Common FHIR profile vendor collaboration

1.0.1 - update Sweden flag

This page is part of the Common FHIR profile vendor collaboration (v1.0.1: Release) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: ServiceRequestSelfReferralSEVendorLite - Detailed Descriptions

Active as of 2023-06-12

Definitions for the ServiceRequestSelfReferralSEVendorLite resource profile.

Guidance on how to interpret the contents of this table can be found here.

1. ServiceRequest
2. ServiceRequest.instantiatesCanonical
Control0..0*
3. ServiceRequest.instantiatesUri
Control0..0*
4. ServiceRequest.basedOn
Control0..0*
5. ServiceRequest.replaces
Control0..0*
6. ServiceRequest.requisition
Control0..01
7. ServiceRequest.intent
Pattern Valueorder
8. ServiceRequest.category
Control0..0*
Comments

Removed as no common strategy for how to manage it among vendors and nationally

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.

9. ServiceRequest.priority
Control0..01
Comments

Removed as not supported by most vendors

10. ServiceRequest.doNotPerform
Control0..01
11. ServiceRequest.code
Control0..01
Comments

Removed as no common strategy for how to manage it among vendors and nationally

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.

12. ServiceRequest.orderDetail
Control0..0*
Comments

Does not need to be included in a first version, not supported by multiple vendors

For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

13. ServiceRequest.quantity[x]
Control0..01
[x] NoteSee Choice of Data Types for further information about how to use [x]
14. ServiceRequest.encounter
Control0..01
Comments

Not applicable for self-referral as there has never been an encounter before the self-referral as it is the start of the process.

15. ServiceRequest.occurrence[x]
Control0..01
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

Removed, self-referral is always here and now.

16. ServiceRequest.asNeeded[x]
Control0..01
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

Not applicable for self-referral

17. ServiceRequest.authoredOn
Control10..1
Must Supporttrue
Comments

Set as mandatory as needed for most systems due to waiting time requirements etc.

18. ServiceRequest.performerType
Control0..01
Comments

Not supported initially, could be good for future if we have a national list of roles/types

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”.

19. ServiceRequest.performer
Control10..1*
TypeReference(Organization|Practitioner|PractitionerRole|CareTeam|HealthcareService|Patient|Device|RelatedPerson)
Must Supporttrue
Comments

Id of the organization (normally via a HSA id)

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).

20. ServiceRequest.performer.type
Control0..?
Pattern ValueOrganization
21. ServiceRequest.locationCode
Control0..0*
22. ServiceRequest.locationReference
Control0..0*
Comments

The target "location" for the request is on performer attribute

23. ServiceRequest.reasonCode
Control0..1*
Must Supporttrue
Comments

Only one reason code is supported by most vendors, hence constrained to 0..1

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

SlicingThis element introduces a set of slices on ServiceRequest.reasonCode. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • pattern @ coding.code
24. ServiceRequest.reasonCode:chiefComplaint
SliceNamechiefComplaint
Control0..1
BindingThe codes SHALL be taken from http://snomed.info/sct/45991000052106?fhir_vs=refset/60001000052100
Must Supporttrue
Comments

Nationally defined implicit value set for chief complaint in Sweden (SWE sökorsak).

25. ServiceRequest.reasonCode:chiefComplaint.coding
Control1..1
Must Supporttrue
26. ServiceRequest.reasonCode:chiefComplaint.coding.system
Control1..?
Must Supporttrue
27. ServiceRequest.reasonCode:chiefComplaint.coding.code
Control1..?
Must Supporttrue
28. ServiceRequest.reasonReference
Control0..0*
Comments

Not supported by most vendors

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

29. ServiceRequest.insurance
Control0..0*
30. ServiceRequest.supportingInfo
Control0..0*
31. ServiceRequest.specimen
Control0..0*
32. ServiceRequest.bodySite
Control0..0*
Comments

Not supported by most vendors

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.

33. ServiceRequest.note
Control0..0*
Comments

Removed, should be managed in more structured ways, potentially using Q and QR

34. ServiceRequest.patientInstruction
Control0..01
Comments

Not applicable for self-referral

35. ServiceRequest.relevantHistory
Control0..0*
Comments

Agreement to remove among most vendors.

