Workflow

HL7 Norway proposed base profiles for Workflow resources in HL7 FHIR R4.

Appointment and ApppointmentResponse profiles and extensions

Only attributes with actual profiling is included in the information model diagram as well as any optional extensions provided as a part of the no-basis package. The model should be forward compatible to Appointment in R5 as far as possible.

Short notice on relationship between no-basis Appointment and no-basis-Encounter

Appointment and Encounter have dependencies as they both describe different aspects of the administrative relationship between patient and health care organizations.

Appointment og AppointmentResponse profiler

Appointment (no:timeavtale; npr:planlagt episode) – describes a planned meeting between a patient and healthcare personell.

Encounter (no: kontakt, besøk, opphold, innleggelse, omsorgsepisode, poliklinisk konsultasjon etc) is defined as: “An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient”. An inpatient encounter (no:inneliggende) is an encounter that can consist of several sub-encounters – for example a radiology examination or a surgery. The national base profile have defined an extension in no-basis-Appointment to mirror this partOf-pattern in the encounter.

The normal scenario is that the Appointment resource is used until the patient is registered as arrived. After arrival the Encounter resource is used to share information about the interaction. Due to the fact that the Encounter resource contains more clinical related information than Appointment, some EHRs may use Encounter with status planned to share information about the interaction also before the patient is registered as arrived.

Inspection (no: tilsyn) are normally not registered as independent encounters in the EHR, but represents and interaction between patient and healthcare personell that is documented in an inspection note (no: tilsynsnotat). Local routines as each hospital can choose to register inspections as encounters, but in most cases such a practice will require too much manual registration in the EHR. An inspection can also be registered as a procedure.

EpisodeOfCare (no: henvisningsperiode) can encompass several ambulatory and inpatient encounters across several organizations. The challenge with tracing such patient trajectory (no: pasientforløp) is that the episode of care will encompass several service requests (no: henvisninger) and there are no common identifier that can be used to trace the patient trajectory across these encounters. Helsedirektoratet has earlier pointed to the need for such an identifier (forløpsidentifikator).

no-basis-AppointmentResponse

Base profile for Norwegian AppointmentResponse information. Defined by HL7 Norway. Should be used as a basis for further profiling in use-cases where specific appointment response information is needed. The basis profile is open, but derived profiles should close down the information elements according to specification relevant to the use-case.

