequest.extension",
"sliceName": "CopiedParticipants",
"definition": "Used to CC updates to the ServiceRequest in cases of forwarding referrals"
},
{
"id": "ServiceRequest.extension:serviceProviderPreference",
"path": "ServiceRequest.extension",
"sliceName": "serviceProviderPreference",
"short": "Service Provider Preference",
"definition": "Indicates preferences related to provider and service location",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-service-provider-preference-EXT"
]
}
],
"mustSupport": true,
"isModifier": false
},
{
"id": "ServiceRequest.identifier.use",
"path": "ServiceRequest.identifier.use",
"mustSupport": true
},
{
"id": "ServiceRequest.identifier.type",
"path": "ServiceRequest.identifier.type",
"mustSupport": false
},
{
"id": "ServiceRequest.identifier.type.coding.system",
"path": "ServiceRequest.identifier.type.coding.system",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.identifier.type.coding.code",
"path": "ServiceRequest.identifier.type.coding.code",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.identifier.type.coding.display",
"path": "ServiceRequest.identifier.type.coding.display",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.basedOn",
"path": "ServiceRequest.basedOn",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-ServiceRequest"
]
}
]
},
{
"id": "ServiceRequest.replaces",
"path": "ServiceRequest.replaces",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-ServiceRequest"
]
}
]
},
{
"id": "ServiceRequest.requisition",
"path": "ServiceRequest.requisition",
"comment": "#### **_` FOR EREFERRAL USAGE: It is highly recommended that the common elements should match between multiple ServiceRequests (e.g., patient, requester, etc...) 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. `_**"
},
{
"id": "ServiceRequest.priority",
"path": "ServiceRequest.priority",
"mustSupport": true
},
{
"id": "ServiceRequest.code",
"path": "ServiceRequest.code",
"comment": "#### **_`FOR EREFERRAL USAGE: The meaning of this field is to be used in conjunction with ServiceRequest.performing pointing to a HealthCareservice, and .code further specifies the service, for example code could be a specific procedure under the specificed HealthcareService (e.g., HealthcareService = Orthopaedic Surgeon, code=Knee Surgery). `_**\n\nMany 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.",
"binding": {
"strength": "extensible",
"valueSet": "https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.2.20.3.271&versionid=20220331"
}
},
{
"id": "ServiceRequest.code.coding",
"path": "ServiceRequest.code.coding",
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.\n\nFor details of the value set, please visit https://tgateway.infoway-inforoute.ca/mtw.html?id=2.16.840.1.113883.2.20.3.97&versionid=20160311"
},
{
"id": "ServiceRequest.code.coding.system",
"path": "ServiceRequest.code.coding.system",
"min": 1,
"fixedUri": "http://snomed.info/sct",
"mustSupport": true
},
{
"id": "ServiceRequest.code.coding.code",
"path": "ServiceRequest.code.coding.code",
"min": 1,
"mustSupport": true,
"binding": {
"strength": "extensible",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/interventioncodesubsetcare"
}
},
{
"id": "ServiceRequest.code.coding.display",
"path": "ServiceRequest.code.coding.display",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.orderDetail",
"path": "ServiceRequest.orderDetail",
"mustSupport": false
},
{
"id": "ServiceRequest.orderDetail.coding",
"path": "ServiceRequest.orderDetail.coding",
"mustSupport": false
},
{
"id": "ServiceRequest.orderDetail.coding.system",
"path": "ServiceRequest.orderDetail.coding.system",
"min": 1,
"mustSupport": false
},
{
"id": "ServiceRequest.orderDetail.coding.code",
"path": "ServiceRequest.orderDetail.coding.code",
"min": 1,
"mustSupport": false
},
{
"id": "ServiceRequest.orderDetail.coding.display",
"path": "ServiceRequest.orderDetail.coding.display",
"min": 1,
"mustSupport": false
},
{
"id": "ServiceRequest.subject",
"path": "ServiceRequest.subject",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Patient"