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.

Guidance on how to interpret the contents of this table can be found here.

1. ServiceRequest
Definition

A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.

Control0..*
Summaryfalse
Alternate Namesdiagnostic request, referral, referral request, transfer of care request
InvariantsDefined on this element
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.`div`.exists())
prr-1: orderDetail SHALL only be present if code is present (: orderDetail.empty() or code.exists())
2. ServiceRequest.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is 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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
3. ServiceRequest.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Summaryfalse
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.

Alternate Namesextensions, 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.

InvariantsDefined on this element
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())
4. ServiceRequest.instantiatesCanonical
Definition

The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

Control0..0*
Typecanonical(ActivityDefinition|PlanDefinition)
Summarytrue
Comments

Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. ServiceRequest.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

Control0..0*
Typeuri
Summarytrue
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. ServiceRequest.basedOn
Definition

Plan/proposal/order fulfilled by this request.

Control0..0*
TypeReference(CarePlan|ServiceRequest|MedicationRequest)
Summarytrue
Alternate Namesfulfills
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. ServiceRequest.replaces
Definition

The request takes the place of the referenced completed or terminated request(s).

Control0..0*
TypeReference(ServiceRequest)
Summarytrue
Alternate Namessupersedes, prior, renewed order
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
8. ServiceRequest.requisition
Definition

A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.

Control0..01
TypeIdentifier
Summarytrue
Requirements

Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

Alternate NamesgrouperId, groupIdentifier
Comments

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
9. ServiceRequest.status
Definition

The status of the order.

Control1..1
BindingThe codes SHALL be taken from RequestStatus

The status of a service order.

Typecode
Is Modifiertrue
Summarytrue
Comments

The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
10. ServiceRequest.intent
Definition

Whether the request is a proposal, plan, an original order or a reflex order.

Control1..1
BindingThe codes SHALL be taken from RequestIntent

The kind of service request.

Typecode
Is Modifiertrue
Summarytrue
Comments

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

Pattern Valueorder
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
11. ServiceRequest.category
Definition

A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").

Control0..0*
BindingFor example codes, see ServiceRequestCategoryCodes

Classification of the requested service.

TypeCodeableConcept
Summarytrue
Requirements

Used for filtering what service request are retrieved and displayed.

Comments

Removed as no common strategy for how to manage it among vendors and nationally

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
12. ServiceRequest.priority
Definition

Indicates how quickly the ServiceRequest should be addressed with respect to other requests.

Control0..01
BindingThe codes SHALL be taken from RequestPriority

Identifies the level of importance to be assigned to actioning the request.

Typecode
Summarytrue
Comments

Removed as not supported by most vendors

Meaning if MissingIf missing, this task should be performed with normal priority
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. ServiceRequest.doNotPerform
Definition

Set this to true if the record is saying that the service/procedure should NOT be performed.

Control0..01
Typeboolean
Is Modifiertrue
Summarytrue
Requirements

Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

Comments

In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

Meaning if MissingIf missing, the request is a positive request e.g. "do perform"
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. ServiceRequest.code
Definition

A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.

Control0..01
BindingFor example codes, see ProcedureCodes(SNOMEDCT)

Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is preferred and a valueset using LOINC Order codes is available here.

TypeCodeableConcept
Summarytrue
Alternate Namesservice requested
Comments

Removed as no common strategy for how to manage it among vendors and nationally

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. ServiceRequest.orderDetail
Definition

Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.

Control0..0* This element is affected by the following invariants: prr-1
BindingFor example codes, see ServiceRequestOrderDetailsCodes

Codified order entry details which are based on order context.

TypeCodeableConcept
Summarytrue
Alternate Namesdetailed instructions
Comments

Does not need to be included in a first version, not supported by multiple vendors

For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. ServiceRequest.quantity[x]
Definition

An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).

Control0..01
TypeChoice of: Quantity, Ratio, Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Requirements

When ordering a service the number of service items may need to be specified separately from the the service item.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. ServiceRequest.subject
Definition

On 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).

