StructureDefinition UKCore-Appointment

Canonical_URLStatusCurrent_VersionLast_UpdatedDescription
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Appointmentactive1.3.02023-12-12

This profile defines the UK constraints and extensions on the International FHIR resource Appointment.


Profile_Purpose

This profile allows recording of detailed information about a planned meeting that may be in the future or past. The resource only describes a single meeting, a series of repeating visits would require multiple appointment resources to be created for each instance.

Examples include a scheduled surgery, a follow-up for a clinical visit, a scheduled conference call between clinicians to discuss a case, the reservation of a piece of diagnostic equipment for a particular use, etc. The visit scheduled by an appointment may be in person or remote (by phone, video conference, etc.) All that matters is that the time and usage of one or more individuals, locations and/or pieces of equipment is being fully or partially reserved for a designated period of time.

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
bookingOrganizationI0..1Extension(Reference(Organization))
deliveryChannelI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
statusS Σ ?!1..1codeBinding
cancelationReasonΣ0..1CodeableConcept
serviceCategoryΣ0..*CodeableConcept
serviceTypeΣ0..*CodeableConcept
specialtyS Σ0..*CodeableConceptBinding
appointmentTypeS Σ0..1CodeableConceptBinding
reasonCodeS Σ0..*CodeableConceptBinding
reasonReferenceS I0..*Reference(Condition | Procedure | Observation | ImmunizationRecommendation)
priority0..1unsignedInt
description0..1string
supportingInformationI0..*Reference(Resource)
startS Σ0..1instant
endΣ0..1instant
minutesDuration0..1positiveInt
slotI0..*Reference(Slot)
created0..1dateTime
comment0..1string
patientInstruction0..1string
basedOnS I0..*Reference(ServiceRequest)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
typeΣ0..*CodeableConceptBinding
actorΣ I0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Device | HealthcareService | Location)
requiredΣ0..1codeBinding
statusΣ1..1codeBinding
periodI0..1Period
requestedPeriodI0..*Period

Detailed Descriptions

Appointment
DefinitionA 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).
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • 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')
  • 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-2: Either start and end are specified, or neither
    start.exists() = end.exists()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Request
  • rim: Act[@moodCode <= 'INT']
  • ical: VEVENT
Appointment.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
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.

Appointment.meta
DefinitionThe 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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Appointment.implicitRules
DefinitionA 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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Appointment.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
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).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Appointment.text
DefinitionA 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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Appointment.contained
DefinitionThese 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.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
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.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Appointment.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
  • rim: N/A
Appointment.extension:bookingOrganization
DefinitionAn extension to record the organisation booking the appointment.
Cardinality0...1
TypeExtension(Reference(Organization))
Aliasextensions, user content
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.

Invariants
  • 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
  • rim: N/A
Appointment.extension:deliveryChannel
DefinitionAn extension to record the delivery channel of a scheduled Appointment.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
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.

Invariants
  • 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
  • rim: N/A
Appointment.modifierExtension
DefinitionMay 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).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
  • rim: N/A
Appointment.identifier
DefinitionThis 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).
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.identifier
  • w5: FiveWs.identifier
  • v2: SCH-1, SCH-2, ARQ-1, ARQ-2
  • rim: .id
  • ical: UID
Appointment.status
DefinitionThe 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.
Cardinality1...1
Typecode
Binding

The free/busy status of an appointment.

AppointmentStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.status
  • w5: FiveWs.status
  • v2: SCH-25
  • rim: .statusCode
  • ical: STATUS
Appointment.cancelationReason
DefinitionThe 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.
Cardinality0...1
TypeCodeableConcept
BindingAppointmentCancellationReason (example)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Appointment.serviceCategory
DefinitionA broad categorization of the service that is to be performed during this appointment.
Cardinality0...*
TypeCodeableConcept
BindingServiceCategory (example)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: n/a, might be inferred from the ServiceDeliveryLocation
  • ical: CATEGORIES
Appointment.serviceType
DefinitionThe specific service that is to be performed during this appointment.
Cardinality0...*
TypeCodeableConcept
BindingServiceType (example)
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.code
  • rim: n/a, might be inferred from the ServiceDeliveryLocation
Appointment.specialty
DefinitionThe specialty of a practitioner that would be required to perform the service requested in this appointment.
Cardinality0...*
TypeCodeableConcept
BindingUKCorePracticeSettingCode (extensible)
Must SupportTrue
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • rim: .performer.AssignedPerson.code
Appointment.appointmentType
DefinitionThe style of appointment or patient that has been booked in the slot (not service type).
Cardinality0...1
TypeCodeableConcept
Binding

A set of codes that define an appointment reason.

