Structure Definition: ServiceRequest Profile
Canonical URL: https://signalbhn.org/fhir/StructureDefinition/servicerequest
Simplifier project page: ServiceRequest
Derived from: US Core ServiceRequest STU6 (R4)
Module: Clinical Categorization Module
Formal profile content
ServiceRequest | I | ServiceRequest | There are no (further) constraints on this element Element IdServiceRequest A request for a service to be performed Alternate namesdiagnostic request, referral, referral request, transfer of care request Definition- -
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identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element IdServiceRequest.identifier Identifiers assigned to this order DefinitionIdentifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller. The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.
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instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | PlanDefinition) | There are no (further) constraints on this element Element IdServiceRequest.instantiatesCanonical Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest. Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. canonical(ActivityDefinition | PlanDefinition) Constraints
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instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element IdServiceRequest.instantiatesUri Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
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basedOn | Σ I | 0..* | Reference(CarePlan | ServiceRequest | MedicationRequest) | There are no (further) constraints on this element Element IdServiceRequest.basedOn What request fulfills Alternate namesfulfills DefinitionPlan/proposal/order fulfilled by this request. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(CarePlan | ServiceRequest | MedicationRequest) Constraints
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replaces | Σ I | 0..* | Reference(ServiceRequest) | There are no (further) constraints on this element Element IdServiceRequest.replaces What request replaces Alternate namessupersedes, prior, renewed order DefinitionThe request takes the place of the referenced completed or terminated request(s). References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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requisition | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdServiceRequest.requisition Composite Request ID Alternate namesgrouperId, groupIdentifier DefinitionA shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier. Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes. 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.
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status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element IdServiceRequest.status (USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown DefinitionThe status of the order. The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource. The status of a service order. RequestStatus (required)Constraints
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intent | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element IdServiceRequest.intent (USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option DefinitionWhether the request is a proposal, plan, an original order or a reflex order. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. The kind of service request. RequestIntent (required)Constraints
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category | S Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.category (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Unordered, Open, by $this(Pattern) Binding Classification of the requested service. ServiceRequestCategoryCodes (example)Constraints
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us-core | S Σ | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element IdServiceRequest.category:us-core (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Note that other codes are permitted, see [Required Bindings When Slicing by Value Sets](http://hl7.org/fhir/us/core/general-requirements.html#required-bindings-when-slicing-by-value-sets) USCoreServiceRequestCategoryCodes (required)Constraints
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serviceCategory | S Σ | 0..* | CodeableConceptBinding | Element IdServiceRequest.category:serviceCategory (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Classification of the requested service. SignalHealthcareServiceCategory (required)Constraints
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serviceType | S Σ | 0..* | CodeableConceptBinding | Element IdServiceRequest.category:serviceType (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Classification of the requested service. SignalHealthcareServiceType (required)Constraints
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priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element IdServiceRequest.priority routine | urgent | asap | stat DefinitionIndicates how quickly the ServiceRequest should be addressed with respect to other requests. Note that FHIR strings SHALL NOT exceed 1MB in size If missing, this task should be performed with normal priority Identifies the level of importance to be assigned to actioning the request. RequestPriority (required)Constraints
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doNotPerform | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element IdServiceRequest.doNotPerform True if service/procedure should not be performed DefinitionSet this to true if the record is saying that the service/procedure should NOT be performed. Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc. In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation. If missing, the request is a positive request e.g. "do perform"
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code | S Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdServiceRequest.code (USCDI) What is being requested/ordered Alternate namesservice requested DefinitionA code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested. 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. Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available [here](valueset-diagnostic-requests.html). USCoreProcedureCodes (extensible)Constraints
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orderDetail | Σ I | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.orderDetail Additional order information Alternate namesdetailed instructions DefinitionAdditional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied. For information from the medical record intended to support the delivery of the requested services, use the Codified order entry details which are based on order context. ServiceRequestOrderDetailsCodes (example)Constraints
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quantity[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdServiceRequest.quantity[x] Service amount DefinitionAn amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction). When ordering a service the number of service items may need to be specified separately from the the service item.
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quantityQuantity | Quantity | There are no (further) constraints on this element Data Type | ||
quantityRatio | Ratio | There are no (further) constraints on this element Data Type | ||
quantityRange | Range | There are no (further) constraints on this element Data Type | ||
subject | S Σ I | 1..1 | Reference(US Core Patient Profile) | There are no (further) constraints on this element Element IdServiceRequest.subject (USCDI) Individual or Entity the service is ordered for DefinitionOn whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans). References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(US Core Patient Profile) Constraints
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encounter | Σ I | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element IdServiceRequest.encounter Encounter in which the request was created Alternate namescontext DefinitionAn encounter that provides additional information about the healthcare context in which this request is made. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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occurrence[x] | S Σ | 0..1 | There are no (further) constraints on this element Element IdServiceRequest.occurrence[x] (USCDI) When service should occur Alternate namesschedule DefinitionThe date/time at which the requested service should occur.