Control1..1
TypeReference(Patient|Group|Location|Device)
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. ServiceRequest.encounter
Definition

An encounter that provides additional information about the healthcare context in which this request is made.

Control0..01
TypeReference(Encounter)
Summarytrue
Alternate Namescontext
Comments

Not applicable for self-referral as there has never been an encounter before the self-referral as it is the start of the process.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. ServiceRequest.occurrence[x]
Definition

The date/time at which the requested service should occur.

Control0..01
TypeChoice of: dateTime, Period, Timing
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Alternate Namesschedule
Comments

Removed, self-referral is always here and now.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. ServiceRequest.asNeeded[x]
Definition

If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.

Control0..01
BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes

A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments

Not applicable for self-referral

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. ServiceRequest.authoredOn
Definition

When the request transitioned to being actionable.

Control10..1
TypedateTime
Must Supporttrue
Summarytrue
Alternate NamesorderedOn
Comments

Set as mandatory as needed for most systems due to waiting time requirements etc.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. ServiceRequest.performerType
Definition

Desired type of performer for doing the requested service.

Control0..01
BindingFor example codes, see ParticipantRoles

Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

TypeCodeableConcept
Summarytrue
Alternate Namesspecialty
Comments

Not supported initially, could be good for future if we have a national list of roles/types

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”.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. ServiceRequest.performer
Definition

The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.

Control10..1*
TypeReference(Organization|Practitioner|PractitionerRole|CareTeam|HealthcareService|Patient|Device|RelatedPerson)
Must Supporttrue
Summarytrue
Alternate Namesrequest recipient
Comments

Id of the organization (normally via a HSA id)

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).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. ServiceRequest.performer.type
Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Control0..1
BindingThe codes SHALL be taken from ResourceType; other codes may be used where these codes are not suitable

Aa resource (or, for logical models, the URI of the logical model).

Typeuri
Summarytrue
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Pattern ValueOrganization
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. ServiceRequest.locationCode
Definition

The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.

Control0..0*
BindingFor example codes, see ServiceDeliveryLocationRoleType

A location type where services are delivered.

TypeCodeableConcept
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. ServiceRequest.locationReference
Definition

A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.

Control0..0*
TypeReference(Location)
Summarytrue
Comments

The target "location" for the request is on performer attribute

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. ServiceRequest.reasonCode
Definition

An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

Control0..1*
BindingFor example codes, see ProcedureReasonCodes

Diagnosis or problem codes justifying the reason for requesting the service investigation.

TypeCodeableConcept
Must Supporttrue
Summarytrue
Comments

Only one reason code is supported by most vendors, hence constrained to 0..1

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on ServiceRequest.reasonCode. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • pattern @ coding.code
28. ServiceRequest.reasonCode:chiefComplaint
SliceNamechiefComplaint
Definition

An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

Control0..1*
BindingThe codes SHALL be taken from http://snomed.info/sct/45991000052106?fhir_vs=refset/60001000052100For example codes, see ProcedureReasonCodes
TypeCodeableConcept
Must Supporttrue
Summarytrue
Comments

Nationally defined implicit value set for chief complaint in Sweden (SWE sökorsak).

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. ServiceRequest.reasonCode:chiefComplaint.coding
Definition

A reference to a code defined by a terminology system.

Control10..1*
TypeCoding
Must Supporttrue
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
30. ServiceRequest.reasonCode:chiefComplaint.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control10..1
Typeuri
Must Supporttrue
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
31. ServiceRequest.reasonCode:chiefComplaint.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control10..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. ServiceRequest.reasonReference
Definition

Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.

Control0..0*
TypeReference(Condition|Observation|DiagnosticReport|DocumentReference)
Summarytrue
Comments

Not supported by most vendors

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
33. ServiceRequest.insurance
Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.

Control0..0*
TypeReference(Coverage|ClaimResponse)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. ServiceRequest.supportingInfo
Definition

Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.