UKCoreAppointmentReasonCode (extensible)
Must SupportTrue
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: ARQ-7
  • rim: .code
  • ical: CLASSIFICATION
Appointment.reasonCode
DefinitionThe coded reason that this appointment is being scheduled. This is more clinical than administrative.
Cardinality0...*
TypeCodeableConcept
Binding

The Reason for the appointment to take place.

EncounterReasonCodes (preferred)
Must SupportTrue
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.reasonCode
  • v2: AIS-3, SCH-7
  • rim: .reasonCode
Appointment.reasonReference
DefinitionReason 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.
Cardinality0...*
TypeReference(Condition | Procedure | Observation | ImmunizationRecommendation)
Must SupportTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.reasonReference
  • rim: .inboundRelationship[@typeCode = 'RSON'].observation
Appointment.priority
DefinitionThe 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).
Cardinality0...1
TypeunsignedInt
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.priority
  • w5: FiveWs.class
  • v2: ARQ-12, SCH-11.6 / TQ1-9
  • rim: .priorityCode
  • ical: PRIORITY
Appointment.description
DefinitionThe 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.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: NTE-3
  • rim: .text
  • ical: SUMMARY
Appointment.supportingInformation
DefinitionAdditional information to support the appointment provided when making the appointment.
Cardinality0...*
TypeReference(Resource)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.supportingInfo
  • w5: FiveWs.context
  • rim: .inboundRelationship[@typeCode = 'SPRT'].observation
  • ical: ATTACH
Appointment.start
DefinitionDate/Time that the appointment is to take place.
Cardinality0...1
Typeinstant
Must SupportTrue
SummaryTrue
Comments

Note: This is intended for where precisely observed times are required, typically system logs etc., and not human-reported times - for them, see date and dateTime (which can be as precise as instant, but is not required to be) below. Time zone is always required

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.occurrence[x]
  • w5: FiveWs.init
  • v2: ARQ-11.1, SCH-11.4 / TQ1-7
  • rim: .effectiveTime.low
  • ical: DTSTART
Appointment.end
DefinitionDate/Time that the appointment is to conclude.
Cardinality0...1
Typeinstant
SummaryTrue
Comments

Note: This is intended for where precisely observed times are required, typically system logs etc., and not human-reported times - for them, see date and dateTime (which can be as precise as instant, but is not required to be) below. Time zone is always required

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.occurrence[x]
  • w5: FiveWs.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
Appointment.minutesDuration
DefinitionNumber 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.
Cardinality0...1
TypepositiveInt
Comments

32 bit number; for values larger than this, use decimal

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.occurrence[x]
  • rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')].width
  • ical: DURATION (e.g. PT15M)
Appointment.slot
DefinitionThe slots from the participants' schedules that will be filled by the appointment.
Cardinality0...*
TypeReference(Slot)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .outboundRelationship[@typeCode = 'REFR'].act[@classCode = 'ACT'][@moodCode = 'SLOT']
Appointment.created
DefinitionThe 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.
Cardinality0...1
TypedateTime
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.authoredOn
  • rim: .author.time
  • ical: CREATED
Appointment.comment
DefinitionAdditional comments about the appointment.
Cardinality0...1
Typestring
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.note
  • v2: NTE-3
  • rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value
  • ical: DESCRIPTION (for internal use)
Appointment.patientInstruction
DefinitionWhile 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).
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: NTE-3
  • rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value
  • ical: DESCRIPTION (for patient use)
Appointment.basedOn
DefinitionThe service request this appointment is allocated to assess (e.g. incoming referral or procedure request).
Cardinality0...*
TypeReference(ServiceRequest)
Must SupportTrue
AliasincomingReferral
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.basedOn
  • rim: .outboundRelationship[@typeCode = 'FLFS'].act[@classCode < 'ActCareProvisionRequestType'][@moodCode = 'RQO']
Appointment.participant
DefinitionList of participants involved in the appointment.
Cardinality1...*
TypeBackboneElement
Must SupportTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • app-1: Either the type or actor on the participant SHALL be specified
    type.exists() or actor.exists()
Mappings
  • rim: n/a
  • workflow: Request.performer, Request.subject
  • v2: PID, AIP, AIG, AIL
  • rim: performer | reusableDevice | subject | location
  • ical: ATTENDEE component to be created
Appointment.participant.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Appointment.participant.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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
  • rim: N/A
Appointment.participant.modifierExtension
DefinitionMay 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).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
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.