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occurrencePeriod | Period | There are no (further) constraints on this element Data Type | ||
occurrenceDateTime | dateTime | There are no (further) constraints on this element Data Type | ||
occurrenceTiming | Timing | There are no (further) constraints on this element Data Type | ||
asNeeded[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdServiceRequest.asNeeded[x] Preconditions for service DefinitionIf a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc. A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc. SNOMEDCTMedicationAsNeededReasonCodes (example)Constraints
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asNeededBoolean | boolean | There are no (further) constraints on this element Data Type | ||
asNeededCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data Type | ||
authoredOn | S Σ | 0..1 | dateTime | There are no (further) constraints on this element Element IdServiceRequest.authoredOn (USCDI) Date request signed Alternate namesorderedOn DefinitionWhen the request transitioned to being actionable.
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requester | S Σ I | 0..1 | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device) | There are no (further) constraints on this element Element IdServiceRequest.requester (USCDI) Who/what is requesting service Alternate namesauthor, orderer DefinitionThe individual who initiated the request and has responsibility for its activation. This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource. Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device) Constraints
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performerType | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.performerType Performer role Alternate namesspecialty DefinitionDesired type of performer for doing the requested service. This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”. Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc. ParticipantRoles (example)Constraints
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performer | Σ I | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) | There are no (further) constraints on this element Element IdServiceRequest.performer Requested performer Alternate namesrequest recipient DefinitionThe desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc. If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B). Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Constraints
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locationCode | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.locationCode Requested location DefinitionThe preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A location type where services are delivered. v3.ServiceDeliveryLocationRoleType (example)Constraints
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locationReference | Σ I | 0..* | Reference(Location) | There are no (further) constraints on this element Element IdServiceRequest.locationReference Requested location DefinitionA reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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reasonCode | Σ | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element IdServiceRequest.reasonCode (USCDI) Explanation/Justification for procedure or service DefinitionAn explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use Diagnosis or problem codes justifying the reason for requesting the service investigation. USCoreConditionCodes (extensible)Constraints
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reasonReference | Σ I | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | There are no (further) constraints on this element Element IdServiceRequest.reasonReference (USCDI) US Core Profile that supports the requested service DefinitionIndicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in Reference(Condition | Observation | DiagnosticReport | DocumentReference) Constraints
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insurance | I | 0..* | Reference(Coverage | ClaimResponse) | There are no (further) constraints on this element Element IdServiceRequest.insurance Associated insurance coverage DefinitionInsurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Coverage | ClaimResponse) Constraints
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supportingInfo | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element IdServiceRequest.supportingInfo Additional clinical information Alternate namesAsk at order entry question, AOE DefinitionAdditional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements. To represent information about how the services are to be delivered use the
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specimen | Σ I | 0..* | Reference(Specimen) | There are no (further) constraints on this element Element IdServiceRequest.specimen Procedure Samples DefinitionOne or more specimens that the laboratory procedure will use. Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.
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bodySite | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.bodySite Location on Body Alternate nameslocation DefinitionAnatomic location where the procedure should be performed. This is the target site. Knowing where the procedure is performed is important for tracking if multiple sites are possible. Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure. Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (example)Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element IdServiceRequest.note Comments DefinitionAny other notes and comments made about the service request. For example, internal billing notes. 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).
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patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element IdServiceRequest.patientInstruction Patient or consumer-oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. Note that FHIR strings SHALL NOT exceed 1MB in size
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relevantHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element IdServiceRequest.relevantHistory Request provenance DefinitionKey events in the history of the request. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.
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ServiceRequest | I | ServiceRequest | There are no (further) constraints on this element Element IdServiceRequest A request for a service to be performed Alternate namesdiagnostic request, referral, referral request, transfer of care request Definition- -
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identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element IdServiceRequest.identifier Identifiers assigned to this order DefinitionIdentifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller. The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.