The full documentation of the profile no-basis-AppointmentResponse

Resource content

AppointmentResponse	I		AppointmentResponse	There are no (further) constraints on this element Element id AppointmentResponse Short description A reply to an appointment request for a patient and/or practitioner(s), such as a confirmation or rejection Definition A reply to an appointment request for a patient and/or practitioner(s), such as a confirmation or rejection. Data type AppointmentResponse Constraints apr-1: Either the participantType or actor must be specified `participantType.exists() or actor.exists()` dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() inv-1: The 'shortNotice' extension can only be used when the 'actor' is of type 'Patient'. `extension.where(url = 'http://hl7.no/fhir/StructureDefinition/no-basis-shortnotice').value.exists() and actor.type.value = 'Patient'` Mappings rim: Entity. Role, or Act workflow: Request rim: Appointment[@moodCode <= 'PRMS'] ical: VEVENT
id	Σ	0..1	id	There are no (further) constraints on this element Element id AppointmentResponse.id Short 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 id
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id AppointmentResponse.meta Short 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())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id AppointmentResponse.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())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id AppointmentResponse.language Short 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 A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id AppointmentResponse.text Short 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: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id AppointmentResponse.contained Short 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: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id AppointmentResponse.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) 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()`
shortNotice	I	0..1	Extension(boolean)	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice Short description no-basis-shortnotice Definition Patient can come on short notice. Data type Extension(boolean) Extension URL http://hl7.no/fhir/StructureDefinition/no-basis-shortnotice 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()`
id		0..1	string	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.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 rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.extension Short description Extension Definition An Extension 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()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.no/fhir/StructureDefinition/no-basis-shortnotice Mappings rim: N/A
value[x]		0..1		There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.value[x] Short description Patient can come on short notice. Definition Patient can come on short notice. Response is boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id AppointmentResponse.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 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 rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id AppointmentResponse.identifier Short description External Ids for this item Definition This records identifiers associated with this appointment response concern that are defined by business processes and/ or used to refer to it when a direct URL reference to the resource itself is not appropriate. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.identifier w5: FiveWs.identifier rim: .id ical: UID
appointment	Σ	1..1	Reference(Appointment)	There are no (further) constraints on this element Element id AppointmentResponse.appointment Short description Appointment this response relates to Definition Appointment that this response is replying to. Data type Reference(Appointment) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.basedOn rim: scheduleRequest.ActAppointmentRequest[@moodCode <= 'ARQ']
start		0..1	instant	There are no (further) constraints on this element Element id AppointmentResponse.start Short description Time from appointment, or requested new start time Definition Date/Time that the appointment is to take place, or requested new start time. Comments This may be either the same as the appointment request to confirm the details of the appointment, or alternately a new time to request a re-negotiation of the start time. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.init rim: .effectiveTime.low
end		0..1	instant	There are no (further) constraints on this element Element id AppointmentResponse.end Short description Time from appointment, or requested new end time Definition This may be either the same as the appointment request to confirm the details of the appointment, or alternately a new time to request a re-negotiation of the end time. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.done[x] rim: .effectiveTime.high
participantType	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id AppointmentResponse.participantType Short description Role of participant in the appointment Definition Role of participant in the appointment. Comments The role of the participant can be used to declare what the actor will be doing in the scope of the referenced appointment. If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning. This value SHALL be the same as specified on the referenced Appointment so that they can be matched, and subsequently updated. Data type CodeableConcept Binding Role of participant in encounter. ParticipantType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performerType rim: (performer \| reusableDevice \| subject \| location).@typeCode ical: n/a
actor	Σ	0..1	Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location)	There are no (further) constraints on this element Element id AppointmentResponse.actor Short description Person, Location, HealthcareService, or Device Definition A Person, Location, HealthcareService, or Device that is participating in the appointment. Data type Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performer w5: FiveWs.who v2: PID-3-Patient ID List rim: performer.person \| reusableDevice.manufacturedDevice \| subject.patient \| location.serviceDeliveryLocation ical: ATTENDEE: (Need to provide the common name CN and also the MAILTO properties from the practitioner resource)
participantStatus	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id AppointmentResponse.participantStatus Short description accepted \| declined \| tentative \| needs-action Definition Participation status of the participant. When the status is declined or tentative if the start/end times are different to the appointment, then these times should be interpreted as a requested time change. When the status is accepted, the times can either be the time of the appointment (as a confirmation of the time) or can be empty. Comments This element is labeled as a modifier because the status contains the code entered-in-error that marks the participant as not currently valid. Data type code Binding The Participation status of an appointment. ParticipationStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.status rim: (performer \| reusableDevice \| subject \| location).statusCode ical: ATTENDEE;CN="Brian Postlethwaite";RSVP=TRUE:mailto:BPostlethwaite@data.com (rsvpparam \| partstatparam)
comment		0..1	string	There are no (further) constraints on this element Element id AppointmentResponse.comment Short description Additional comments Definition Additional comments about the appointment. Comments This comment is particularly important when the responder is declining, tentatively accepting or requesting another time to indicate the reasons why. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.note rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: COMMENT

