Administration
This
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part
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Integration
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FHIR
Specification
(v5.0.0:
R5
-
STU
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Page
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|
Responsible
Owner:
Patient
Administration
Work
Group
|
|
Security Category : Patient | Compartments : Encounter , Group , Patient , Practitioner , RelatedPerson |
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient. Encounter is primarily used to record information about the actual activities that occurred, where Appointment is used to record planned activities.
A patient encounter is further characterized by the setting in which it takes place. Amongst them are ambulatory, emergency, home health, inpatient and virtual encounters. An Encounter encompasses the lifecycle from pre-admission, the actual encounter (for ambulatory encounters), and admission, stay and discharge (for inpatient encounters). During the encounter the patient may move from practitioner to practitioner and location to location.
Because of the broad scope of Encounter, not all elements will be relevant in all settings. For this reason, admission/discharge related information is kept in a separate admission component within Encounter. The class element is used to distinguish between these settings, which will guide further validation and application of business rules.
There is also substantial variance from organization to organization (and between jurisdictions and countries) on which business events translate to the start of a new Encounter, or what level of aggregation is used for Encounter. For example, each single visit of a practitioner during a hospitalization may lead to a new instance of Encounter, but depending on local practice and the systems involved, it may well be that this is aggregated to a single instance for a whole admission. Even more aggregation may occur where jurisdictions introduce groups of Encounters for financial or other reasons. Encounters can be aggregated or grouped under other Encounters using the partOf element. See below for examples.
Encounter instances may exist before the actual encounter takes place to convey pre-admission information, including using Encounters elements to reflect the planned start date or planned encounter locations. In this case the status element is set to 'planned'.
The admission component is intended to store the extended information relating to an admission event. It is always expected to be the same period as the encounter itself. Where the period is different, another encounter instance should be used to capture this information as a partOf this encounter instance.
The Procedure and encounter have references to each other, and these should be to different procedures; one for the procedure that was performed during the encounter (stored in Procedure.encounter), and another for cases where an encounter is a result of another procedure (stored in Encounter.reason) such as a follow-up encounter to resolve complications from an earlier procedure.
During
the
life-cycle
of
an
encounter
it
will
pass
through
many
statuses
and
subject
statuses.
Typically
these
are
in
order
or
the
organization/department's
workflow(s)
e.g.
planned,
in-progress,
completed/cancelled.
In
general
terms
the
Encounter
and
Appointment
both
align
with
the
Clinical
Workflow
Process
Life
Cycle
pattern.
The
status
property
tracks
the
(current)
overall
status
of
the
encounter,
whereas
the
subjectStatus
property
more
closely
tracks
the
patient
explicitly.
For
example
in
a
hospital
emergency
department
the
subjectStatus
would
reflect
the
patient's
status
e.g.
arrived
(when
the
patient
first
presents
to
the
ED),
triaged
(when
the
patient
is
assessed
by
a
triage
nurse),
etc.
This
status
information
is
often
used
for
other
things,
and
often
an
analysis
of
the
status
history
is
required
for
things
like
billing.
This
could
be
done
by
scanning
through
all
the
resource
history
versions
of
the
encounter,
checking
the
period
of
each,
and
then
doing
some
form
of
post
processing.
However,
this
information
is
not
always
completed
in
real-time
(or
even
in
the
same
system)
and
needs
to
be
updated
over
time
-
as
a
result
the
resource
history
is
not
adequate
to
satisfy
these
needs,
and
subsequently
the
new
EncounterHistory
resource
provides
this
information
Note to Implementers: In FHIR R4 and earlier this was done using the statusHistory and classHistory backbone elements, however with longer duration encounters (where a patient encounter might be considered active for years) this would become increasingly inefficient, and EncounterHistory remediates this issue.
There
is
no
direct
indication
purely
by
the
status
or
subjectStatus
field
as
to
whether
an
encounter
is
considered
"admitted".
The
context
of
the
encounter
and
business
practices/policies/workflows/types
can
influence
this
definition.
(e.g.,
acute
care
facility,
aged
care
center,
outpatient
clinic,
emergency
department,
community-based
clinic).
Subject
statuses
of
"arrived",
"triaged"
or
"receiving-care"
could
be
considered
the
start
of
the
admission,
and
also
have
the
presence
of
the
admission
sub-component
entered.
The
"discharged"
status
can
be
used
when
the
patient
care
is
complete
but
the
encounter
itself
is
not
yet
completed,
such
as
while
collating
required
information
for
billing
or
other
purposes,
or
could
be
skipped
and
go
direct
to
"completed".
Refer
to
the
appointment
page
for
some
sample
possible
workflows.
Also
note
that
the
binding
for
subjectStatus
is
"example"
so
that
local
use-cases
could
also
include
their
own
states
to
capture
things
like
a
"waiting"
status
if
they
decide
to
capture
this
in
their
specific
workflow.
Subjects that have left without being seen would have a subjectStatus of departed, or possibly an implementer-specific code, while the Encounter.status could be completed or cancelled, depending on whether the patient had received some care before leaving, or other local business rules that could impact billing.
The
"on-leave"
subject
status
might
or
might
not
be
a
part
of
the
admission,
for
example
if
the
patient
was
permitted
to
go
home
for
a
weekend
or
some
other
form
of
external
event.
During
this
time
the
encounter
status
itself
might
be
marked
as
"on-hold".
Local
systems
may
have
multiple
different
types
of
leave/hold
and
these
can
use
appropriate
combinations
fo
the
status/subjectStatus
fields
to
represent
this.
The
location
is
also
likely
to
be
filled
in
with
a
location
status
of
"active".
For
other
examples
such
as
an
outpatient
visit
(day
procedure
-
colonoscopy),
the
patient
could
also
be
considered
to
be
admitted,
hence
the
encounter
doesn't
have
a
fixed
definition
of
admitted.
At
a
minimum,
we
do
believe
that
a
patient
IS
admitted
when
the
status
is
in-progress.
The
Encounter
resource
is
not
to
be
used
to
store
appointment
information,
the
Appointment
resource
is
intended
to
be
used
for
that.
Note
that
in
many
systems
outpatient
encounters
(which
are
in
scope
for
Encounter)
and
Appointment
are
used
concurrently.
In
FHIR,
Appointment
is
used
for
establishing
a
date
for
the
encounter,
while
Encounter
is
applicable
to
information
about
the
actual
Encounter,
i.e.,
the
patient
showing
up.
As
such,
an
encounter
in
the
"planned"
status
is
not
identical
to
the
appointment
that
scheduled
it,
but
it
is
the
encounter
prior
to
its
actual
occurrence,
with
the
expectation
that
encounter
will
be
updated
as
it
progresses
to
completion.
Patient
arrival
at
a
location
does
not
necessarily
mean
the
start
of
the
encounter
(e.g.
a
patient
arrives
an
hour
earlier
than
he
is
actually
seen
by
a
practitioner).
An
appointment
is
normally
used
for
the
planning
stage
of
an
appointment,
searching,
locating
an
available
time,
then
making
the
appointment.
Once
this
process
is
completed
and
the
appointment
is
about
to
start,
then
the
appointment
will
be
marked
as
fulfilled,
and
linked
to
the
newly
created
encounter.
This
new
encounter
may
start
in
an
"arrived"
status
when
they
are
admitted
at
a
location
of
the
facility,
and
then
will
move
to
the
ward
where
another
part-of
encounter
may
begin.
Communication
resources
are
used
for
a
simultaneous
interaction
between
a
practitioner
and
a
patient
where
there
is
no
direct
contact.
Examples
include
a
phone
message,
or
transmission
of
some
correspondence
documentation.
There
is
no
duration
recorded
for
a
communication
resource,
but
it
could
contain
sent
and
received
times.