]
}
]
},
{
"id": "ServiceRequest.authoredOn",
"path": "ServiceRequest.authoredOn",
"comment": "#### **_`FOR EREFERRAL USAGE: authoredOn is the submission time of the sending system `_**"
},
{
"id": "ServiceRequest.requester",
"path": "ServiceRequest.requester",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-PractitionerRole",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Patient"
]
}
]
},
{
"id": "ServiceRequest.requester.extension:serviceRequestDelegate",
"path": "ServiceRequest.requester.extension",
"sliceName": "serviceRequestDelegate",
"short": "Identified Delegate",
"definition": "The person or provider identified as a delegate for a service request",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-service-request-delegate-EXT"
]
}
],
"mustSupport": true,
"isModifier": false
},
{
"id": "ServiceRequest.performer",
"path": "ServiceRequest.performer",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-PractitionerRole",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-HealthcareService"
]
}
]
},
{
"id": "ServiceRequest.performer.extension:performerIdentifier",
"path": "ServiceRequest.performer.extension",
"sliceName": "performerIdentifier",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-performer-identifier-EXT"
]
}
],
"mustSupport": true,
"isModifier": false
},
{
"id": "ServiceRequest.reasonCode.coding",
"path": "ServiceRequest.reasonCode.coding",
"mustSupport": false
},
{
"id": "ServiceRequest.reasonCode.coding.system",
"path": "ServiceRequest.reasonCode.coding.system",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.reasonCode.coding.code",
"path": "ServiceRequest.reasonCode.coding.code",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.reasonCode.coding.display",
"path": "ServiceRequest.reasonCode.coding.display",
"min": 1,
"mustSupport": true
},
{
"id": "ServiceRequest.reasonCode.text",
"path": "ServiceRequest.reasonCode.text",
"mustSupport": true
},
{
"id": "ServiceRequest.supportingInfo",
"path": "ServiceRequest.supportingInfo",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Resource",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-QuestionnaireResponse",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-DocumentReference",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Consent",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-AllergyIntolerance",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Condition",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Communication",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-MedicationStatement",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Procedure",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-FamilyMemberHistory"
]
}
]
},
{
"id": "ServiceRequest.note",
"path": "ServiceRequest.note",
"comment": "#### **_`FOR EREFERRAL USAGE: 'note' is used to include additional information in the referral that is not captured by an existing resource or in a DocumentReference. This is often used when the sending application has a custom data capture form with fields are not mapped to a resource (e.g., Food preference, home visit risk factors, etc...). `_**\n\nFor 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)."
},
{
"id": "ServiceRequest.note.author[x]",
"path": "ServiceRequest.note.author[x]",
"comment": "#### **_`FOR EREFERRAL USAGE: On submission of the ServiceRequest, if .author[x] and .time are not included, they are assumed to be the requester and received time of the ServiceRequest respectively (this is expected to be the normal use case). `_**\nOrganization is used when there's no need for specific attribution as to who made the comment.",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Practitioner",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Organization",
"http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Patient"
]
},
{
"code": "string"
}
]
},
{
"id": "ServiceRequest.note.text",
"path": "ServiceRequest.note.text",
"mustSupport": false
}
]
}
}