Control0..0*
TypeReference(Resource)
Summaryfalse
Alternate NamesAsk at order entry question, AOE
Comments

To represent information about how the services are to be delivered use the instructions element.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. ServiceRequest.specimen
Definition

One or more specimens that the laboratory procedure will use.

Control0..0*
TypeReference(Specimen)
Summarytrue
Comments

Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. ServiceRequest.bodySite
Definition

Anatomic location where the procedure should be performed. This is the target site.

Control0..0*
BindingFor example codes, see SNOMEDCTBodyStructures

Codes describing anatomical locations. May include laterality.

TypeCodeableConcept
Summarytrue
Requirements

Knowing where the procedure is performed is important for tracking if multiple sites are possible.

Alternate Nameslocation
Comments

Not supported by most vendors

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
37. ServiceRequest.note
Definition

Any other notes and comments made about the service request. For example, internal billing notes.

Control0..0*
TypeAnnotation
Summaryfalse
Comments

Removed, should be managed in more structured ways, potentially using Q and QR

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
38. ServiceRequest.patientInstruction
Definition

Instructions in terms that are understood by the patient or consumer.

Control0..01
Typestring
Summarytrue
Comments

Not applicable for self-referral

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
39. ServiceRequest.relevantHistory
Definition

Key events in the history of the request.

Control0..0*
TypeReference(Provenance)
Summaryfalse
Comments

Agreement to remove among most vendors.

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be found here.

1. ServiceRequest
Definition

A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.

Control0..*
Summaryfalse
Alternate Namesdiagnostic request, referral, referral request, transfer of care request
2. ServiceRequest.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
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.

3. ServiceRequest.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Control0..1
TypeMeta
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. ServiceRequest.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is 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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. ServiceRequest.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages A human language
Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Summaryfalse
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).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. ServiceRequest.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1
TypeNarrative
Summaryfalse
Alternate Namesnarrative, 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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. ServiceRequest.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Summaryfalse
Alternate Namesinline 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.

8. ServiceRequest.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Summaryfalse
Alternate Namesextensions, 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.

InvariantsDefined on this element
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())
9. ServiceRequest.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Summaryfalse
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.

Alternate Namesextensions, 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.

InvariantsDefined on this element
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())
10. ServiceRequest.identifier
Definition

Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Summarytrue
Comments

The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
11. ServiceRequest.instantiatesCanonical
Definition

The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

Control0..0
Typecanonical(ActivityDefinition|PlanDefinition)
Summarytrue
Comments

Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
12. ServiceRequest.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

Control0..0
Typeuri
Summarytrue
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. ServiceRequest.basedOn
Definition

Plan/proposal/order fulfilled by this request.

Control0..0
TypeReference(CarePlan|ServiceRequest|MedicationRequest)
Summarytrue
Alternate Namesfulfills
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. ServiceRequest.replaces
Definition

The request takes the place of the referenced completed or terminated request(s).

Control0..0
TypeReference(ServiceRequest)
Summarytrue
Alternate Namessupersedes, prior, renewed order
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. ServiceRequest.requisition
Definition

A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.

Control0..0
TypeIdentifier
Summarytrue
Requirements

Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

Alternate NamesgrouperId, groupIdentifier
Comments

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. ServiceRequest.status
Definition

The status of the order.

Control1..1
BindingThe codes SHALL be taken from RequestStatus The status of a service order
Typecode
Is Modifiertrue
Summarytrue
Comments

The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. ServiceRequest.intent
Definition

Whether the request is a proposal, plan, an original order or a reflex order.

Control1..1
BindingThe codes SHALL be taken from RequestIntent The kind of service request
Typecode
Is Modifiertrue
Summarytrue
Comments

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

Pattern Valueorder
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. ServiceRequest.category
Definition

A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").

Control0..0
BindingFor example codes, see ServiceRequestCategoryCodes Classification of the requested service
TypeCodeableConcept
Summarytrue
Requirements

Used for filtering what service request are retrieved and displayed.

Comments

Removed as no common strategy for how to manage it among vendors and nationally

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. ServiceRequest.priority
Definition

Indicates how quickly the ServiceRequest should be addressed with respect to other requests.