Invariants
  • 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
  • rim: N/A
Appointment.participant.type
DefinitionRole of participant in the appointment.
Cardinality0...*
TypeCodeableConcept
Binding

Role of participant in encounter.

ParticipantType (extensible)
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: AIP-4, AIG-4
  • rim: (performer | reusableDevice | subject | location).@typeCode
  • ical: n/a
Appointment.participant.actor
DefinitionA Person, Location/HealthcareService or Device that is participating in the appointment.
Cardinality0...1
TypeReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Device | HealthcareService | Location)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.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"
Appointment.participant.required
DefinitionWhether 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.
Cardinality0...1
Typecode
Binding

Is the Participant required to attend the appointment.

ParticipantRequired (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: (performer | reusableDevice | subject | location).@performInd
  • ical: ROLE=REQ-PARTICIPANT (roleparam)
Appointment.participant.status
DefinitionParticipation status of the actor.
Cardinality1...1
Typecode
Binding

The Participation status of an appointment.

ParticipationStatus (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: AIP-12, AIG-14
  • rim: (performer | reusableDevice | subject | location).statusCode
  • ical: ATTENDEE;CN="John Doe";RSVP=TRUE:mailto:john@doe.com (rsvpparam | partstatparam)
Appointment.participant.period
DefinitionParticipation period of the actor.
Cardinality0...1
TypePeriod
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
Appointment.requestedPeriod
DefinitionA 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.
Cardinality0...*
TypePeriod
Comments

This does not introduce a capacity for recurring appointments.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • workflow: Request.occurrence[x]
  • v2: ARQ-11
  • rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')]