Standard
Extension:
Associated
Encounter
This
extension
should
be
used
to
reference
an
encounter
where
there
is
no
property
that
already
defines
this
association
on
the
resource.
Structure
| Name | Flags | Card. | Type |
Description
&
Constraints
Filter:
|
||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Encounter
|
TU | DomainResource |
An
interaction
during
which
services
are
provided
to
the
patient
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension |
|||||||||
identifier
|
Σ | 0..* | Identifier |
Identifier(s)
by
which
this
encounter
is
known
|
||||||||
status
|
?! Σ | 1..1 | code |
planned
|
in-progress
|
on-hold
|
discharged
|
completed
|
cancelled
|
discontinued
|
entered-in-error
|
unknown
Binding: Encounter Status ( Required ) |
||||||||
businessStatus
| 0..* | BackboneElement |
A
granular,
workflows
specific
set
of
statuses
that
apply
to
the
encounter
| |||||||||
code
| 1..1 | CodeableConcept |
The
current
business
status
Binding: BusinessStatus ( Example )
| |||||||||
|
type
| 0..1 | Coding |
The
kind
of
workflow
the
status
is
tracking
Binding: Encounter Business Status Type ( Example ) | |||||||||
effectiveDate
| 0..1 | dateTime |
When
the
encounter
entered
this
business
status
| |||||||||
|
class
|
Σ | 0..* | CodeableConcept |
Classification
of
patient
encounter
context
-
e.g.
Inpatient,
outpatient
Binding: Encounter class
(
Preferred
)
|
||||||||
|
priority
|
0..1 | CodeableConcept |
Indicates
the
urgency
of
the
encounter
Binding: ActPriority
(
Example
)
|
|||||||||
|
type
|
Σ | 0..* | CodeableConcept |
Specific
type
of
encounter
(e.g.
e-mail
consultation,
surgical
day-care,
...)
Binding: Encounter Type ( Example ) |
||||||||
serviceType
|
Σ | 0..* | CodeableReference ( HealthcareService ) |
Specific
type
of
service
Binding: Service Type ( Example ) |
||||||||
|
subject
|
Σ | 0..1 | Reference ( Patient | Group ) |
The
patient
or
group
related
to
this
encounter
|
||||||||
|
subjectStatus
|
0..1 | CodeableConcept |
The
current
status
of
the
subject
in
relation
to
the
Encounter
Binding: Encounter Subject Status ( Example ) |
|||||||||
|
episodeOfCare
|
Σ | 0..* | Reference ( EpisodeOfCare ) |
Episode(s)
of
care
that
this
encounter
should
be
recorded
against
|
||||||||
|
basedOn
|
0..* | Reference ( CarePlan | DeviceRequest | MedicationRequest | ServiceRequest | RequestOrchestration | NutritionOrder | VisionPrescription ) |
The
request
that
initiated
this
encounter
|
|||||||||
|
careTeam
|
0..* | Reference ( CareTeam ) |
The
group(s)
that
are
allocated
to
participate
in
this
encounter
|
|||||||||
|
partOf
|
0..1 | Reference ( Encounter ) |
Another
Encounter
this
encounter
is
part
of
|
|||||||||
|
serviceProvider
|
0..1 | Reference ( Organization ) |
The
organization
(facility)
responsible
for
this
encounter
|
|||||||||
|
participant
|
Σ C | 0..* | BackboneElement |
List
of
participants
involved
in
the
encounter
+ Rule: A type must be provided when no explicit actor is specified + Rule: A type cannot be provided for a patient or group participant |
||||||||
|
type
|
Σ C | 0..* | CodeableConcept |
Role
of
participant
in
encounter
Binding: Participant Type ( Extensible ) |
||||||||
|
period
|
0..1 | Period |
Period
of
time
during
the
encounter
that
the
participant
participated
|
|||||||||
|
actor
|
Σ C | 0..1 | Reference ( Patient | Group | RelatedPerson | Practitioner | PractitionerRole | Device | HealthcareService ) |
The
individual,
device,
or
service
participating
in
the
encounter
|
||||||||
|
appointment
|
Σ | 0..* | Reference ( Appointment ) |
The
appointment
that
scheduled
this
encounter
|
||||||||
|
virtualService
|
0..* | VirtualServiceDetail |
Connection
details
of
a
virtual
service
(e.g.
conference
call)
|
|||||||||
|
actualPeriod
|
0..1 | Period |
The
actual
start
and
end
time
of
the
encounter
|
|||||||||
|
plannedStartDate
|
0..1 | dateTime |
The
planned
start
date/time
(or
admission
date)
of
the
encounter
|
|||||||||
|
plannedEndDate
|
0..1 | dateTime |
The
planned
end
date/time
(or
discharge
date)
of
the
encounter
|
|||||||||
|
length
|
0..1 | Duration |
Actual
quantity
of
time
the
encounter
lasted
(less
time
absent)
|
|||||||||
|
reason
|
Σ | 0..* | BackboneElement |
The
list
of
medical
reasons
that
are
expected
to
be
addressed
during
the
episode
of
care
|
||||||||
|
use
|
Σ | 0..* | CodeableConcept |
What
the
reason
value
should
be
used
for/as
Binding: Encounter Reason Use ( Example ) |
||||||||
|
value
|
Σ | 0..* |
CodeableReference
(
Condition
|
DiagnosticReport
|
Observation
|
|
Reason
the
encounter
takes
place
(core
or
reference)
Binding: Encounter Reason Codes ( Preferred ) |
||||||||
|
diagnosis
|
Σ | 0..* | BackboneElement |
The
list
of
diagnosis
relevant
to
this
encounter
|
||||||||
|
condition
|
Σ | 0..* | CodeableReference ( Condition ) |
The
diagnosis
relevant
to
the
encounter
Binding: Condition/Problem/Diagnosis Codes ( Example ) |
||||||||
|
use
|
0..* | CodeableConcept |
Role
that
this
diagnosis
has
within
the
encounter
(e.g.
admission,
billing,
discharge
…)
Binding: Encounter Diagnosis Use ( Preferred ) |
|||||||||
|
account
|
0..* | Reference ( Account ) |
The
set
of
accounts
that
may
be
used
for
billing
for
this
Encounter
|
|||||||||
|
dietPreference
|
0..* | CodeableConcept |
Diet
preferences
reported
by
the
patient
Binding: Diet ( Example ) |
|||||||||
|
specialArrangement
|
0..* | CodeableConcept |
Wheelchair,
translator,
stretcher,
etc
Binding: Special Arrangements ( Preferred ) |
|||||||||
|
specialCourtesy
|
0..* | CodeableConcept |
Special
courtesies
(VIP,
board
member)
Binding: Special Courtesy ( Preferred ) |
|||||||||
|
admission
|
0..1 | BackboneElement |
Details
about
the
admission
to
a
healthcare
service
|
|||||||||
|
preAdmissionIdentifier
|
0..1 | Identifier |
Pre-admission
identifier
|
|||||||||
|
origin
|
0..1 | Reference ( Location | Organization ) |
The
location/organization
from
which
the
patient
came
before
admission
|
|||||||||
|
admitSource
|
0..1 | CodeableConcept |
From
where
patient
was
admitted
(physician
referral,
transfer)
Binding: Admit Source ( Preferred ) |
|||||||||
|
reAdmission
|
0..1 | CodeableConcept |
Indicates
that
the
patient
is
being
re-admitted
Binding: hl7VS-re-admissionIndicator
(
Example
)
|
|||||||||
|
destination
|
0..1 | Reference ( Location | Organization ) |
Location/organization
to
which
the
patient
is
discharged
|
|||||||||
|
dischargeDisposition
|
0..1 | CodeableConcept |
Category
or
kind
of
location
after
discharge
Binding: Discharge Disposition ( Example ) |
|||||||||
location
|
0..* | BackboneElement |
List
of
locations
where
the
patient
has
been
|
|||||||||
location
|
1..1 | Reference ( Location ) |
Location
the
encounter
takes
place
|
|||||||||
|
status
|
0..1 | code |
planned
|
active
|
reserved
|
completed
Binding: Encounter Location Status ( Required ) |
|||||||||
|
form
|
0..1 | CodeableConcept |
The
physical
type
of
the
location
(usually
the
level
in
the
location
hierarchy
-
bed,
room,
ward,
virtual
etc.)