STABILITY RISK: This profile is undergoing Ontario Health harmonization and may be adjusted as part of this process (e.g., adjustments to Must Support obligations).

Usage

The ServiceRequest resource is the primary resource used to represent a referral request in this IG. References to other resources are used to convey the details of the request including the Patient (ServiceRequest.subject), Referrer (ServiceRequest.requester) and supporting information (ServiceRequest.supportingInfo).

Notes

.id

  • used to uniquely identify the resource
  • if a persistent identity for the resource is not available to use when constructing a message Bundle for transmission via Direct Messaging, a UUID SHOULD be used in this element (with a corresponding value in Bundle.entry.fullUrl)

.meta.profile

  • used to declare conformance to this profile
  • populate with a fixed value: http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-ServiceRequest|1.1.0

.extension:PatientPresentLocation

  • used to communicate the present location of the patient if it is different than the patient's home address
  • see business rules for more information

.extension:DARC

  • used to communicate dates affecting reason to consult

.extension:DART

  • used to communicate dates affecting reason to treat

.extension:RoutingOptions

  • used to communicate referral source type information to support referral processes with automated referral processing rules
  • see business rules for more information

.extension:CopiedParticipant

  • used to communicate updates to the ServiceRequest in cases of forwarding referrals. The original ServiceRequest is sent to central intake and is copied to another ProviderRole. The forwarded ServiceRequest is the same as the original with an added ProviderRole

.extension:serviceProviderPreference

  • used to indicate preferences related to provider and service location -'.extension:serviceProviderPreference.valueString' is only to be used when the RMS Source is not integrated with the Provincial Healthcare Service Directory

.extension:serviceRequestDelegate

  • used to indicate a person or provider identified as a delegate for a service request

.identifier

  • business identifers associate the information exchanged between systems with the real world entity
  • any number of business identifiers MAY be included in the resource (e.g., Ontario HCN, Band #, CHRIS #, Caredove #, Hubly ID, etc...).
  • when a resource is send back to the sender in a message, all business identifiers received SHOULD be included with the resource to help the sending system to associate the information received with the resource sent
  • for Health Information System assigned and similar Identifier values record the organization that issued the identifier in identifier.assigner.display.
  • Systems that create ServiceRequests to support Routing, Splitting, or Chaining workflows SHALL populate the official identifier as follows:
    • Routing: the official .identifier SHALL be the same for both the parent and child ServiceRequests
    • Splitting: each child ServiceRequest SHALL have an official .identifier assigned that is unique from the parent
    • Chaining: each child ServiceRequest SHALL have an official .identifier assigned that is unique from the parent

.identifier.use

  • the RMS Source that initiates the ServiceRequest MUST set .identifier.use to 'official'

.basedOn

  • used when the recipient of a ServiceRequest, creates ServiceRequests (i.e., chaining when one new request is created, or splitting when two or more requests are created) for other service providers (e.g.: a coordinator in a central intake or assessment centre may create requests for other service providers basedOn the ServiceRequest being peformed)
  • basedOn SHALL NOT be populated when a new ServiceRequest is created to initiate a referral
  • when a service provider performing a ServiceRequest creates another, basedOn SHALL be populated on the new ServiceRequest with a reference to the ServiceRequest being performed
  • if the ServiceRequest is being transmitted via messaging, the referenced ServiceRequest resource SHALL be included in the message as a Bundle.entry

.replaces

  • used when a ServiceRequest is passed to a new handler or destination as the same ServiceRequest and replaces the ServiceRequest being performed

.requisition

  • used in cases where multiple connected referrals are made simultaneously (i.e. a requisition

  • in these cases:

    • multiple ServiceRequests SHALL be referenced in MessageHeader.focus
    • each of the ServiceRequests in MessageHeader.focus SHALL have the same identifier in ServiceRequest.requisition
    • the identifier used in ServiceRequest.requisition SHALL also be used in MessageHeader.extension:ReferralIdentifier
    • When splitting a received parent ServiceRequest to create many child ServiceRequests, .requisition SHALL be copied from the official .identifier from the parent ServiceRequest

  • Note that additional business rules apply to requisitions

  • FOR EREFERRAL USAGE: It is highly recommended that the common elements should match between multiple ServiceRequests (e.g., patient, requester, etc...) 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.

.status

  • used to communicate the current status of the ServiceRequest on the requester's system
  • see Direct Messaging for a discussion of ServiceRequest.status and the state machine

.intent

  • populate with the fixed value: "proposal"

.category

  • see note on terminology binding in profile

.code

  • Specifies the specific type of service to be performed (e.g., Urinalysis, Renal/Bladder Ultrasound, etc.)
  • Expected to be populated in the majority of instances
  • eREFERRAL USAGE:
    • the meaning of this field is to be used in conjunction with ServiceRequest.performer which points to a HealthCareservice,
    • .code further specifies the service, for example code could be a specific procedure under the specificed HealthcareService (e.g., HealthcareService = Orthopaedic Surgeon, code=Knee Surgery).
    • 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.

.subject

  • identifies the patient being referred to the service provider
  • SHALL be populated with a reference to a Patient resource
  • if the ServiceRequest is being transmitted via messaging, the referenced Patient resource SHALL be included in the message as a Bundle.entry

.authoredOn

  • FOR EREFERRAL AND ECONSULT USAGE: .authoredOn is the submission time of the sending system
  • note: if this element corresponds to the dateTime the author "signed" the request, it could be populated with a time before the message was actually submitted
  • recommentation: to track the time that a ServiceRequest message was submitted to the performer, Task.authoredOn will contain the time the ServiceRequest was received and the Task (perform-request) was created

.requester

  • identifies the person who requested the service
  • SHALL be populated with a reference to a PractitionerRole resource or, for self-referrals, a Patient resource
  • For eConsult the PractionerRole SHALL include the organization of the requesting provider (PractionerRole.Organization), the CPSO/CNOnumber AND the OHIP billing number (PractitionerRole.identifier), and the practitioner’s legal name (PractitionerRole.Practitioner.Display)
  • if the ServiceRequest is being transmitted via messaging, the referenced resource SHALL be included in the message as a Bundle.entry

.performer

  • identifies the requested service or service provider
  • populate with a reference to a HealthcareService for services, or a PractitionerRole for clinicians
  • IMPORTANT if the ServiceRequest is being transmitted via messaging, this element SHALL always reference a resource known to the recipient of the message, therefore this resource is not expected to be included as a Bundle.entry when transmitting a ServiceRequest to a service provider
  • for eConsult .performer.PractitionerRole.Practitioner.identifier MUST be an ID retrieved from the Ontario Provincial Health and Service Directory (PHSD)
  • .extension.request-performerOrder - Performer recommendations can be communicated by setting the value of the request-PerformerOrder extension to ‘1’. The URL for this extension can be found at http://hl7.org/fhir/StructureDefinition/request-performerOrder.
  • see business rules for more information

.reasonCode

  • FOR ECONSULT USAGE:
    • .text - will contain a description of the eConsult "question"

.supportingInfo

  • used to associate supporting information in the patient's record with a ServiceRequest
  • MAY be populated with references to AllergyIntolerance, Condition, Consent, QuestionnaireResponse, FamilyMemberHistory, MedicationStatement, Procedure, or other FHIR resources in the future to associate structured information with a ServiceRequest
    • AllergyIntolerance, Condition, Family History, Medication, and Procedure information SHALL be communicated with discrete FHIR resources
  • MAY be populated with references to DocumentReference to associate binary attachments with a ServiceRequest
  • at least one Condition resource SHALL be present
  • if the ServiceRequest is being transmitted via messaging, any resource referenced here SHALL be included in messages from the requester to the performer as a Bundle.entry
  • Attachments in a parent, unsplit referral should be associated (e.g., attachment download URLs and other attachment data) with all of the child, split referrals. .basedOn relationship to the parent ServiceRequest can provide linkages to the parent .supportingInfo
Communicating Vital Signs: Implementers can use the FHIR vital signs profiles (e.g., Observation Body Mass Index Profile, Observation Body Height Profile, Observation Body Weight Profile, Observation Blood Pressure Profile, and Observation Heart Rate Profile)
Social History can be communicated via:
- Observation Tobacco Use (PS-CA). This profile - created by the pan-Canadian Patient Summary project (PS-CA) - represents the constraints applied to the Observation resource to represent a tobacco use assessment. It is informed by the constraints of the IPS Observation - SH: tobacco use profile and the Canadian Baseline package/structuredefinition-profile-smokingstatus.json
- Observation Alcohol Use (PS-CA). This profile - created PS-CA - represents the constraints applied to the Observation resource to represent Alcohol use assessment. It is informed by the constraints of the IPS Observation - SH: alcohol use. No equivalent Canadian Baseline Profile exists at the time of this draft.
- Observation Social History (PS-CA). This profile - created by PS-CA - represents the constraints applied to the Observation resource to represent a broader set of social history observations, and to house coded and non-coded lifestyle risk factors (e.g. amount of exercise, etc.). It is informed by the constraints of the US Core, Cyprus Core, Malaysia Core. No equivalent Canadian Baseline Profile exists at the time of this draft. If one wishes to assert conformance to the generic social history profile, observation.code SHALL NOT be 74013-4 or 72166-2 LOINC codes.
Diagnostic Results can be communicated with:
-DiagnosticReport (PS-CA). Constrains DiagnosticReport and is informed by the IPS-DiagnosticReport profile to represent diagnostic test and procedure reports.
-ObservationLaboratory (PS-CA). Constrains the Observation resource and is informed by constraints to the IPS-UV Observation to represent results produced by laboratory tests or panels/studies. This observation may represent the result of a simple laboratory test such as hematocrit or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, or a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and or a global interpretation by the producer of the study, in the comment element; and references the atomic results of the study as "has-member" child observations. Notably there is no equivalent Canadian Baseline Profile at the time of this draft.
-ObservationPathology (PS-CA). Constrains Observation and is informed by the IPS-UV-Pathology profile to represent results produced by pathology studies. Notably there is no equivalent Canadian Baseline Profile at the time of this draft.
-ObservationRadiology (PS-CA). Constrains Observation and is informed by the IPS-UV Observation Radiology profile to specify a radiology observation for a patient summary based on the FHIR standard R4. This observation may represent the conclusions of a diagnostic procedure such a Chest RX, or it may group the set of results produced by that single or multi-modality procedure. In the latter case, the main observation (this one) carries the overall conclusion of the study and/or a global interpretation by the observer of the study as value of this observation; and may reference the atomic results of the study as "child observations". It also allows providing details about the related study using the partOf element referring to an ImagingStudy resource.

.note

  • used to communicate information that cannot be referenced in supportingInfo with a ServiceRequest

  • MAY be used when the referral source system has a custom data capture form with fields are not mapped to a resource (e.g., Food preference, home visit risk factors, etc...).

  • if note.author and note.time are not populated, these SHOULD be assumed to be the requester and authoredOn respectively (this is expected to be the normal use case)

  • an Organization MAY be referenced as the note.author when there's no need for specific attribution as to who made the comment.

  • FOR EREFERRAL USAGE:

  • note is used to include additional information in the referral that is not captured by an existing resource or in a DocumentReference. This is often used when the sending application has a custom data capture form with fields are not mapped to a resource (e.g., Food preference, home visit risk factors, etc...).

  • 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).

Search Parameters

Name Parameter Description Sample Expression
authored ServiceRequest.authoredOn Date request signed GET [BASE]/ServiceRequest?authored=2022-07-01
status ServiceRequest.status Status of the ServiceRequest GET [BASE]/ServiceRequest?status=completed
category ServiceRequest.category Classification of service GET [BASE]/ServiceRequest?category=424008009
code ServiceRequest.code What is being requested/ordered GET [BASE]/ServiceRequest?code=105385000
identifier ServiceRequest.identifier Identifiers assigned to this order GET [BASE]/ServiceRequest?identifier=123
patient ServiceRequest.subject.where(resolve() is Patient) Search by subject - a patient GET [BASE]/ServiceRequest?patient=3640897
performer ServiceRequest.performer Performer role GET [BASE]/ServiceRequest?performer=6478147
requester ServiceRequest.requester Who/what is requesting service GET [BASE]/ServiceRequest?requester=6840735
_id The logical ID of the resource. GET [BASE]/ServiceRequest?_id=123
_lastUpdated This parameter can be used to select resources based on the last time they were changed. GET [BASE]/ServiceRequest?_lastUpdated=gt2020-01-01&_lastUpdated=lt2021-03-31
_include This parameter retrieves the primary resource and resources that are referenced by the primary resource. For HealthcareService, the _include parameter is used to return addtional resources such as Organization. GET [BASE]/ServiceRequest?id=23414_include=*
GET [BASE]/ServiceRequest?patient=3640897&_include=
ServiceRequest:patient&_include=ServiceRequest:performer&_include=ServiceRequest:requester
_revinclude This parameter retrieves resources that reference the primary resource. GET [base]/ServiceRequest?_revinclude=ServiceRequest:identifier
GET [base]/ServiceRequest?_revinclude=*