Table View

Appointment..
Appointment.extensionExtension..
Appointment.extensionExtension..1
Appointment.status..
Appointment.specialty..
Appointment.appointmentType..
Appointment.reasonCode..
Appointment.reasonReference..
Appointment.start..
Appointment.basedOn..
Appointment.participant..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Appointment" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Appointment" />
    <version value="1.3.0" />
    <name value="UKCoreAppointment" />
    <title value="UK Core Appointment" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Appointment](https://hl7.org/fhir/R4/Appointment.html)." />
    <purpose value="This profile allows recording of detailed information about a planned meeting that may be in the future or past. The resource only describes a single meeting, a series of repeating visits would require multiple appointment resources to be created for each instance. \n\n Examples include a scheduled surgery, a follow-up for a clinical visit, a scheduled conference call between clinicians to discuss a case, the reservation of a piece of diagnostic equipment for a particular use, etc. The visit scheduled by an appointment may be in person or remote (by phone, video conference, etc.) All that matters is that the time and usage of one or more individuals, locations and/or pieces of equipment is being fully or partially reserved for a designated period of time." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Appointment" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Appointment" />
    <derivation value="constraint" />
    <differential>
        <element id="Appointment.extension:bookingOrganization">
            <path value="Appointment.extension" />
            <sliceName value="bookingOrganization" />
            <short value="A reference to the source Organization of the booked appointment." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BookingOrganization" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="Appointment.extension:deliveryChannel">
            <path value="Appointment.extension" />
            <sliceName value="deliveryChannel" />
            <short value="Defines the delivery channel of a scheduled appointment." />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeliveryChannel" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="Appointment.status">
            <path value="Appointment.status" />
            <short value="The overall status of the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.specialty">
            <path value="Appointment.specialty" />
            <short value="The specialty of a practitioner that would be required to perform the service requested in this appointment." />
            <mustSupport value="true" />
            <binding>
                <strength value="extensible" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode" />
            </binding>
        </element>
        <element id="Appointment.appointmentType">
            <path value="Appointment.appointmentType" />
            <short value="The type of appointment or patient that has been booked in the slot." />
            <mustSupport value="true" />
            <binding>
                <strength value="extensible" />
                <description value="A set of codes that define an appointment reason." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AppointmentReasonCode" />
            </binding>
        </element>
        <element id="Appointment.reasonCode">
            <path value="Appointment.reasonCode" />
            <short value="The reason for the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.reasonReference">
            <path value="Appointment.reasonReference" />
            <short value="A reference to the Observation, Condition, Procedure, or ImmunizationRecommendation that is the reason for the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.start">
            <path value="Appointment.start" />
            <short value="The start time of the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.basedOn">
            <path value="Appointment.basedOn" />
            <short value="The service request this appointment is allocated to assess." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.participant">
            <path value="Appointment.participant" />
            <short value="A list of participants involved in the appointment." />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Appointment",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Appointment",
    "version": "1.3.0",
    "name": "UKCoreAppointment",
    "title": "UK Core Appointment",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Appointment](https://hl7.org/fhir/R4/Appointment.html).",
    "purpose": "This profile allows recording of detailed information about a planned meeting that may be in the future or past. The resource only describes a single meeting, a series of repeating visits would require multiple appointment resources to be created for each instance. \n\n Examples include a scheduled surgery, a follow-up for a clinical visit, a scheduled conference call between clinicians to discuss a case, the reservation of a piece of diagnostic equipment for a particular use, etc. The visit scheduled by an appointment may be in person or remote (by phone, video conference, etc.) All that matters is that the time and usage of one or more individuals, locations and/or pieces of equipment is being fully or partially reserved for a designated period of time.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Appointment",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Appointment",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Appointment.extension:bookingOrganization",
                "path": "Appointment.extension",
                "sliceName": "bookingOrganization",
                "short": "A reference to the source Organization of the booked appointment.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BookingOrganization"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "Appointment.extension:deliveryChannel",
                "path": "Appointment.extension",
                "sliceName": "deliveryChannel",
                "short": "Defines the delivery channel of a scheduled appointment.",
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeliveryChannel"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "Appointment.status",
                "path": "Appointment.status",
                "short": "The overall status of the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.specialty",
                "path": "Appointment.specialty",
                "short": "The specialty of a practitioner that would be required to perform the service requested in this appointment.",
                "mustSupport": true,
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode"
                }
            },
            {
                "id": "Appointment.appointmentType",
                "path": "Appointment.appointmentType",
                "short": "The type of appointment or patient that has been booked in the slot.",
                "mustSupport": true,
                "binding": {
                    "strength": "extensible",
                    "description": "A set of codes that define an appointment reason.",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AppointmentReasonCode"
                }
            },
            {
                "id": "Appointment.reasonCode",
                "path": "Appointment.reasonCode",
                "short": "The reason for the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.reasonReference",
                "path": "Appointment.reasonReference",
                "short": "A reference to the Observation, Condition, Procedure, or ImmunizationRecommendation that is the reason for the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.start",
                "path": "Appointment.start",
                "short": "The start time of the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.basedOn",
                "path": "Appointment.basedOn",
                "short": "The service request this appointment is allocated to assess.",
                "mustSupport": true
            },
            {
                "id": "Appointment.participant",
                "path": "Appointment.participant",
                "short": "A list of participants involved in the appointment.",
                "mustSupport": true
            }
        ]
    }
}

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Examples

Orthopaedic Surgery - An example to illustrate an Orthopaedic Surgery appointment.
Example UKCore-Appointment-OrthopaedicSurgery

Booking Organization - An example to illustrate the booking organization extension associated with an appointment.
Example UKCore-Extension-BookingOrganization

Delivery Channel - An example to illustrate the delivery channel associated with an appointment.
Example UKCore-Extension-DeliveryChannel

Example Usage Scenarios

The following are example usage scenarios for the UK Core Appointment profile:

  • Query for appointment information for a given Patient
  • Exchange appointment information within a FHIR document or message.