Binding: Location Form ( Example ) |
|||||||||
|
period
|
0..1 | Period |
Time
period
during
which
the
patient
was
present
at
the
location
|
|||||||||
|
Documentation
for
this
format
|
||||||||||||
See the Extensions for this resource
UML Diagram ( Legend )
XML Template
<Encounter xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known --></identifier> <status value="[code]"/><!-- 1..1 planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown -->
<</class> <</priority><businessStatus> <!-- 0..* A granular, workflows specific set of statuses that apply to the encounter --> <code><!-- 1..1 CodeableConcept The current business status --></code> <type><!-- 0..1 Coding The kind of workflow the status is tracking --></type> <effectiveDate value="[dateTime]"/><!-- 0..1 When the encounter entered this business status --> </businessStatus> <class><!-- 0..* CodeableConcept Classification of patient encounter context - e.g. Inpatient, outpatient</basedOn>NutritionOrder|RequestOrchestration|ServiceRequest|VisionPrescription) The request that initiated this encounter --></basedOn> <careTeam><!-- 0..* Reference(CareTeam) The group(s) that are allocated to participate in this encounter --></careTeam> <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf> <serviceProvider><!-- 0..1 Reference(Organization) The organization (facility) responsible for this encounter --></serviceProvider> <participant> <!-- 0..* List of participants involved in the encounter --> <type><!-- I 0..* CodeableConcept Role of participant in encounter --></type> <period><!-- 0..1 Period Period of time during the encounter that the participant participated --></period> <actor><!-- I 0..1 Reference(Device|Group|HealthcareService|Patient|Practitioner| PractitionerRole|RelatedPerson) The individual, device, or service participating in the encounter --></actor> </participant> <appointment><!-- 0..* Reference(Appointment) The appointment that scheduled this encounter --></appointment> <virtualService><!-- 0..* VirtualServiceDetail Connection details of a virtual service (e.g. conference call) --></virtualService> <actualPeriod><!-- 0..1 Period The actual start and end time of the encounter --></actualPeriod> <plannedStartDate value="[dateTime]"/><!-- 0..1 The planned start date/time (or admission date) of the encounter --> <plannedEndDate value="[dateTime]"/><!-- 0..1 The planned end date/time (or discharge date) of the encounter --><<a href="encounter-definitions.html#Encounter.length" title="Actual quantity of time the encounter lasted. This excludes the time during leaves of absence. When missing it is the time in between the start and end values." class="dict"></length><length><!-- 0..1 Duration Actual quantity of time the encounter lasted (less time absent) --></length> <reason> <!-- 0..* The list of medical reasons that are expected to be addressed during the episode of care --> <use><!-- 0..* CodeableConcept What the reason value should be used for/as --></use><| </value><value><!-- 0..* CodeableReference(Condition|DiagnosticReport|Observation| Procedure) Reason the encounter takes place (core or reference) --></value> </reason> <diagnosis> <!-- 0..* The list of diagnosis relevant to this encounter --> <condition><!-- 0..* CodeableReference(Condition) The diagnosis relevant to the encounter --></condition> <use><!-- 0..* CodeableConcept Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) --></use> </diagnosis> <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account> <dietPreference><!-- 0..* CodeableConcept Diet preferences reported by the patient --></dietPreference> <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc --></specialArrangement> <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy><<a href="encounter-definitions.html#Encounter.admission" title="Details about the stay during which a healthcare service is provided. This does not describe the event of admitting the patient, but rather any information that is relevant from the time of admittance until the time of discharge." class="dict"><admission> <!-- 0..1 Details about the admission to a healthcare service --> <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier> <origin><!-- 0..1 Reference(Location|Organization) The location/organization from which the patient came before admission --></origin> <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource><</reAdmission><reAdmission><!-- 0..1 CodeableConcept Indicates that the patient is being re-admitted
JSON Template
{
"resourceType" : "Encounter",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
"status" : "<code>", // R! planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown
"
"
"businessStatus" : [{ // A granular, workflows specific set of statuses that apply to the encounter
"code" : { CodeableConcept }, // R! The current business status
"type" : { Coding }, // The kind of workflow the status is tracking
"effectiveDate" : "<dateTime>" // When the encounter entered this business status
}],
"class" : [{ CodeableConcept }], // Classification of patient encounter context - e.g. Inpatient, outpatient
"priority" : { CodeableConcept }, // Indicates the urgency of the encounter
"type" : [{ CodeableConcept }], // Specific type of encounter (e.g. e-mail consultation, surgical day-care, ...)
"serviceType" : [{ CodeableReference(HealthcareService) }], // Specific type of service
"subject" : { Reference(Group|Patient) }, // The patient or group related to this encounter
"subjectStatus" : { CodeableConcept }, // The current status of the subject in relation to the Encounter
"episodeOfCare" : [{ Reference(EpisodeOfCare) }], // Episode(s) of care that this encounter should be recorded against
"basedOn" : [{ Reference(CarePlan|DeviceRequest|MedicationRequest|
NutritionOrder|RequestOrchestration|ServiceRequest|VisionPrescription) }], // The request that initiated this encounter
"careTeam" : [{ Reference(CareTeam) }], // The group(s) that are allocated to participate in this encounter
"partOf" : { Reference(Encounter) }, // Another Encounter this encounter is part of
"serviceProvider" : { Reference(Organization) }, // The organization (facility) responsible for this encounter
"participant" : [{ // List of participants involved in the encounter
"type" : [{ CodeableConcept }], // I Role of participant in encounter
"period" : { Period }, // Period of time during the encounter that the participant participated
"actor" : { Reference(Device|Group|HealthcareService|Patient|Practitioner|
PractitionerRole|RelatedPerson) } // I The individual, device, or service participating in the encounter
}],
"appointment" : [{ Reference(Appointment) }], // The appointment that scheduled this encounter
"virtualService" : [{ VirtualServiceDetail }], // Connection details of a virtual service (e.g. conference call)
"actualPeriod" : { Period }, // The actual start and end time of the encounter
"plannedStartDate" : "<dateTime>", // The planned start date/time (or admission date) of the encounter
"plannedEndDate" : "<dateTime>", // The planned end date/time (or discharge date) of the encounter
"<a href="encounter-definitions.html#Encounter.length" title="Actual quantity of time the encounter lasted. This excludes the time during leaves of absence.
When missing it is the time in between the start and end values." class="dict">length
"length" : { Duration }, // Actual quantity of time the encounter lasted (less time absent)
"reason" : [{ // The list of medical reasons that are expected to be addressed during the episode of care
"use" : [{ CodeableConcept }], // What the reason value should be used for/as
"|
"value" : [{ CodeableReference(Condition|DiagnosticReport|Observation|
Procedure) }] // Reason the encounter takes place (core or reference)
}],
"diagnosis" : [{ // The list of diagnosis relevant to this encounter
"condition" : [{ CodeableReference(Condition) }], // The diagnosis relevant to the encounter
"use" : [{ CodeableConcept }] // Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
}],
"account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
"dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
"specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc
"specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
"<a href="encounter-definitions.html#Encounter.admission" title="Details about the stay during which a healthcare service is provided.