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instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | PlanDefinition) | There are no (further) constraints on this element Element IdServiceRequest.instantiatesCanonical Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest. Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. canonical(ActivityDefinition | PlanDefinition) Constraints
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instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element IdServiceRequest.instantiatesUri Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
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basedOn | Σ I | 0..* | Reference(CarePlan | ServiceRequest | MedicationRequest) | There are no (further) constraints on this element Element IdServiceRequest.basedOn What request fulfills Alternate namesfulfills DefinitionPlan/proposal/order fulfilled by this request. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(CarePlan | ServiceRequest | MedicationRequest) Constraints
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replaces | Σ I | 0..* | Reference(ServiceRequest) | There are no (further) constraints on this element Element IdServiceRequest.replaces What request replaces Alternate namessupersedes, prior, renewed order DefinitionThe request takes the place of the referenced completed or terminated request(s). References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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requisition | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdServiceRequest.requisition Composite Request ID Alternate namesgrouperId, groupIdentifier DefinitionA shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier. Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes. 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.
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status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element IdServiceRequest.status (USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown DefinitionThe status of the order. The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource. The status of a service order. RequestStatus (required)Constraints
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intent | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element IdServiceRequest.intent (USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option DefinitionWhether the request is a proposal, plan, an original order or a reflex order. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. The kind of service request. RequestIntent (required)Constraints
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category | S Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.category (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Unordered, Open, by $this(Pattern) Binding Classification of the requested service. ServiceRequestCategoryCodes (example)Constraints
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us-core | S Σ | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element IdServiceRequest.category:us-core (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Note that other codes are permitted, see [Required Bindings When Slicing by Value Sets](http://hl7.org/fhir/us/core/general-requirements.html#required-bindings-when-slicing-by-value-sets) USCoreServiceRequestCategoryCodes (required)Constraints
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serviceCategory | S Σ | 0..* | CodeableConceptBinding | Element IdServiceRequest.category:serviceCategory (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Classification of the requested service. SignalHealthcareServiceCategory (required)Constraints
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serviceType | S Σ | 0..* | CodeableConceptBinding | Element IdServiceRequest.category:serviceType (USCDI) Classification of service DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). Used for filtering what service request are retrieved and displayed. There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set. Classification of the requested service. SignalHealthcareServiceType (required)Constraints
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priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element IdServiceRequest.priority routine | urgent | asap | stat DefinitionIndicates how quickly the ServiceRequest should be addressed with respect to other requests. Note that FHIR strings SHALL NOT exceed 1MB in size If missing, this task should be performed with normal priority Identifies the level of importance to be assigned to actioning the request. RequestPriority (required)Constraints
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doNotPerform | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element IdServiceRequest.doNotPerform True if service/procedure should not be performed DefinitionSet this to true if the record is saying that the service/procedure should NOT be performed. Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc. In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation. If missing, the request is a positive request e.g. "do perform"
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code | S Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdServiceRequest.code (USCDI) What is being requested/ordered Alternate namesservice requested DefinitionA code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested. 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. Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available [here](valueset-diagnostic-requests.html). USCoreProcedureCodes (extensible)Constraints
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orderDetail | Σ I | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.orderDetail Additional order information Alternate namesdetailed instructions DefinitionAdditional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied. For information from the medical record intended to support the delivery of the requested services, use the Codified order entry details which are based on order context. ServiceRequestOrderDetailsCodes (example)Constraints
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quantity[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdServiceRequest.quantity[x] Service amount DefinitionAn amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction). When ordering a service the number of service items may need to be specified separately from the the service item.
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quantityQuantity | Quantity | There are no (further) constraints on this element Data Type | ||
quantityRatio | Ratio | There are no (further) constraints on this element Data Type | ||
quantityRange | Range | There are no (further) constraints on this element Data Type | ||
subject | S Σ I | 1..1 | Reference(US Core Patient Profile) | There are no (further) constraints on this element Element IdServiceRequest.subject (USCDI) Individual or Entity the service is ordered for DefinitionOn whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans). References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(US Core Patient Profile) Constraints
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encounter | Σ I | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element IdServiceRequest.encounter Encounter in which the request was created Alternate namescontext DefinitionAn encounter that provides additional information about the healthcare context in which this request is made. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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occurrence[x] | S Σ | 0..1 | There are no (further) constraints on this element Element IdServiceRequest.occurrence[x] (USCDI) When service should occur Alternate namesschedule DefinitionThe date/time at which the requested service should occur.
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occurrencePeriod | Period | There are no (further) constraints on this element Data Type | ||
occurrenceDateTime | dateTime | There are no (further) constraints on this element Data Type | ||
occurrenceTiming | Timing | There are no (further) constraints on this element Data Type | ||
asNeeded[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdServiceRequest.asNeeded[x] Preconditions for service DefinitionIf a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc. A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc. SNOMEDCTMedicationAsNeededReasonCodes (example)Constraints
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asNeededBoolean | boolean | There are no (further) constraints on this element Data Type | ||
asNeededCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data Type | ||
authoredOn | S Σ | 0..1 | dateTime | There are no (further) constraints on this element Element IdServiceRequest.authoredOn (USCDI) Date request signed Alternate namesorderedOn DefinitionWhen the request transitioned to being actionable.
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requester | S Σ I | 0..1 | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device) | There are no (further) constraints on this element Element IdServiceRequest.requester (USCDI) Who/what is requesting service Alternate namesauthor, orderer DefinitionThe individual who initiated the request and has responsibility for its activation. This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource. Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device) Constraints
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performerType | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.performerType Performer role Alternate namesspecialty DefinitionDesired type of performer for doing the requested service. This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”. Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc. ParticipantRoles (example)Constraints
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performer | Σ I | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) | There are no (further) constraints on this element Element IdServiceRequest.performer Requested performer Alternate namesrequest recipient DefinitionThe desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc. If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B). Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Constraints
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locationCode | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.locationCode Requested location DefinitionThe preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A location type where services are delivered. v3.ServiceDeliveryLocationRoleType (example)Constraints
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locationReference | Σ I | 0..* | Reference(Location) | There are no (further) constraints on this element Element IdServiceRequest.locationReference Requested location DefinitionA reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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reasonCode | Σ | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element IdServiceRequest.reasonCode (USCDI) Explanation/Justification for procedure or service DefinitionAn explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use Diagnosis or problem codes justifying the reason for requesting the service investigation. USCoreConditionCodes (extensible)Constraints
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reasonReference | Σ I | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | There are no (further) constraints on this element Element IdServiceRequest.reasonReference (USCDI) US Core Profile that supports the requested service DefinitionIndicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in Reference(Condition | Observation | DiagnosticReport | DocumentReference) Constraints
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insurance | I | 0..* | Reference(Coverage | ClaimResponse) | There are no (further) constraints on this element Element IdServiceRequest.insurance Associated insurance coverage DefinitionInsurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Coverage | ClaimResponse) Constraints
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supportingInfo | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element IdServiceRequest.supportingInfo Additional clinical information Alternate namesAsk at order entry question, AOE DefinitionAdditional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements. To represent information about how the services are to be delivered use the
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specimen | Σ I | 0..* | Reference(Specimen) | There are no (further) constraints on this element Element IdServiceRequest.specimen Procedure Samples DefinitionOne or more specimens that the laboratory procedure will use. Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.
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bodySite | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdServiceRequest.bodySite Location on Body Alternate nameslocation DefinitionAnatomic location where the procedure should be performed. This is the target site. Knowing where the procedure is performed is important for tracking if multiple sites are possible. Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure. Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (example)Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element IdServiceRequest.note Comments DefinitionAny other notes and comments made about the service request. For example, internal billing notes. 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).
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patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element IdServiceRequest.patientInstruction Patient or consumer-oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. Note that FHIR strings SHALL NOT exceed 1MB in size
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relevantHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element IdServiceRequest.relevantHistory Request provenance DefinitionKey events in the history of the request. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.
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{ "resourceType": "StructureDefinition", "id": "signal-servicerequest", "url": "https://signalbhn.org/fhir/StructureDefinition/servicerequest", "name": "SignalServiceRequest", "title": "ServiceRequest Profile", "status": "draft", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "ServiceRequest", "baseDefinition": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest", "derivation": "constraint", "differential": { "element": [ { "id": "ServiceRequest.category:serviceCategory", "path": "ServiceRequest.category", "sliceName": "serviceCategory", "binding": { "strength": "required", "valueSet": "https://signalbhn.org/fhir/ValueSet/signal-healthcare-service-category" } }, { "id": "ServiceRequest.category:serviceType", "path": "ServiceRequest.category", "sliceName": "serviceType", "binding": { "strength": "required", "valueSet": "https://signalbhn.org/fhir/ValueSet/signal-healthcare-service-type" } } ] } }
Profile usage
Record of request (referral) for a procedure or service to be planned, proposed, or performed on a patient. This will come directly from the referral system of record, Jolata, and will include only necessary details for handling the service in FHIR.
Jolata will be used as the system of record (source) that will maintain referral details. Any updates on the system of record will cascade down to the associated FHIR resources. No new information specific to the referral should be stored in FHIR.
Profile element notes
.category:serviceCategory
- Signal custom service category classification (type of service to be performed).