Control0..0
BindingThe codes SHALL be taken from RequestPriority Identifies the level of importance to be assigned to actioning the request
Typecode
Summarytrue
Comments

Removed as not supported by most vendors

Meaning if MissingIf missing, this task should be performed with normal priority
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. ServiceRequest.doNotPerform
Definition

Set this to true if the record is saying that the service/procedure should NOT be performed.

Control0..0
Typeboolean
Is Modifiertrue
Summarytrue
Requirements

Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

Comments

In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

Meaning if MissingIf missing, the request is a positive request e.g. "do perform"
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. ServiceRequest.code
Definition

A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.

Control0..0
BindingFor example codes, see ProcedureCodes(SNOMEDCT) Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is preferred and a valueset using LOINC Order codes is available here
TypeCodeableConcept
Summarytrue
Alternate Namesservice requested
Comments

Removed as no common strategy for how to manage it among vendors and nationally

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. ServiceRequest.orderDetail
Definition

Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.

Control0..0 This element is affected by the following invariants: prr-1
BindingFor example codes, see ServiceRequestOrderDetailsCodes Codified order entry details which are based on order context
TypeCodeableConcept
Summarytrue
Alternate Namesdetailed instructions
Comments

Does not need to be included in a first version, not supported by multiple vendors

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. ServiceRequest.quantity[x]
Definition

An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).

Control0..0
TypeChoice of: Quantity, Ratio, Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Requirements

When ordering a service the number of service items may need to be specified separately from the the service item.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. ServiceRequest.subject
Definition

On 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).

Control1..1
TypeReference(Patient|Group|Location|Device)
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. ServiceRequest.encounter
Definition

An encounter that provides additional information about the healthcare context in which this request is made.

Control0..0
TypeReference(Encounter)
Summarytrue
Alternate Namescontext
Comments

Not applicable for self-referral as there has never been an encounter before the self-referral as it is the start of the process.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. ServiceRequest.occurrence[x]
Definition

The date/time at which the requested service should occur.

Control0..0
TypeChoice of: dateTime, Period, Timing
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Alternate Namesschedule
Comments

Removed, self-referral is always here and now.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. ServiceRequest.asNeeded[x]
Definition

If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.

Control0..0
BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc
TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments

Not applicable for self-referral

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
28. ServiceRequest.authoredOn
Definition

When the request transitioned to being actionable.

Control1..1
TypedateTime
Must Supporttrue
Summarytrue
Alternate NamesorderedOn
Comments

Set as mandatory as needed for most systems due to waiting time requirements etc.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. ServiceRequest.requester
Definition

The individual who initiated the request and has responsibility for its activation.

Control0..1
TypeReference(Practitioner|PractitionerRole|Organization|Patient|RelatedPerson|Device)
Summarytrue
Alternate Namesauthor, orderer
Comments

This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
30. ServiceRequest.performerType
Definition

Desired type of performer for doing the requested service.

Control0..0
BindingFor example codes, see ParticipantRoles Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc
TypeCodeableConcept
Summarytrue
Alternate Namesspecialty
Comments

Not supported initially, could be good for future if we have a national list of roles/types

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
31. ServiceRequest.performer
Definition

The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.

Control1..1
TypeReference(Organization)
Must Supporttrue
Summarytrue
Alternate Namesrequest recipient
Comments

Id of the organization (normally via a HSA id)

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. ServiceRequest.performer.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
33. ServiceRequest.performer.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Summaryfalse
Alternate Namesextensions, 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.

InvariantsDefined on this element
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())
SlicingThis element introduces a set of slices on ServiceRequest.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
34. ServiceRequest.performer.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control0..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. ServiceRequest.performer.type
Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Control0..1
BindingThe codes SHALL be taken from ResourceType; other codes may be used where these codes are not suitable Aa resource (or, for logical models, the URI of the logical model)
Typeuri
Summarytrue
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Pattern ValueOrganization
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. ServiceRequest.performer.identifier
Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
37. ServiceRequest.performer.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Summarytrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
38. ServiceRequest.locationCode
Definition

The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.