This does not describe the event of admitting the patient, but rather any information that is relevant from the time of admittance until the time of discharge." class="dict">admission
"admission" : { // Details about the admission to a healthcare service
"preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
"origin" : { Reference(Location|Organization) }, // The location/organization from which the patient came before admission
"admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
"
"reAdmission" : { CodeableConcept }, // Indicates that the patient is being re-admitted
"destination" : { Reference(Location|Organization) }, // Location/organization to which the patient is discharged
"dischargeDisposition" : { CodeableConcept } // Category or kind of location after discharge
},
"location" : [{ // List of locations where the patient has been
"location" : { Reference(Location) }, // R! Location the encounter takes place
"status" : "<code>", // planned | active | reserved | completed
"form" : { CodeableConcept }, // The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.)
"period" : { Period } // Time period during which the patient was present at the location
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .# from # from# from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension fhir:identifier ( [ Identifier ] ... ) ; # 0..* Identifier(s) by which this encounter is known fhir:status [ code ] ; # 1..1 planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown fhir:businessStatus ( [ # 0..* A granular, workflows specific set of statuses that apply to the encounter fhir:code [ CodeableConcept ] ; # 1..1 The current business status fhir:type [ Coding ] ; # 0..1 The kind of workflow the status is tracking fhir:effectiveDate [ dateTime ] ; # 0..1 When the encounter entered this business status ] ... ) ; fhir:class ( [ CodeableConcept ] ... ) ; # 0..* Classification of patient encounter context - e.g. Inpatient, outpatient fhir:priority [ CodeableConcept ] ; # 0..1 Indicates the urgency of the encounter fhir:type ( [ CodeableConcept ] ... ) ; # 0..* Specific type of encounter (e.g. e-mail consultation, surgical day-care, ...) fhir:serviceType ( [ CodeableReference(HealthcareService) ] ... ) ; # 0..* Specific type of service fhir:subject [ Reference(Group|Patient) ] ; # 0..1 The patient or group related to this encounter fhir:subjectStatus [ CodeableConcept ] ; # 0..1 The current status of the subject in relation to the Encounter fhir:episodeOfCare ( [ Reference(EpisodeOfCare) ] ... ) ; # 0..* Episode(s) of care that this encounter should be recorded againstfhir:fhir:basedOn ( [ Reference(CarePlan|DeviceRequest|MedicationRequest|NutritionOrder|RequestOrchestration| ServiceRequest|VisionPrescription) ] ... ) ; # 0..* The request that initiated this encounter fhir:careTeam ( [ Reference(CareTeam) ] ... ) ; # 0..* The group(s) that are allocated to participate in this encounter fhir:partOf [ Reference(Encounter) ] ; # 0..1 Another Encounter this encounter is part of fhir:serviceProvider [ Reference(Organization) ] ; # 0..1 The organization (facility) responsible for this encounter fhir:participant ( [ # 0..* List of participants involved in the encounter fhir:type ( [ CodeableConcept ] ... ) ; # 0..* I Role of participant in encounter fhir:period [ Period ] ; # 0..1 Period of time during the encounter that the participant participated fhir:actor [ Reference(Device|Group|HealthcareService|Patient|Practitioner|PractitionerRole| RelatedPerson) ] ; # 0..1 I The individual, device, or service participating in the encounter ] ... ) ; fhir:appointment ( [ Reference(Appointment) ] ... ) ; # 0..* The appointment that scheduled this encounter fhir:virtualService ( [ VirtualServiceDetail ] ... ) ; # 0..* Connection details of a virtual service (e.g. conference call) fhir:actualPeriod [ Period ] ; # 0..1 The actual start and end time of the encounter fhir:plannedStartDate [ dateTime ] ; # 0..1 The planned start date/time (or admission date) of the encounter fhir:plannedEndDate [ dateTime ] ; # 0..1 The planned end date/time (or discharge date) of the encounterfhir:<a href="encounter-definitions.html#Encounter.length" title="Actual quantity of time the encounter lasted. This excludes the time during leaves of absence. When missing it is the time in between the start and end values." class="dict">lengthfhir:length [ Duration ] ; # 0..1 Actual quantity of time the encounter lasted (less time absent) fhir:reason ( [ # 0..* The list of medical reasons that are expected to be addressed during the episode of care fhir:use ( [ CodeableConcept ] ... ) ; # 0..* What the reason value should be used for/asfhir:fhir:value ( [ CodeableReference(Condition|DiagnosticReport|Observation|Procedure) ] ... ) ; # 0..* Reason the encounter takes place (core or reference) ] ... ) ; fhir:diagnosis ( [ # 0..* The list of diagnosis relevant to this encounter fhir:condition ( [ CodeableReference(Condition) ] ... ) ; # 0..* The diagnosis relevant to the encounter fhir:use ( [ CodeableConcept ] ... ) ; # 0..* Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) ] ... ) ; fhir:account ( [ Reference(Account) ] ... ) ; # 0..* The set of accounts that may be used for billing for this Encounter fhir:dietPreference ( [ CodeableConcept ] ... ) ; # 0..* Diet preferences reported by the patient fhir:specialArrangement ( [ CodeableConcept ] ... ) ; # 0..* Wheelchair, translator, stretcher, etc fhir:specialCourtesy ( [ CodeableConcept ] ... ) ; # 0..* Special courtesies (VIP, board member)fhir:<a href="encounter-definitions.html#Encounter.admission" title="Details about the stay during which a healthcare service is provided. This does not describe the event of admitting the patient, but rather any information that is relevant from the time of admittance until the time of discharge." class="dict">admissionfhir:admission [ # 0..1 Details about the admission to a healthcare service fhir:preAdmissionIdentifier [ Identifier ] ; # 0..1 Pre-admission identifier fhir:origin [ Reference(Location|Organization) ] ; # 0..1 The location/organization from which the patient came before admission fhir:admitSource [ CodeableConcept ] ; # 0..1 From where patient was admitted (physician referral, transfer) fhir:reAdmission [ CodeableConcept ] ; # 0..1 Indicates that the patient is being re-admitted fhir:destination [ Reference(Location|Organization) ] ; # 0..1 Location/organization to which the patient is discharged fhir:dischargeDisposition [ CodeableConcept ] ; # 0..1 Category or kind of location after discharge ] ; fhir:location ( [ # 0..* List of locations where the patient has been fhir:location [ Reference(Location) ] ; # 1..1 Location the encounter takes place fhir:status [ code ] ; # 0..1 planned | active | reserved | completed fhir:form [ CodeableConcept ] ; # 0..1 The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.) fhir:period [ Period ] ; # 0..1 Time period during which the patient was present at the location ] ... ) ; ]
Changes from both R4 and R4B
| Encounter | |
| Encounter.status |
|
| Encounter.businessStatus |
|
| Encounter.businessStatus.code |
|
| Encounter.businessStatus.type |
|
| Encounter.businessStatus.effectiveDate |
|
| Encounter.class |
|
| Encounter.serviceType |
|
| Encounter.subjectStatus |
|
| Encounter.basedOn |
|
| Encounter.careTeam |
|
| Encounter.participant.actor |
|
| Encounter.virtualService |
|
| Encounter.actualPeriod |
|
| Encounter.plannedStartDate |
|
| Encounter.plannedEndDate |
|
| Encounter.reason |
|
| Encounter.reason.use |
|
| Encounter.reason.value |
|
| Encounter.diagnosis.condition |
|
| Encounter.diagnosis.use |
|
| Encounter.dietPreference |
|
| Encounter.specialArrangement |
|
| Encounter.specialCourtesy |
|
| Encounter.admission |
|
| Encounter.admission.preAdmissionIdentifier |
|
| Encounter.admission.origin |
|
| Encounter.admission.admitSource |
|
| Encounter.admission.reAdmission |
|
| Encounter.admission.destination |
|
| Encounter.admission.dischargeDisposition |
|
| Encounter.location.form |
|
| Encounter.statusHistory |
|
| Encounter.classHistory |
|
| Encounter.reasonReference |
|
| Encounter.diagnosis.rank |
|
See the Full Difference for further information
This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .
Structure
| Name | Flags | Card. | Type |
Description
&
Constraints
Filter:
|
||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Encounter
|
TU | DomainResource |
An
interaction
during
which
services
are
provided
to
the
patient
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension |
|||||||||
|
identifier
|
Σ | 0..* | Identifier |
Identifier(s)
by
which
this
encounter
is
known
|
||||||||
|
status
|
?! Σ | 1..1 | code |
planned
|
in-progress
|
on-hold
|
discharged
|
completed
|
cancelled
|
discontinued
|
entered-in-error
|
unknown
Binding: Encounter Status ( Required ) |
||||||||
|
businessStatus
| 0..* | BackboneElement |
A
granular,
workflows
specific
set
of
statuses
that
apply
to
the
encounter
| |||||||||
|
code
| 1..1 | CodeableConcept |
The
current
business
status
Binding: BusinessStatus ( Example )
| |||||||||
|
type
| 0..1 | Coding |
The
kind
of
workflow
the
status
is
tracking
Binding: Encounter Business Status Type ( Example ) | |||||||||
|
effectiveDate
| 0..1 | dateTime |
When
the
encounter
entered
this
business
status
| |||||||||
|
class
|
Σ | 0..* | CodeableConcept |
Classification
of
patient
encounter
context
-
e.g.
Inpatient,
outpatient
Binding: Encounter class
(
Preferred
)
|
||||||||
|
priority
|
0..1 | CodeableConcept |
Indicates
the
urgency
of
the
encounter
Binding: ActPriority
(
Example
)
|
|||||||||
|
type
|
Σ | 0..* | CodeableConcept |
Specific
type
of
encounter
(e.g.
e-mail
consultation,
surgical
day-care,
...)
Binding: Encounter Type ( Example ) |
||||||||
|
serviceType
|
Σ | 0..* | CodeableReference ( HealthcareService ) |
Specific
type
of
service
Binding: Service Type ( Example ) |
||||||||
|
subject
|
Σ | 0..1 | Reference ( Patient | Group ) |
The
patient
or
group
related
to
this
encounter
|
||||||||
|
subjectStatus
|
0..1 | CodeableConcept |
The
current
status
of
the
subject
in
relation
to
the
Encounter
Binding: Encounter Subject Status ( Example ) |
|||||||||
|
episodeOfCare
|
Σ | 0..* | Reference ( EpisodeOfCare ) |
Episode(s)
of
care
that
this
encounter
should
be
recorded
against
|
||||||||
|
basedOn
|
0..* | Reference ( CarePlan | DeviceRequest | MedicationRequest | ServiceRequest | RequestOrchestration | NutritionOrder | VisionPrescription ) |
The
request
that
initiated
this
encounter
|
|||||||||
|
careTeam
|
0..* | Reference ( CareTeam ) |
The
group(s)
that
are
allocated
to
participate
in
this
encounter
|
|||||||||
|
partOf
|
0..1 | Reference ( Encounter ) |
Another
Encounter
this
encounter
is
part
of
|
|||||||||
|
serviceProvider
|
0..1 | Reference ( Organization ) |
The
organization
(facility)
responsible
for
this
encounter
|
|||||||||
|
participant
|
Σ C | 0..* | BackboneElement |
List
of
participants
involved
in
the
encounter
+ Rule: A type must be provided when no explicit actor is specified + Rule: A type cannot be provided for a patient or group participant |
||||||||
|
type
|
Σ C | 0..* | CodeableConcept |
Role
of
participant
in
encounter
Binding: Participant Type ( Extensible ) |
||||||||
|
period
|
0..1 | Period |
Period
of
time
during
the
encounter
that
the
participant
participated
|
|||||||||
|
actor
|
Σ C | 0..1 | Reference ( Patient | Group | RelatedPerson | Practitioner | PractitionerRole | Device | HealthcareService ) |
The
individual,
device,
or
service
participating
in
the
encounter
|
||||||||
|
appointment
|
Σ | 0..* | Reference ( Appointment ) |
The
appointment
that
scheduled
this
encounter
|
||||||||
|
virtualService
|
0..* | VirtualServiceDetail |
Connection
details
of
a
virtual
service
(e.g.
conference
call)
|
|||||||||
|
actualPeriod
|
0..1 | Period |
The
actual
start
and
end
time
of
the
encounter
|
|||||||||
|
plannedStartDate
|
0..1 | dateTime |
The
planned
start
date/time
(or
admission
date)
of
the
encounter
|
|||||||||
|
plannedEndDate
|
0..1 | dateTime |
The
planned
end
date/time
(or
discharge
date)
of
the
encounter
|
|||||||||
|
length
|
0..1 | Duration |
Actual
quantity
of
time
the
encounter
lasted
(less
time
absent)
|
|||||||||
|
reason
|
Σ | 0..* | BackboneElement |
The
list
of
medical
reasons
that
are
expected
to
be
addressed
during
the
episode
of
care
|
||||||||
|
use
|
Σ | 0..* | CodeableConcept |
What
the
reason
value
should
be
used
for/as
Binding: Encounter Reason Use ( Example ) |
||||||||
|
value
|
Σ | 0..* |
CodeableReference
(
Condition
|
DiagnosticReport
|
Observation
|
|
Reason
the
encounter
takes
place
(core
or
reference)
Binding: Encounter Reason Codes ( Preferred ) |
||||||||
|
diagnosis
|
Σ | 0..* | BackboneElement |
The
list
of
diagnosis
relevant
to
this
encounter
|
||||||||
|
condition
|
Σ | 0..* | CodeableReference ( Condition ) |
The
diagnosis
relevant
to
the
encounter
Binding: Condition/Problem/Diagnosis Codes ( Example ) |
||||||||
|
use
|
0..* | CodeableConcept |
Role
that
this
diagnosis
has
within
the
encounter
(e.g.
admission,
billing,
discharge
…)
Binding: Encounter Diagnosis Use ( Preferred ) |
|||||||||
|
account
|
0..* | Reference ( Account ) |
The
set
of
accounts
that
may
be
used
for
billing
for
this
Encounter
|
|||||||||
|
dietPreference
|
0..* | CodeableConcept |
Diet
preferences
reported
by
the
patient
Binding: Diet ( Example ) |
|||||||||
|
specialArrangement
|
0..* | CodeableConcept |
Wheelchair,
translator,
stretcher,
etc
Binding: Special Arrangements ( Preferred ) |
|||||||||
|
specialCourtesy
|
0..* | CodeableConcept |
Special
courtesies
(VIP,
board
member)
Binding: Special Courtesy ( Preferred ) |
|||||||||
|
admission
|
0..1 | BackboneElement |
Details
about
the
admission
to
a
healthcare
service
|
|||||||||
|
preAdmissionIdentifier
|
0..1 | Identifier |
Pre-admission
identifier
|
|||||||||
|
origin
|
0..1 | Reference ( Location | Organization ) |
The
location/organization
from
which
the
patient
came
before
admission
|
|||||||||
|
admitSource
|
0..1 | CodeableConcept |
From
where
patient
was
admitted
(physician
referral,
transfer)
Binding: Admit Source ( Preferred ) |
|||||||||
|
reAdmission
|
0..1 | CodeableConcept |
Indicates
that
the
patient
is
being
re-admitted
Binding: hl7VS-re-admissionIndicator
(
Example
)
|
|||||||||
|
destination
|
0..1 | Reference ( Location | Organization ) |
Location/organization
to
which
the
patient
is
discharged
|
|||||||||
|
dischargeDisposition
|
0..1 | CodeableConcept |
Category
or
kind
of
location
after
discharge
Binding: Discharge Disposition ( Example ) |
|||||||||
|
location
|
0..* | BackboneElement |
List
of
locations
where
the
patient
has
been
|
|||||||||
|
location
|
1..1 | Reference ( Location ) |
Location
the
encounter
takes
place
|
|||||||||
|
status
|
0..1 | code |
planned
|
active
|
reserved
|
completed
Binding: Encounter Location Status ( Required ) |
|||||||||
|
form
|
0..1 | CodeableConcept |
The
physical
type
of
the
location
(usually
the
level
in
the
location
hierarchy
-
bed,
room,
ward,
virtual
etc.)