no-basis-AppointmentResponse

The full documentation of the profile no-basis-Appointment

Resource content

Appointment	I		Appointment	There are no (further) constraints on this element Element id Appointment Short description A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s) Definition A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s). Data type Appointment Constraints app-2: Either start and end are specified, or neither `start.exists() = end.exists()` app-3: Only proposed or cancelled appointments can be missing start/end dates `(start.exists() and end.exists()) or (status in ('proposed' \| 'cancelled' \| 'waitlist'))` app-4: Cancelation reason is only used for appointments that have been cancelled, or no-show `Appointment.cancelationReason.exists() implies (Appointment.status='no-show' or Appointment.status='cancelled')` dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Request rim: Act[@moodCode <= 'INT'] ical: VEVENT
id	Σ	0..1	id	There are no (further) constraints on this element Element id Appointment.id Short 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 id
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Appointment.meta Short 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())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Appointment.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())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Appointment.language Short 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 A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Appointment.text Short 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: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Appointment.contained Short 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: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) 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()`
virtualService	S I	0..*	Extension(Complex)	There are no (further) constraints on this element Element id Appointment.extension:virtualService Short description Virtual Service Definition The VirtualService structure defines details of a virtual communication capability, such as a web conference call. Data type Extension(Complex) Extension URL http://hl7.no/fhir/StructureDefinition/no-basis-virtual-service 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()`
group	S I	0..1	Extension(boolean)	There are no (further) constraints on this element Element id Appointment.extension:group Short description no-basis-group Definition The appointment is a group session. Data type Extension(boolean) Extension URL http://hl7.no/fhir/StructureDefinition/no-basis-group 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()`
partOf	S I	0..1	Extension(Reference(no-basis-Appointment))	There are no (further) constraints on this element Element id Appointment.extension:partOf Short description no-basis-partof Definition This basis extension mirrors the Encounter.partOF-attribute. The partOf-attribute enables booking of a set of related appointments with a set of sub-appointments being linked to the main appointment in the same way as encounters are being linked. A larger appointment of which this particular appointment is a component or step. Data type Extension(Reference(no-basis-Appointment)) Extension URL http://hl7.no/fhir/StructureDefinition/no-basis-partof 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()`
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.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 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 rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Appointment.identifier Short description External Ids for this item Definition This records identifiers associated with this appointment concern that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.identifier w5: FiveWs.identifier v2: SCH-1, SCH-2, ARQ-1, ARQ-2 rim: .id ical: UID
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id Appointment.status Short description proposed \| pending \| booked \| arrived \| fulfilled \| cancelled \| noshow \| entered-in-error \| checked-in \| waitlist Definition The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status. Comments If the Appointment's status is "cancelled" then all participants are expected to have their calendars released for the appointment period, and as such any Slots that were marked as BUSY can be re-set to FREE. This element is labeled as a modifier because the status contains the code entered-in-error that mark the Appointment as not currently valid. Data type code Binding The free/busy status of an appointment. AppointmentStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.status w5: FiveWs.status v2: SCH-25 rim: .statusCode ical: STATUS
cancelationReason	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id Appointment.cancelationReason Short description The coded reason for the appointment being cancelled Definition The coded reason for the appointment being cancelled. This is often used in reporting/billing/futher processing to determine if further actions are required, or specific fees apply. Data type CodeableConcept Binding AppointmentCancellationReason (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
serviceCategory	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Appointment.serviceCategory Short description A broad categorization of the service that is to be performed during this appointment Definition A broad categorization of the service that is to be performed during this appointment. Data type CodeableConcept Binding ServiceCategory (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a, might be inferred from the ServiceDeliveryLocation ical: CATEGORIES
serviceType	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Appointment.serviceType Short description The specific service that is to be performed during this appointment Definition The specific service that is to be performed during this appointment. Comments For a provider to provider appointment the code "FOLLOWUP" may be appropriate, as this is expected to be discussing some patient that was seen in the past. Data type CodeableConcept Binding ServiceType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.code rim: n/a, might be inferred from the ServiceDeliveryLocation
specialty	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Appointment.specialty Short description The specialty of a practitioner that would be required to perform the service requested in this appointment Definition The specialty of a practitioner that would be required to perform the service requested in this appointment. Data type CodeableConcept Binding PracticeSettingCodeValueSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class rim: .performer.AssignedPerson.code
appointmentType	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Appointment.appointmentType Short description The style of appointment or patient that has been booked in the slot (not service type) Definition The style of appointment or patient that has been booked in the slot (not service type). Data type CodeableConcept Binding v2.0276 (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ARQ-7 rim: .code ical: CLASSIFICATION