Control0..0
BindingFor example codes, see ServiceDeliveryLocationRoleType A location type where services are delivered
TypeCodeableConcept
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
39. ServiceRequest.locationReference
Definition

A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.

Control0..0
TypeReference(Location)
Summarytrue
Comments

The target "location" for the request is on performer attribute

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
40. ServiceRequest.reasonCode
Definition

An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

Control0..1
BindingFor example codes, see ProcedureReasonCodes Diagnosis or problem codes justifying the reason for requesting the service investigation
TypeCodeableConcept
Must Supporttrue
Summarytrue
Comments

Only one reason code is supported by most vendors, hence constrained to 0..1

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on ServiceRequest.reasonCode. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • pattern @ coding.code
41. ServiceRequest.reasonCode:chiefComplaint
SliceNamechiefComplaint
Definition

An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

Control0..1
BindingThe codes SHALL be taken from http://snomed.info/sct/45991000052106?fhir_vs=refset/60001000052100
TypeCodeableConcept
Must Supporttrue
Summarytrue
Comments

Nationally defined implicit value set for chief complaint in Sweden (SWE sökorsak).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
42. ServiceRequest.reasonCode:chiefComplaint.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
43. ServiceRequest.reasonCode:chiefComplaint.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Summaryfalse
Alternate Namesextensions, 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.

InvariantsDefined on this element
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())
SlicingThis element introduces a set of slices on ServiceRequest.reasonCode.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
44. ServiceRequest.reasonCode:chiefComplaint.coding
Definition

A reference to a code defined by a terminology system.

Control1..1
TypeCoding
Must Supporttrue
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
45. ServiceRequest.reasonCode:chiefComplaint.coding.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
46. ServiceRequest.reasonCode:chiefComplaint.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Summaryfalse
Alternate Namesextensions, 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.

InvariantsDefined on this element
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())
SlicingThis element introduces a set of slices on ServiceRequest.reasonCode.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
47. ServiceRequest.reasonCode:chiefComplaint.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Must Supporttrue
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
48. ServiceRequest.reasonCode:chiefComplaint.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
49. ServiceRequest.reasonCode:chiefComplaint.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
50. ServiceRequest.reasonCode:chiefComplaint.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
51. ServiceRequest.reasonCode:chiefComplaint.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
52. ServiceRequest.reasonCode:chiefComplaint.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
53. ServiceRequest.reasonReference
Definition

Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.

Control0..0
TypeReference(Condition|Observation|DiagnosticReport|DocumentReference)
Summarytrue
Comments

Not supported by most vendors

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
54. ServiceRequest.insurance
Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.

Control0..0
TypeReference(Coverage|ClaimResponse)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
55. ServiceRequest.supportingInfo
Definition

Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.

Control0..0
TypeReference(Resource)
Summaryfalse
Alternate NamesAsk at order entry question, AOE
Comments

To represent information about how the services are to be delivered use the instructions element.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
56. ServiceRequest.specimen
Definition

One or more specimens that the laboratory procedure will use.

Control0..0
TypeReference(Specimen)
Summarytrue
Comments

Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
57. ServiceRequest.bodySite
Definition

Anatomic location where the procedure should be performed. This is the target site.

Control0..0
BindingFor example codes, see SNOMEDCTBodyStructures Codes describing anatomical locations. May include laterality
TypeCodeableConcept
Summarytrue
Requirements

Knowing where the procedure is performed is important for tracking if multiple sites are possible.

Alternate Nameslocation
Comments

Not supported by most vendors

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
58. ServiceRequest.note
Definition

Any other notes and comments made about the service request. For example, internal billing notes.

Control0..0
TypeAnnotation
Summaryfalse
Comments

Removed, should be managed in more structured ways, potentially using Q and QR

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
59. ServiceRequest.patientInstruction
Definition

Instructions in terms that are understood by the patient or consumer.

Control0..0
Typestring
Summarytrue
Comments

Not applicable for self-referral

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
60. ServiceRequest.relevantHistory
Definition

Key events in the history of the request.

Control0..0
TypeReference(Provenance)
Summaryfalse
Comments

Agreement to remove among most vendors.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))