Binding: Location Form ( Example ) |
|||||||||
|
period
|
0..1 | Period |
Time
period
during
which
the
patient
was
present
at
the
location
|
|||||||||
|
Documentation
for
this
format
|
||||||||||||
See the Extensions for this resource
XML Template
<Encounter xmlns="http://hl7.org/fhir"><</class> <</priority><businessStatus> <!-- 0..* A granular, workflows specific set of statuses that apply to the encounter --> <code><!-- 1..1 CodeableConcept The current business status --></code> <type><!-- 0..1 Coding The kind of workflow the status is tracking --></type> <effectiveDate value="[dateTime]"/><!-- 0..1 When the encounter entered this business status --> </businessStatus> <class><!-- 0..* CodeableConcept Classification of patient encounter context - e.g. Inpatient, outpatient</basedOn>NutritionOrder|RequestOrchestration|ServiceRequest|VisionPrescription) The request that initiated this encounter --></basedOn> <careTeam><!-- 0..* Reference(CareTeam) The group(s) that are allocated to participate in this encounter --></careTeam> <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf> <serviceProvider><!-- 0..1 Reference(Organization) The organization (facility) responsible for this encounter --></serviceProvider> <participant> <!-- 0..* List of participants involved in the encounter --> <type><!-- I 0..* CodeableConcept Role of participant in encounter --></type> <period><!-- 0..1 Period Period of time during the encounter that the participant participated --></period> <actor><!-- I 0..1 Reference(Device|Group|HealthcareService|Patient|Practitioner| PractitionerRole|RelatedPerson) The individual, device, or service participating in the encounter --></actor> </participant> <appointment><!-- 0..* Reference(Appointment) The appointment that scheduled this encounter --></appointment> <virtualService><!-- 0..* VirtualServiceDetail Connection details of a virtual service (e.g. conference call) --></virtualService> <actualPeriod><!-- 0..1 Period The actual start and end time of the encounter --></actualPeriod> <plannedStartDate value="[dateTime]"/><!-- 0..1 The planned start date/time (or admission date) of the encounter --> <plannedEndDate value="[dateTime]"/><!-- 0..1 The planned end date/time (or discharge date) of the encounter --><<a href="encounter-definitions.html#Encounter.length" title="Actual quantity of time the encounter lasted. This excludes the time during leaves of absence. When missing it is the time in between the start and end values." class="dict"></length><length><!-- 0..1 Duration Actual quantity of time the encounter lasted (less time absent) --></length> <reason> <!-- 0..* The list of medical reasons that are expected to be addressed during the episode of care --> <use><!-- 0..* CodeableConcept What the reason value should be used for/as --></use><| </value><value><!-- 0..* CodeableReference(Condition|DiagnosticReport|Observation| Procedure) Reason the encounter takes place (core or reference) --></value> </reason> <diagnosis> <!-- 0..* The list of diagnosis relevant to this encounter --> <condition><!-- 0..* CodeableReference(Condition) The diagnosis relevant to the encounter --></condition> <use><!-- 0..* CodeableConcept Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) --></use> </diagnosis> <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account> <dietPreference><!-- 0..* CodeableConcept Diet preferences reported by the patient --></dietPreference> <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc --></specialArrangement> <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy><<a href="encounter-definitions.html#Encounter.admission" title="Details about the stay during which a healthcare service is provided. This does not describe the event of admitting the patient, but rather any information that is relevant from the time of admittance until the time of discharge." class="dict"><admission> <!-- 0..1 Details about the admission to a healthcare service --> <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier> <origin><!-- 0..1 Reference(Location|Organization) The location/organization from which the patient came before admission --></origin> <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource><</reAdmission><reAdmission><!-- 0..1 CodeableConcept Indicates that the patient is being re-admitted
JSON Template
{
"resourceType" : "Encounter",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
"status" : "<code>", // R! planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown
"
"
"businessStatus" : [{ // A granular, workflows specific set of statuses that apply to the encounter
"code" : { CodeableConcept }, // R! The current business status
"type" : { Coding }, // The kind of workflow the status is tracking
"effectiveDate" : "<dateTime>" // When the encounter entered this business status
}],
"class" : [{ CodeableConcept }], // Classification of patient encounter context - e.g. Inpatient, outpatient
"priority" : { CodeableConcept }, // Indicates the urgency of the encounter
"type" : [{ CodeableConcept }], // Specific type of encounter (e.g. e-mail consultation, surgical day-care, ...)
"serviceType" : [{ CodeableReference(HealthcareService) }], // Specific type of service
"subject" : { Reference(Group|Patient) }, // The patient or group related to this encounter
"subjectStatus" : { CodeableConcept }, // The current status of the subject in relation to the Encounter
"episodeOfCare" : [{ Reference(EpisodeOfCare) }], // Episode(s) of care that this encounter should be recorded against
"basedOn" : [{ Reference(CarePlan|DeviceRequest|MedicationRequest|
NutritionOrder|RequestOrchestration|ServiceRequest|VisionPrescription) }], // The request that initiated this encounter
"careTeam" : [{ Reference(CareTeam) }], // The group(s) that are allocated to participate in this encounter
"partOf" : { Reference(Encounter) }, // Another Encounter this encounter is part of
"serviceProvider" : { Reference(Organization) }, // The organization (facility) responsible for this encounter
"participant" : [{ // List of participants involved in the encounter
"type" : [{ CodeableConcept }], // I Role of participant in encounter
"period" : { Period }, // Period of time during the encounter that the participant participated
"actor" : { Reference(Device|Group|HealthcareService|Patient|Practitioner|
PractitionerRole|RelatedPerson) } // I The individual, device, or service participating in the encounter
}],
"appointment" : [{ Reference(Appointment) }], // The appointment that scheduled this encounter
"virtualService" : [{ VirtualServiceDetail }], // Connection details of a virtual service (e.g. conference call)
"actualPeriod" : { Period }, // The actual start and end time of the encounter
"plannedStartDate" : "<dateTime>", // The planned start date/time (or admission date) of the encounter
"plannedEndDate" : "<dateTime>", // The planned end date/time (or discharge date) of the encounter
"<a href="encounter-definitions.html#Encounter.length" title="Actual quantity of time the encounter lasted. This excludes the time during leaves of absence.
When missing it is the time in between the start and end values." class="dict">length
"length" : { Duration }, // Actual quantity of time the encounter lasted (less time absent)
"reason" : [{ // The list of medical reasons that are expected to be addressed during the episode of care
"use" : [{ CodeableConcept }], // What the reason value should be used for/as
"|
"value" : [{ CodeableReference(Condition|DiagnosticReport|Observation|
Procedure) }] // Reason the encounter takes place (core or reference)
}],
"diagnosis" : [{ // The list of diagnosis relevant to this encounter
"condition" : [{ CodeableReference(Condition) }], // The diagnosis relevant to the encounter
"use" : [{ CodeableConcept }] // Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
}],
"account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
"dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
"specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc
"specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
"<a href="encounter-definitions.html#Encounter.admission" title="Details about the stay during which a healthcare service is provided.
This does not describe the event of admitting the patient, but rather any information that is relevant from the time of admittance until the time of discharge." class="dict">admission
"admission" : { // Details about the admission to a healthcare service
"preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
"origin" : { Reference(Location|Organization) }, // The location/organization from which the patient came before admission
"admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
"
"reAdmission" : { CodeableConcept }, // Indicates that the patient is being re-admitted
"destination" : { Reference(Location|Organization) }, // Location/organization to which the patient is discharged
"dischargeDisposition" : { CodeableConcept } // Category or kind of location after discharge
},
"location" : [{ // List of locations where the patient has been
"location" : { Reference(Location) }, // R! Location the encounter takes place
"status" : "<code>", // planned | active | reserved | completed
"form" : { CodeableConcept }, // The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.)
"period" : { Period } // Time period during which the patient was present at the location
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .# from # from# from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension fhir:identifier ( [ Identifier ] ... ) ; # 0..* Identifier(s) by which this encounter is known fhir:status [ code ] ; # 1..1 planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown fhir:businessStatus ( [ # 0..* A granular, workflows specific set of statuses that apply to the encounter fhir:code [ CodeableConcept ] ; # 1..1 The current business status fhir:type [ Coding ] ; # 0..1 The kind of workflow the status is tracking fhir:effectiveDate [ dateTime ] ; # 0..1 When the encounter entered this business status ] ... ) ; fhir:class ( [ CodeableConcept ] ... ) ; # 0..* Classification of patient encounter context - e.g. Inpatient, outpatient fhir:priority [ CodeableConcept ] ; # 0..1 Indicates the urgency of the encounter fhir:type ( [ CodeableConcept ] ... ) ; # 0..* Specific type of encounter (e.g. e-mail consultation, surgical day-care, ...) fhir:serviceType ( [ CodeableReference(HealthcareService) ] ... ) ; # 0..* Specific type of service fhir:subject [ Reference(Group|Patient) ] ; # 0..1 The patient or group related to this encounter fhir:subjectStatus [ CodeableConcept ] ; # 0..1 The current status of the subject in relation to the Encounter fhir:episodeOfCare ( [ Reference(EpisodeOfCare) ] ... ) ; # 0..* Episode(s) of care that this encounter should be recorded againstfhir:fhir:basedOn ( [ Reference(CarePlan|DeviceRequest|MedicationRequest|NutritionOrder|RequestOrchestration| ServiceRequest|VisionPrescription) ] ... ) ; # 0..* The request that initiated this encounter fhir:careTeam ( [ Reference(CareTeam) ] ... ) ; # 0..* The group(s) that are allocated to participate in this encounter fhir:partOf [ Reference(Encounter) ] ; # 0..1 Another Encounter this encounter is part of fhir:serviceProvider [ Reference(Organization) ] ; # 0..1 The organization (facility) responsible for this encounter fhir:participant ( [ # 0..* List of participants involved in the encounter fhir:type ( [ CodeableConcept ] ... ) ; # 0..* I Role of participant in encounter fhir:period [ Period ] ; # 0..1 Period of time during the encounter that the participant participated fhir:actor [ Reference(Device|Group|HealthcareService|Patient|Practitioner|PractitionerRole| RelatedPerson) ] ; # 0..1 I The individual, device, or service participating in the encounter ] ... ) ; fhir:appointment ( [ Reference(Appointment) ] ... ) ; # 0..* The appointment that scheduled this encounter fhir:virtualService ( [ VirtualServiceDetail ] ... ) ; # 0..* Connection details of a virtual service (e.g. conference call) fhir:actualPeriod [ Period ] ; # 0..1 The actual start and end time of the encounter fhir:plannedStartDate [ dateTime ] ; # 0..1 The planned start date/time (or admission date) of the encounter fhir:plannedEndDate [ dateTime ] ; # 0..1 The planned end date/time (or discharge date) of the encounterfhir:<a href="encounter-definitions.html#Encounter.length" title="Actual quantity of time the encounter lasted. This excludes the time during leaves of absence. When missing it is the time in between the start and end values." class="dict">lengthfhir:length [ Duration ] ; # 0..1 Actual quantity of time the encounter lasted (less time absent) fhir:reason ( [ # 0..* The list of medical reasons that are expected to be addressed during the episode of care fhir:use ( [ CodeableConcept ] ... ) ; # 0..* What the reason value should be used for/asfhir:fhir:value ( [ CodeableReference(Condition|DiagnosticReport|Observation|Procedure) ] ... ) ; # 0..* Reason the encounter takes place (core or reference) ] ... ) ; fhir:diagnosis ( [ # 0..* The list of diagnosis relevant to this encounter fhir:condition ( [ CodeableReference(Condition) ] ... ) ; # 0..* The diagnosis relevant to the encounter fhir:use ( [ CodeableConcept ] ... ) ; # 0..* Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) ] ... ) ; fhir:account ( [ Reference(Account) ] ... ) ; # 0..* The set of accounts that may be used for billing for this Encounter fhir:dietPreference ( [ CodeableConcept ] ... ) ; # 0..* Diet preferences reported by the patient fhir:specialArrangement ( [ CodeableConcept ] ... ) ; # 0..* Wheelchair, translator, stretcher, etc fhir:specialCourtesy ( [ CodeableConcept ] ... ) ; # 0..* Special courtesies (VIP, board member)fhir:<a href="encounter-definitions.html#Encounter.admission" title="Details about the stay during which a healthcare service is provided. This does not describe the event of admitting the patient, but rather any information that is relevant from the time of admittance until the time of discharge." class="dict">admissionfhir:admission [ # 0..1 Details about the admission to a healthcare service fhir:preAdmissionIdentifier [ Identifier ] ; # 0..1 Pre-admission identifier fhir:origin [ Reference(Location|Organization) ] ; # 0..1 The location/organization from which the patient came before admission fhir:admitSource [ CodeableConcept ] ; # 0..1 From where patient was admitted (physician referral, transfer) fhir:reAdmission [ CodeableConcept ] ; # 0..1 Indicates that the patient is being re-admitted fhir:destination [ Reference(Location|Organization) ] ; # 0..1 Location/organization to which the patient is discharged fhir:dischargeDisposition [ CodeableConcept ] ; # 0..1 Category or kind of location after discharge ] ; fhir:location ( [ # 0..* List of locations where the patient has been fhir:location [ Reference(Location) ] ; # 1..1 Location the encounter takes place fhir:status [ code ] ; # 0..1 planned | active | reserved | completed fhir:form [ CodeableConcept ] ; # 0..1 The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.) fhir:period [ Period ] ; # 0..1 Time period during which the patient was present at the location ] ... ) ; ]
Changes from both R4 and R4B
| Encounter | |
| Encounter.status |
|
| Encounter.businessStatus |
|
| Encounter.businessStatus.code |
|
| Encounter.businessStatus.type |
|
| Encounter.businessStatus.effectiveDate |
|
| Encounter.class |
|
| Encounter.serviceType |
|
| Encounter.subjectStatus |
|
| Encounter.basedOn |
|
| Encounter.careTeam |
|
| Encounter.participant.actor |
|
| Encounter.virtualService |
|
| Encounter.actualPeriod |
|
| Encounter.plannedStartDate |
|
| Encounter.plannedEndDate |
|
| Encounter.reason |
|
| Encounter.reason.use |
|
| Encounter.reason.value |
|
| Encounter.diagnosis.condition |
|
| Encounter.diagnosis.use |
|
| Encounter.dietPreference |
|
| Encounter.specialArrangement |
|
| Encounter.specialCourtesy |
|
| Encounter.admission |
|
| Encounter.admission.preAdmissionIdentifier |
|
| Encounter.admission.origin |
|
| Encounter.admission.admitSource |
|
| Encounter.admission.reAdmission |
|
| Encounter.admission.destination |
|
| Encounter.admission.dischargeDisposition |
|
| Encounter.location.form |
|
| Encounter.statusHistory |
|
| Encounter.classHistory |
|
| Encounter.reasonReference |
|
| Encounter.diagnosis.rank |
|
See the Full Difference for further information
This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .
Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis
| Path | ValueSet | Type | Documentation |
|---|---|---|---|
| Encounter.status | EncounterStatus | Required |
Current state of the encounter. |
| Encounter.businessStatus.code | Example | ||
| Encounter Business Status - Inpatient | starter | Inpatient business statuses: pre-admit | pend-admit | admit | discharge | unknown | |
| Encounter Business Status - Outpatient | starter | Outpatient business statuses: check-in | check-out | |
| Encounter Business Status - Emergency | starter | Emergency business statuses: arrived | triaged | dismissed | unknown | |
| Encounter.businessStatus.type | EncounterBusinessStatusType | Example | The kind of workflow the business status is tracking. |
| Encounter.class |
EncounterClass
|
Preferred |
This value set defines a set of codes that can be used to indicate the class of encounter: a specific code indicating class of service provided. |
| Encounter.priority |
ActPriority
|
Example |
A code or set of codes (e.g., for routine, emergency,) specifying the urgency under which the Act happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. Discussion: This attribute is used in orders to indicate the ordered priority, and in event documentation it indicates the actual priority used to perform the act. In definition mood it indicates the available priorities. |
| Encounter.type | EncounterType | Example |
This example value set defines a set of codes that can be used to indicate the type of encounter: a specific code indicating type of service provided. |
| Encounter.serviceType | ServiceType | Example |
This value set defines an example set of codes of service-types. |
| Encounter.subjectStatus | EncounterSubjectStatus | Example |
This example value set defines a set of codes that can be used to indicate the status of the subject within the encounter |
| Encounter.participant.type | ParticipantType | Extensible |
This value set defines a set of codes that can be used to indicate how an individual participates in an encounter. |
| Encounter.reason.use | EncounterReasonUse | Example |
What
a
specific
Encounter/EpisodeOfCare
|
| Encounter.reason.value | EncounterReasonCodes | Preferred |
This examples value set defines the set of codes that can be used to indicate reasons for an encounter. |
| Encounter.diagnosis.condition | ConditionProblemDiagnosisCodes | Example |
Example value set for Condition/Problem/Diagnosis codes. |
| Encounter.diagnosis.use | EncounterDiagnosisUse | Preferred |
What
a
specific
Encounter/EpisodeOfCare
|
| Encounter.dietPreference |
EncounterDiet
(a
valid
code
from
Diet
)
|
Example |
This value set defines a set of codes that can be used to indicate dietary preferences or restrictions a patient may have. |
| Encounter.specialArrangement | SpecialArrangements | Preferred |
This value set defines a set of codes that can be used to indicate the kinds of special arrangements in place for a patients visit. |
| Encounter.specialCourtesy | SpecialCourtesy | Preferred |
This value set defines a set of codes that can be used to indicate special courtesies provided to the patient. |
| Encounter.admission.admitSource | AdmitSource | Preferred |
This value set defines a set of codes that can be used to indicate from where the patient came in. |
| Encounter.admission.reAdmission |
Hl7VSReAdmissionIndicator
(a
valid
code
from
re-admissionIndicator
)
|
Example |
Value Set of codes which are used to specify that a patient is being re-admitted to a healthcare facility from which they were discharged, and indicates the circumstances around such re-admission. |
| Encounter.admission.dischargeDisposition | DischargeDisposition | Example |
This value set defines a set of codes that can be used to where the patient left the hospital. |
| Encounter.location.status | EncounterLocationStatus | Required |
The status of the location. |
| Encounter.location.form |
LocationForm
(a
valid
code
from
Location
type
)
|
Example |
This example value set defines a set of codes that can be used to indicate the physical form of the Location. |
| UniqueKey | Level | Location | Description | Expression |
enc-1
|
Rule | Encounter.participant | A type must be provided when no explicit actor is specified | actor.exists() or type.exists() |
|
enc-2
|
Rule | Encounter.participant | A type cannot be provided for a patient or group participant | actor.exists(resolve() is Patient or resolve() is Group) implies type.exists().not() |
As stated, Encounter allows a flexible nesting of Encounters using the partOf element. For example:
Exactly how the Encounter is used depends on information available in the source system, the relevance of exchange of each level of Encounter and demands specific to the communicating partners. The expectation is that for each domain of exchange, profiles are used to limit the flexibility of Encounter to meet the demands of the use case.
Search parameters for this resource. See also the full list of search parameters for this resource , and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| account | reference | The set of accounts that may be used for billing for this Encounter |
Encounter.account
( Account ) |
|
| appointment | reference | The appointment that scheduled this encounter |
Encounter.appointment
( Appointment ) |
|
| based-on | reference | The ServiceRequest that initiated this encounter |
Encounter.basedOn
( CarePlan , MedicationRequest , RequestOrchestration , NutritionOrder , VisionPrescription , DeviceRequest , ServiceRequest ) |
|
| business-status | token | The current business status of the Encounter | Encounter.businessStatus.code | |
| careteam | reference | Careteam allocated to participate in the encounter |
Encounter.careTeam
( CareTeam ) |
|
| class | token | Classification of patient encounter | Encounter.class | |
| date | date | A date within the actualPeriod the Encounter lasted | Encounter.actualPeriod |
|
| date-start | date | The actual start date of the Encounter | Encounter.actualPeriod.start | |
| diagnosis-code | token | The diagnosis or procedure relevant to the encounter (coded) | Encounter.diagnosis.condition.concept | |
| diagnosis-reference | reference | The diagnosis or procedure relevant to the encounter (resource reference) | Encounter.diagnosis.condition.reference | |
| end-date | date | The actual end date of the Encounter | Encounter.actualPeriod.end | |
| episode-of-care | reference | Episode(s) of care that this encounter should be recorded against |
Encounter.episodeOfCare
( EpisodeOfCare ) |
|
| identifier | token | Identifier(s) by which this encounter is known | Encounter.identifier |
|
| length | quantity | Length of encounter in days | Encounter.length | |
| location | reference | Location the encounter takes place |
Encounter.location.location
( Location ) |
|
| location-period | date | Time period during which the patient was present at a location (generally used via composite location-period) | Encounter.location.period | |
| location-value-period | composite | Time period during which the patient was present at the location |
On
Encounter.location:
location: |
|
| part-of | reference | Another Encounter this encounter is part of |
Encounter.partOf
( Encounter ) |
|
| participant | reference | Persons involved in the encounter other than the patient |
Encounter.participant.actor
( Practitioner , Group , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson ) |
|
| participant-type | token | Role of participant in encounter | Encounter.participant.type | |
| patient | reference | The patient present at the encounter |
Encounter.subject.where(resolve()
is
Patient)
( Patient ) |
|
| practitioner | reference | Persons involved in the encounter other than the patient |
Encounter.participant.actor.where(resolve()
is
Practitioner)
( Practitioner ) |
|
| reason-code | token | Reference to a concept (coded) | Encounter.reason.value.concept | |
| reason-reference | reference | Reference to a resource (resource reference) | Encounter.reason.value.reference | |
| service-provider | reference | The organization (facility) responsible for this encounter |
Encounter.serviceProvider
( Organization ) |
|
| special-arrangement | token | Wheelchair, translator, stretcher, etc. | Encounter.specialArrangement | |
| status | token | planned | in-progress | on-hold | completed | cancelled | entered-in-error | unknown | Encounter.status | |
| subject | reference | The patient or group present at the encounter |
Encounter.subject
( Group , Patient ) |
|
| subject-status | token | The current status of the subject in relation to the Encounter | Encounter.subjectStatus | |
| type | token | Specific type of encounter | Encounter.type |
|
FHIR
®©
HL7.org
2011+.
FHIR
R5
hl7.fhir.core#5.0.0
R6
hl7.fhir.core#6.0.0-ballot3
generated
on
Sun,
Mar
26,
2023
15:24+1100.
Thu,
Nov
13,
2025
03:07+0000.
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