id		0..1	string	There are no (further) constraints on this element Element id Appointment.appointmentType.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 rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.appointmentType.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 rim: n/a
coding	Σ	0..*	Coding	There are no (further) constraints on this element Element id Appointment.appointmentType.coding Short description Recomended code systems for no-basis-Appointment. Definition Recomended code systems for no-basis-Appointment. The recomended code systems might not be suficient for defining appointment type and in an implemented profile - some other coding might be needed. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments 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. Data type Coding Sliced: Unordered, Open, by $this(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
omsorgsNiva	Σ	0..1	CodingBinding	There are no (further) constraints on this element Element id Appointment.appointmentType.coding:omsorgsNiva Short description Volven 8406 Definition Omsorgsnivå (OID=8406). Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments 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. Data type Coding Binding Volven urn:oid:2.16.578.1.12.4.1.1.8406 (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
kontaktType	Σ	0..1	CodingBinding	There are no (further) constraints on this element Element id Appointment.appointmentType.coding:kontaktType Short description Volven 8432 Definition Kontakttype (OID=8432) Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments 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. Data type Coding Binding Volven urn:oid:2.16.578.1.12.4.1.1.8432 (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
innbygger	Σ	0..1	CodingBinding	There are no (further) constraints on this element Element id Appointment.appointmentType.coding:innbygger Short description Volven 7617 Definition Timetype innbyggerportal (OID=7617) Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments 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. Data type Coding Binding Volven urn:oid:2.16.578.1.12.4.1.1.7617 (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element id Appointment.appointmentType.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
reasonCode	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Appointment.reasonCode Short description Coded reason this appointment is scheduled Definition The coded reason that this appointment is being scheduled. This is more clinical than administrative. Data type CodeableConcept Binding The Reason for the appointment to take place. EncounterReasonCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonCode v2: AIS-3, SCH-7 rim: .reasonCode
reasonReference		0..*	Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation)	There are no (further) constraints on this element Element id Appointment.reasonReference Short description Reason the appointment is to take place (resource) Definition Reason the appointment has been scheduled to take place, as specified using information from another resource. When the patient arrives and the encounter begins it may be used as the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure. Data type Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonReference rim: .inboundRelationship[@typeCode = 'RSON'].observation
priority		0..1	unsignedInt	There are no (further) constraints on this element Element id Appointment.priority Short description Used to make informed decisions if needing to re-prioritize Definition The priority of the appointment. Can be used to make informed decisions if needing to re-prioritize appointments. (The iCal Standard specifies 0 as undefined, 1 as highest, 9 as lowest priority). Comments Seeking implementer feedback on this property and how interoperable it is. Using an extension to record a CodeableConcept for named values may be tested at a future connectathon. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.priority w5: FiveWs.class v2: ARQ-12, SCH-11.6 / TQ1-9 rim: .priorityCode ical: PRIORITY
description		0..1	string	There are no (further) constraints on this element Element id Appointment.description Short description Shown on a subject line in a meeting request, or appointment list Definition The brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Detailed or expanded information should be put in the comment field. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NTE-3 rim: .text ical: SUMMARY
supportingInformation		0..*	Reference(Resource)	There are no (further) constraints on this element Element id Appointment.supportingInformation Short description Additional information to support the appointment Definition Additional information to support the appointment provided when making the appointment. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.supportingInfo w5: FiveWs.context rim: .inboundRelationship[@typeCode = 'SPRT'].observation ical: ATTACH
start	Σ	0..1	instant	There are no (further) constraints on this element Element id Appointment.start Short description When appointment is to take place Definition Date/Time that the appointment is to take place. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.init v2: ARQ-11.1, SCH-11.4 / TQ1-7 rim: .effectiveTime.low ical: DTSTART
end	Σ	0..1	instant	There are no (further) constraints on this element Element id Appointment.end Short description When appointment is to conclude Definition Date/Time that the appointment is to conclude. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.done[x] v2: SCH-11.5 / TQ1-8/ calculated based on the start and the duration which is in ARQ-9 rim: .effectiveTime.high ical: DTEND
minutesDuration		0..1	positiveInt	There are no (further) constraints on this element Element id Appointment.minutesDuration Short description Can be less than start/end (e.g. estimate) Definition Number of minutes that the appointment is to take. This can be less than the duration between the start and end times. For example, where the actual time of appointment is only an estimate or if a 30 minute appointment is being requested, but any time would work. Also, if there is, for example, a planned 15 minute break in the middle of a long appointment, the duration may be 15 minutes less than the difference between the start and end. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')].width ical: DURATION (e.g. PT15M)
slot		0..*	Reference(Slot)	There are no (further) constraints on this element Element id Appointment.slot Short description The slots that this appointment is filling Definition The slots from the participants' schedules that will be filled by the appointment. Data type Reference(Slot) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[@typeCode = 'REFR'].act[@classCode = 'ACT'][@moodCode = 'SLOT']
created		0..1	dateTime	There are no (further) constraints on this element Element id Appointment.created Short description The date that this appointment was initially created Definition The date that this appointment was initially created. This could be different to the meta.lastModified value on the initial entry, as this could have been before the resource was created on the FHIR server, and should remain unchanged over the lifespan of the appointment. Comments This property is required for many use cases where the age of an appointment is considered in processing workflows for scheduling and billing of appointments. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.authoredOn rim: .author.time ical: CREATED
comment		0..1	string	There are no (further) constraints on this element Element id Appointment.comment Short description Additional comments Definition Additional comments about the appointment. Comments Additional text to aid in facilitating the appointment. For instance, a comment might be, "patient should proceed immediately to infusion room upon arrival" Where this is a planned appointment and the start/end dates are not set then this field can be used to provide additional guidance on the details of the appointment request, including any restrictions on when to book it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.note v2: NTE-3 rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: DESCRIPTION (for internal use)
patientInstruction		0..1	string	There are no (further) constraints on this element Element id Appointment.patientInstruction Short description Detailed information and instructions for the patient Definition While Appointment.comment contains information for internal use, Appointment.patientInstructions is used to capture patient facing information about the Appointment (e.g. please bring your referral or fast from 8pm night before). Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NTE-3 rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: DESCRIPTION (for patient use)
basedOn		0..*	Reference(ServiceRequest)	There are no (further) constraints on this element Element id Appointment.basedOn Short description The service request this appointment is allocated to assess Alternate names incomingReferral Definition The service request this appointment is allocated to assess (e.g. incoming referral or procedure request). Data type Reference(ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.basedOn rim: .outboundRelationship[@typeCode = 'FLFS'].act[@classCode < 'ActCareProvisionRequestType'][@moodCode = 'RQO']
participant	I	1..*	BackboneElement	There are no (further) constraints on this element Element id Appointment.participant Short description Participants involved in appointment Definition List of participants involved in the appointment. Data type BackboneElement Constraints app-1: Either the type or actor on the participant SHALL be specified `type.exists() or actor.exists()` ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performer, Request.subject v2: PID, AIP, AIG, AIL rim: performer \| reusableDevice \| subject \| location ical: ATTENDEE component to be created
id		0..1	string	There are no (further) constraints on this element Element id Appointment.participant.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 rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.participant.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 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 rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.participant.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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 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 rim: N/A
type	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Appointment.participant.type Short description Role of participant in the appointment Definition Role of participant in the appointment. Comments The role of the participant can be used to declare what the actor will be doing in the scope of this appointment. If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning. This value SHALL be the same when creating an AppointmentResponse so that they can be matched, and subsequently update the Appointment. Data type CodeableConcept Binding Role of participant in encounter. ParticipantType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: AIP-4, AIG-4 rim: (performer \| reusableDevice \| subject \| location).@typeCode ical: n/a
actor	Σ	0..1	Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location)	There are no (further) constraints on this element Element id Appointment.participant.actor Short description Person, Location/HealthcareService or Device Definition A Person, Location/HealthcareService or Device that is participating in the appointment. Data type Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.who v2: PID-3-Patient ID List \| AIL-3 \| AIG-3 \| AIP-3 rim: performer.person \| reusableDevice.manufacturedDevice \| subject.patient \| location.serviceDeliveryLocation ical: ATTENDEE: (Need to provide the common name CN and also the MAILTO properties from the practitioner resource) where the participant type is not "information-only"
required	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id Appointment.participant.required Short description required \| optional \| information-only Definition Whether this participant is required to be present at the meeting. This covers a use-case where two doctors need to meet to discuss the results for a specific patient, and the patient is not required to be present. Data type code Binding Is the Participant required to attend the appointment. ParticipantRequired (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: (performer \| reusableDevice \| subject \| location).@performInd ical: ROLE=REQ-PARTICIPANT (roleparam)
status	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id Appointment.participant.status Short description accepted \| declined \| tentative \| needs-action Definition Participation status of the actor. Data type code Binding The Participation status of an appointment. ParticipationStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: AIP-12, AIG-14 rim: (performer \| reusableDevice \| subject \| location).statusCode ical: ATTENDEE;CN="John Doe";RSVP=TRUE:mailto:john@doe.com (rsvpparam \| partstatparam)
period		0..1	Period	There are no (further) constraints on this element Element id Appointment.participant.period Short description Participation period of the actor Definition Participation period of the actor. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
requestedPeriod		0..*	Period	There are no (further) constraints on this element Element id Appointment.requestedPeriod Short description Potential date/time interval(s) requested to allocate the appointment within Definition A set of date ranges (potentially including times) that the appointment is preferred to be scheduled within. The duration (usually in minutes) could also be provided to indicate the length of the appointment to fill and populate the start/end times for the actual allocated time. However, in other situations the duration may be calculated by the scheduling system. Comments This does not introduce a capacity for recurring appointments. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] v2: ARQ-11 rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')]