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

The following elements are identified as MustSupport, and it is expected that consumers and suppliers SHALL support these as per the MustSupport Guidance.

ElementReason
Appointment.statusThe overall status of the appointment.
Appointment.specialtyThe specialty of a practitioner that would be required to perform the service requested in this appointment.
Appointment.appointmentTypeThe type of appointment or patient that has been booked in the slot.
Appointment.reasonCodeThe reason for the appointment.
Appointment.reasonReferenceA reference to the Observation, Condition, Procedure, or ImmunizationRecommendation that is the reason for the appointment.
Appointment.startThe start time of the appointment.
Appointment.basedOnThe service request this appointment is allocated to assess.
Appointment.participantA list of participants involved in the appointment.


Extensions

More information about the extensions on the UKCore-Appointment profile can be found using the links below.

ExtensionContextLinkComment
bookingOrganizationAppointment.extensionhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BookingOrganizationA reference to the source Organization of the booked appointment.
deliveryChannelAppointment.extensionhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeliveryChannelDefines the delivery channel of a scheduled appointment.


Bindings (differential)

More information about the bindings to UK Core ValueSets can be found below.

ContextStrengthLink
Appointment.specialtyextensiblehttps://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode
Appointment.appointmentTypeextensiblehttps://fhir.hl7.org.uk/ValueSet/UKCore-AppointmentReasonCode


reasonReference

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:


supportingInformation

Where possible, it is expected that the resource being referenced SHOULD conform to the UK Core profile for that resource, if a profile exists.


slot

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Slot.


basedOn

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-ServiceRequest.


participant

A list of participants involved in the appointment.

participant.type

Optional role of participant in the appointment that uses the following values which may be extended. The binding is to the International FHIR ValueSet encounter-participant-type, which is shown expanded here due to the complexity of included codes and systems.

Code System Display Definition
ADM http://terminology.hl7.org/CodeSystem/v3-ParticipationType admitter The practitioner who is responsible for admitting a patient to a patient encounter.
ATND http://terminology.hl7.org/CodeSystem/v3-ParticipationType attender The practitioner that has responsibility for overseeing a patient's care during a patient encounter.
CALLBCK http://terminology.hl7.org/CodeSystem/v3-ParticipationType callback contact A person or organization who should be contacted for follow-up questions about the act in place of the author.
CON http://terminology.hl7.org/CodeSystem/v3-ParticipationType consultant An advisor participating in the service by performing evaluations and making recommendations.
DIS http://terminology.hl7.org/CodeSystem/v3-ParticipationType discharger The practitioner who is responsible for the discharge of a patient from a patient encounter.
ESC http://terminology.hl7.org/CodeSystem/v3-ParticipationType escort Only with Transportation services. A person who escorts the patient.
REF http://terminology.hl7.org/CodeSystem/v3-ParticipationType referrer A person having referred the subject of the service to the performer (referring physician). Typically, a referring physician will receive a report.
SPRF http://terminology.hl7.org/CodeSystem/v3-ParticipationType secondary performer A person assisting in an act through his substantial presence and involvement This includes: assistants, technicians, associates, or whatever the job titles may be.
PPRF http://terminology.hl7.org/CodeSystem/v3-ParticipationType primary performer The principal or primary performer of the act.
PART http://terminology.hl7.org/CodeSystem/v3-ParticipationType Participation Indicates that the target of the participation is involved in some manner in the act, but does not qualify how.
translator http://terminology.hl7.org/CodeSystem/participant-type Translator A translator who is facilitating communication with the patient during the encounter.
emergency http://terminology.hl7.org/CodeSystem/participant-type Emergency A person to be contacted in case of an emergency during the encounter.

participant.actor

Optional Person, Location/HealthcareService or Device that is participating in the appointment.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles: