4.7 4.9 Resource ReferralRequest - Content Resource ReferralRequest - Content

4.7.1 Scope and Usage 4.9.1 Scope and Usage This resource is used to share relevant information required to support a referral request or a transfer of care request from one practitioner or organization to another. It is intended for use when a patient is required to be referred to another provider for a consultation/second opinion and/or for short term or longer term management of one or more health issues or problems. Examples include: Request for a consult from a specialist Referral for support from community services District nursing services referral Request for Aged care placement assessment Request for a pharmacist medication review Referral for physiotherapy or occupational therapy ReferralRequest is also intended for use when there is a complete and more permanent transfer of care responsibility from one practitioner/organization to another (for example, as in the case of requesting the transfer of care for a patient from an acute care setting to rehabilitation, aged care, or a skilled nursing facility).

This resource is used to share relevant information required to support a referral request or a transfer of care request from one practitioner or organization to another. It is intended for use when a patient is required to be referred to another provider for a consultation/second opinion and/or for short term or longer term management of one or more health issues or problems.

Examples include:

• Request for a consult from a specialist
• Referral for support from community services
• District nursing services referral
• Request for Aged care placement assessment
• Request for a pharmacist medication review
• Referral for physiotherapy or occupational therapy

ReferralRequest is also intended for use when there is a complete and more permanent transfer of care responsibility from one practitioner/organization to another (for example, as in the case of requesting the transfer of care for a patient from an acute care setting to rehabilitation, aged care, or a skilled nursing facility).

4.7.2 Boundaries and Relationships 4.9.2 Boundaries and Relationships ReferralRequest is closely related to other types of "request" resources, particularly

ReferralRequest is closely related to other types of "request" resources, particularly DiagnosticOrder and ProcedureRequest . In fact, for some services, it may be appropriate to use any one of these resources to request that the service be performed. Which one is used may be driven by organizational practice and by context. When it is unclear which to use, the following principles may be helpful: and ProcedureRequest or DiagnosticOrder are typically used when the requesting clinician has and wishes to exercise the authority (and expertise) to decide exactly what action will be done. A ReferralRequest is used when the requesting practitioner is seeking another practitioner or organization to use their own expertise and/or authority to determine the specific action to take. Whether an activity is deemed to be a procedure or only a diagnostic order is typically driven by how invasive the diagnostic process is. More invasive processes are typically represented as procedures, though the dividing line may vary by organization. Irrespective of the guidance above, systems should be prepared for some degree of overlap between these resources and should be prepared to execute searches against multiple resources in cases where differentiation cannot be guaranteed. As well, in some workflows more than one type of resource or even all three might exist; E.g., upon receiving a ReferralRequest a practitioner might initiate a DiagnosticOrder. The diagnostic service might then initiate a ProcedureRequest. A "referral" is often thought of as a document that contains a great deal of information about the patient being referred. This resource does not actually contain the clinical background information for the patient. Instead, it supports references to the numerous other resources that define this information. For example, Condition, Family History, Allergy/Intolerance, Alerts, Medication, Diagnostic Reports, etc. Alternatively, some systems may choose to bundle up a ReferralRequest and this referenced information into a . In fact, for some services, it may be appropriate to use any one of these resources to request that the service be performed. Which one is used may be driven by organizational practice and by context. When it is unclear which to use, the following principles may be helpful:

• ProcedureRequest or DiagnosticOrder are typically used when the requesting clinician has and wishes to exercise the authority (and expertise) to decide exactly what action will be done.
• A ReferralRequest is used when the requesting practitioner is seeking another practitioner or organization to use their own expertise and/or authority to determine the specific action to take.
• Whether an activity is deemed to be a procedure or only a diagnostic order is typically driven by how invasive the diagnostic process is. More invasive processes are typically represented as procedures, though the dividing line may vary by organization.

Irrespective of the guidance above, systems should be prepared for some degree of overlap between these resources and should be prepared to execute searches against multiple resources in cases where differentiation cannot be guaranteed. As well, in some workflows more than one type of resource or even all three might exist; E.g., upon receiving a ReferralRequest a practitioner might initiate a DiagnosticOrder. The diagnostic service might then initiate a ProcedureRequest.

A "referral" is often thought of as a document that contains a great deal of information about the patient being referred. This resource does not actually contain the clinical background information for the patient. Instead, it supports references to the numerous other resources that define this information. For example, Condition, Family History, Allergy/Intolerance, Alerts, Medication, Diagnostic Reports, etc. Alternatively, some systems may choose to bundle up a ReferralRequest and this referenced information into a Document for delivery to the recipient. However, for delivery to the recipient. However, REST , , Messaging and and Services are also valid architectures for managing referrals and may be more appropriate where active workflow management is needed. The details of the type of care desired as part of a referral may be conveyed using any of the "request" or "order" resources, likely with a status of "proposed". The are also valid architectures for managing referrals and may be more appropriate where active workflow management is needed.

The details of the type of care desired as part of a referral may be conveyed using any of the "request" or "order" resources, likely with a status of "proposed". The CarePlan resource can be used to describe more sophisticated requests for combinations of services. Likewise, ReferralRequest may be referenced as part of a CarePlan. A ReferralRequest may be targeted (identifying a specific Practitioner or Organization to perform the requested care) or untargeted (merely identifying the type of care desired). The resource can be used to describe more sophisticated requests for combinations of services. Likewise, ReferralRequest may be referenced as part of a CarePlan.

A ReferralRequest may be targeted (identifying a specific Practitioner or Organization to perform the requested care) or untargeted (merely identifying the type of care desired). The Order and and OrderResponse resources may be used to help manage such workflows. A ReferralRequest might be fulfilled by a resources may be used to help manage such workflows.

A ReferralRequest might be fulfilled by a DiagnosticReport , , Encounter , , Procedure , or other assessment-related resource. A ReferralRequest should not be confused with an , or other assessment-related resource.

A ReferralRequest should not be confused with an Appointment , as appointments are intended for booking/scheduling purposes. This resource is referenced by , as appointments are intended for booking/scheduling purposes.

• Structure
• UML
• XML
• JSON
• All

Structure

?! code ReferralStatus

Name	Flags	Card.	Type	Description & Constraints Description & Constraints
ReferralRequest			DomainResource	A request for referral or transfer of care A request for referral or transfer of care
status identifier		0..*	Σ Identifier	1..1 Business identifier
basedOn		draft | requested | active | cancelled | accepted | rejected | completed 0..*	Reference ( Required ReferralRequest | CarePlan | DiagnosticOrder | ProcedureRequest )	Request fulfilled by this request
identifier parent	Σ	0..* 0..1	Identifier	Business identifier Composite request this is part of
date status	?! Σ	0..1 1..1	dateTime code	Date of creation/activation draft | active | cancelled | completed | entered-in-error ReferralStatus ( Required )
type category	?! Σ	0..1 1..1	CodeableConcept code	Referral/Transition of care request type proposal | plan | request ReferralCategory ( Required )
specialty type	Σ	0..1	CodeableConcept	The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty ( Example ) Referral/Transition of care request type
priority	Σ	0..1	CodeableConcept	Urgency of referral / transfer of care request Urgency of referral / transfer of care request DiagnosticOrderPriority ( ( Example )
patient	Σ	0..1	Reference ( Patient )	Patient referred to care or transfer Patient referred to care or transfer
requester context		0..1	Reference ( Encounter | EpisodeOfCare )	Originating encounter
fulfillmentTime	Σ	0..1	Reference ( Practitioner Period | Organization	Requested service(s) fulfillment time
authored | Patient	Σ	0..1	dateTime )	Requester of referral / transfer of care Date of creation/activation
recipient requester	Σ	0..* 0..1	Reference ( Practitioner | | Organization | Patient )	Receiver of referral / transfer of care request Requester of referral / transfer of care
encounter specialty		0..1	Reference ( Encounter CodeableConcept )	Originating encounter The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty ( Example )
dateSent recipient	Σ	0..1 0..*	dateTime Reference ( Practitioner | Organization )	Date referral/transfer of care request is sent Receiver of referral / transfer of care request
reason	Σ	0..1	CodeableConcept	Reason for referral / transfer of care request Reason for referral / transfer of care request
description		0..1	string	A textual description of the referral A textual description of the referral
serviceRequested	Σ	0..*	CodeableConcept	Actions requested as part of the referral Actions requested as part of the referral Practice Setting Code Value Set ( Practice Setting Code Value Set ( Example )
supportingInformation	Σ	0..*	Reference ( Any )	Additonal information to support referral or transfer of care request fulfillmentTime Σ 0..1 Period Requested service(s) fulfillment time Additonal information to support referral or transfer of care request
Documentation for this format Documentation for this format

<ReferralRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <

 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <

 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|DiagnosticOrder|
   ProcedureRequest) Request fulfilled by this request --></basedOn>

 <parent><!-- 0..1 Identifier Composite request this is part of --></parent>
 <status value="[code]"/><!-- 1..1 draft | active | cancelled | completed | entered-in-error -->
 <category value="[code]"/><!-- 1..1 proposal | plan | request -->

 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <</specialty>

 <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority>
 <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context>
 <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime>
 <authored value="[dateTime]"/><!-- 0..1 Date of creation/activation -->

 <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) Requester of referral / transfer of care --></requester>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>

 <recipient><!-- 0..* Reference(Practitioner|Organization) Receiver of referral / transfer of care request --></recipient>
 <</encounter>
 <

 <reason><!-- 0..1 CodeableConcept Reason for referral / transfer of care request --></reason>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <supportingInformation><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInformation>
 <</fulfillmentTime>

</ReferralRequest>

{
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "

  "identifier" : [{ Identifier }], // Business identifier
  "

  "basedOn" : [{ Reference(ReferralRequest|CarePlan|DiagnosticOrder|
   ProcedureRequest) }], // Request fulfilled by this request

  "parent" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  draft | active | cancelled | completed | entered-in-error
  "category" : "<code>", // R!  proposal | plan | request

  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "

  "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request
  "patient" : { Reference(Patient) }, // Patient referred to care or transfer
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter
  "fulfillmentTime" : { Period }, // Requested service(s) fulfillment time
  "authored" : "<dateTime>", // Date of creation/activation

  "requester" : { Reference(Practitioner|Organization|Patient) }, // Requester of referral / transfer of care
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for

  "recipient" : [{ Reference(Practitioner|Organization) }], // Receiver of referral / transfer of care request
  "
  "

  "reason" : { CodeableConcept }, // Reason for referral / transfer of care request
  "description" : "<string>", // A textual description of the referral
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "
  "

  "supportingInformation" : [{ Reference(Any) }] // Additonal information to support referral or transfer of care request

}

Structure

?! code ReferralStatus

Name	Flags	Card.	Type	Description & Constraints Description & Constraints
ReferralRequest			DomainResource	A request for referral or transfer of care A request for referral or transfer of care
status identifier		0..*	Σ Identifier	1..1 Business identifier
basedOn		draft | requested | active | cancelled | accepted | rejected | completed 0..*	Reference ( Required ReferralRequest | CarePlan | DiagnosticOrder | ProcedureRequest )	Request fulfilled by this request
identifier parent	Σ	0..* 0..1	Identifier	Business identifier Composite request this is part of
date status	?! Σ	0..1 1..1	dateTime code	Date of creation/activation draft | active | cancelled | completed | entered-in-error ReferralStatus ( Required )
type category	?! Σ	0..1 1..1	CodeableConcept code	Referral/Transition of care request type proposal | plan | request ReferralCategory ( Required )
specialty type	Σ	0..1	CodeableConcept	The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty ( Example ) Referral/Transition of care request type
priority	Σ	0..1	CodeableConcept	Urgency of referral / transfer of care request Urgency of referral / transfer of care request DiagnosticOrderPriority ( ( Example )
patient	Σ	0..1	Reference ( Patient )	Patient referred to care or transfer Patient referred to care or transfer
requester context		0..1	Reference ( Encounter | EpisodeOfCare )	Originating encounter
fulfillmentTime	Σ	0..1	Reference ( Practitioner Period | Organization	Requested service(s) fulfillment time
authored | Patient	Σ	0..1	dateTime )	Requester of referral / transfer of care Date of creation/activation
recipient requester	Σ	0..* 0..1	Reference ( Practitioner | | Organization | Patient )	Receiver of referral / transfer of care request Requester of referral / transfer of care
encounter specialty		0..1	Reference ( Encounter CodeableConcept )	Originating encounter The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty ( Example )
dateSent recipient	Σ	0..1 0..*	dateTime Reference ( Practitioner | Organization )	Date referral/transfer of care request is sent Receiver of referral / transfer of care request
reason	Σ	0..1	CodeableConcept	Reason for referral / transfer of care request Reason for referral / transfer of care request
description		0..1	string	A textual description of the referral A textual description of the referral
serviceRequested	Σ	0..*	CodeableConcept	Actions requested as part of the referral Actions requested as part of the referral Practice Setting Code Value Set ( Practice Setting Code Value Set ( Example )
supportingInformation	Σ	0..*	Reference ( Any )	Additonal information to support referral or transfer of care request fulfillmentTime Σ 0..1 Period Requested service(s) fulfillment time Additonal information to support referral or transfer of care request
Documentation for this format Documentation for this format

UML Diagram UML Diagram

XML Template XML Template

<ReferralRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <

 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <

 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|DiagnosticOrder|
   ProcedureRequest) Request fulfilled by this request --></basedOn>

 <parent><!-- 0..1 Identifier Composite request this is part of --></parent>
 <status value="[code]"/><!-- 1..1 draft | active | cancelled | completed | entered-in-error -->
 <category value="[code]"/><!-- 1..1 proposal | plan | request -->

 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <</specialty>

 <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority>
 <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context>
 <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime>
 <authored value="[dateTime]"/><!-- 0..1 Date of creation/activation -->

 <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) Requester of referral / transfer of care --></requester>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>

 <recipient><!-- 0..* Reference(Practitioner|Organization) Receiver of referral / transfer of care request --></recipient>
 <</encounter>
 <

 <reason><!-- 0..1 CodeableConcept Reason for referral / transfer of care request --></reason>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <supportingInformation><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInformation>
 <</fulfillmentTime>

</ReferralRequest>

JSON Template JSON Template

{
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "

  "identifier" : [{ Identifier }], // Business identifier
  "

  "basedOn" : [{ Reference(ReferralRequest|CarePlan|DiagnosticOrder|
   ProcedureRequest) }], // Request fulfilled by this request

  "parent" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  draft | active | cancelled | completed | entered-in-error
  "category" : "<code>", // R!  proposal | plan | request

  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "

  "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request
  "patient" : { Reference(Patient) }, // Patient referred to care or transfer
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter
  "fulfillmentTime" : { Period }, // Requested service(s) fulfillment time
  "authored" : "<dateTime>", // Date of creation/activation

  "requester" : { Reference(Practitioner|Organization|Patient) }, // Requester of referral / transfer of care
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for

  "recipient" : [{ Reference(Practitioner|Organization) }], // Receiver of referral / transfer of care request
  "
  "

  "reason" : { CodeableConcept }, // Reason for referral / transfer of care request
  "description" : "<string>", // A textual description of the referral
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "
  "

  "supportingInformation" : [{ Reference(Any) }] // Additonal information to support referral or transfer of care request

}