Release 4B 5 Ballot

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0-ballot: R5 Ballot - STU see ballot notes ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4

12.14 12.18 Resource ServiceRequest - Content

Orders and Observations icon Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

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

12.14.1 12.18.1 Scope and Usage

This resource is a request resource from a FHIR workflow perspective - see Workflow .

ServiceRequest is a record of a request for a procedure or diagnostic represents an order or other service to be planned, proposed, proposal or performed, plan, as distinguished by the ServiceRequest.intent field value, with to perform a diagnostic or other service on or for a patient. The procedure will lead ServiceRequest represents a proposal or plan or order for a service to either be performed that would result in a Procedure or DiagnosticReport , which in turn may reference one or more Observations , which summarize the performance of the procedures and associated documentation such as observations, images, findings that are relevant to the treatment/management of the subject. This resource may be used to share relevant information required to support a referral or a transfer of care request from one practitioner or organization to another 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:

  • diagnostic tests/studies
  • endoscopic procedures
  • counseling
  • biopsies
  • therapies (e.g., physio-, social-, psychological-)
  • (exploratory) surgeries or procedures
  • exercises
  • specialist consultation and assessments
  • community services
  • nursing services
  • pharmacist medication review, and
  • other clinical interventions.

Procedures may be performed by a healthcare professional, a friend or relative or in some cases by the patient themselves.

The principal intention of ServiceRequest is to support ordering procedures for one patient (which includes non-human patients in veterinary medicine). However, in many contexts, healthcare related processes include performing diagnostic investigations on groups of subjects, devices involved in the provision of healthcare, and even environmental locations such as ducts, bodies of water, etc. ServiceRequest supports all these usages. The service request may represent an order that is entered by a practitioner in a CPOE system as well as a proposal made by a clinical decision support (CDS) system based on a patient's clinical record and context of care. Planned procedures referenced by a CarePlan may also be represented by this resource.

The general work flow that this resource facilitates is that a clinical system creates a service request. The service request is then accessed by or exchanged with a system, perhaps via intermediaries, that represents an organization (e.g., diagnostic or imaging service, surgical team, physical therapy department) that can perform the procedure. The organization receiving the service request will, after it accepts the request, update the request as the work is performed, and then finally issue a report that references the requests that it fulfilled.

The ServiceRequest resource allows requesting only a single procedure. If a workflow requires requesting multiple procedures simultaneously, this is done using multiple instances of this resource. These instances can be linked in different ways, depending on the needs of the workflow. For guidance, refer to the Request pattern

12.14.2 12.18.2 Boundaries and Relationships

ServiceRequest is a record of a proposal/plan or order for a service to be performed that would result in a Procedure , Observation , DiagnosticReport , ImagingStudy or similar resource. In contrast to ServiceRequest, Task which spans both intent and event and tracks the execution through to completion and is intended for "administrative" actions like requesting and tracking things to be done to a record, or keeping track of a checklist of steps such to be performed as part of a fulfilment process. A ServiceRequest can be higher-level authorization that triggered the creation of Task, or it can be the "request" resource Task is seeking to fulfill.

ServiceRequest and CommunicationRequest are related. A CommunicationRequest is a request to merely disclose information. Whereas a ServiceRequest would be used to request information as part of training or counseling - i.e. when the process will involve verification of the patient's comprehension or an attempt to change the patient's mental state. In some workflows both may exist. For example, upon receiving a CommunicationRequest a practitioner might initiate a ServiceRequest.

12.14.3 12.18.3 References to this Resource

This resource is referenced by

12.14.4 12.18.4 Resource Content

Structure

Requested performer locationCode Σ 0..* CodeableConcept
Name Flags Card. Type Description & Constraints doco
. . ServiceRequest TU DomainResource A request for a service to be performed
+ Rule: orderDetail SHALL only be present if code is present

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Identifiers assigned to this order

. . . instantiatesCanonical Σ 0..* canonical ( ActivityDefinition | PlanDefinition ) Instantiates FHIR protocol or definition

. . . instantiatesUri Σ 0..* uri Instantiates external protocol or definition

. . . basedOn Σ 0..* Reference ( CarePlan | ServiceRequest | MedicationRequest ) What request fulfills

. . . replaces Σ 0..* Reference ( ServiceRequest ) What request replaces

. . . requisition Σ 0..1 Identifier Composite Request ID
. . . status ?! Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
RequestStatus ( Required )
. . . intent ?! Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option +
RequestIntent ( Required )
. . . category Σ 0..* CodeableConcept Classification of service
Service Request Category Codes ( Example )

. . . priority Σ 0..1 code routine | urgent | asap | stat
RequestPriority ( Required )
. . . doNotPerform ?! Σ 0..1 boolean True if service/procedure should not be performed
. . . code Σ 0..1 CodeableConcept CodeableReference ( ActivityDefinition | PlanDefinition ) What is being requested/ordered
Procedure Codes (SNOMED CT) ( Example )
. . . orderDetail Σ I C 0..* CodeableConcept Additional order information
Service Request Order Details Codes ( Example )

. . . quantity[x] Σ 0..1 Service amount
. . . . quantityQuantity Quantity
. . . . quantityRatio Ratio
. . . . quantityRange Range
. . . subject Σ 1..1 Reference ( Patient | Group | Location | Device ) Individual or Entity the service is ordered for
. . . focus Σ 0..* Reference ( Any ) What the service request is about, when it is not about the subject of record

... encounter Σ 0..1 Reference ( Encounter ) Encounter in which the request was created
. . . occurrence[x] Σ 0..1 When service should occur
. . . . occurrenceDateTime dateTime
. . . . occurrencePeriod Period
. . . . occurrenceTiming Timing
. . . asNeeded[x] Σ 0..1 Preconditions for service
SNOMED CT Medication As Needed Reason Codes ( Example )
. . . . asNeededBoolean boolean
. . . . asNeededCodeableConcept CodeableConcept
. . . authoredOn Σ 0..1 dateTime Date request signed
. . . requester Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device ) Who/what is requesting service
. . . performerType Σ 0..1 CodeableConcept Performer role
ActionParticipantRole Participant Roles ( Example )
. . . performer Σ 0..* Reference ( Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson ) Requested location performer
ServiceDeliveryLocationRoleType ( Example )
. . . locationReference location Σ 0..* Reference CodeableReference ( Location ) Requested location
ServiceDeliveryLocationRoleType icon ( Example )

. . reasonCode . reason Σ 0..* CodeableConcept CodeableReference ( Condition | Observation | DiagnosticReport | DocumentReference | DetectedIssue ) Explanation/Justification for procedure or service
Procedure Reason Codes ( Example )

. . . reasonReference insurance Σ 0..* Reference ( Condition | Observation | DiagnosticReport Coverage | DocumentReference ClaimResponse ) Explanation/Justification for service or service Associated insurance coverage

. . . insurance supportingInfo 0..* Reference ( Coverage | ClaimResponse Any ) Associated insurance coverage Additional clinical information

. . . supportingInfo specimen Σ 0..* Reference ( Any Specimen ) Additional clinical information Procedure Samples

. . specimen . bodySite Σ 0..* Reference CodeableConcept Coded location on Body
SNOMED CT Body Structures ( Specimen Example )
Procedure Samples
. . bodySite . bodyStructure Σ C 0..* 0..1 CodeableConcept Reference ( BodyStructure ) Location BodyStructure-based location on Body the body
SNOMED CT Body Structures ( Example ) + Rule: bodyStructure SHALL only be present if bodySite is not present
. . . note 0..* Annotation Comments

. . . patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
. . . relevantHistory 0..* Reference ( Provenance ) Request provenance


doco Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

ServiceRequest ( DomainResource ) Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller identifier : Identifier [0..*] 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 instantiatesCanonical : canonical [0..*] « ActivityDefinition | PlanDefinition » 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 instantiatesUri : uri [0..*] Plan/proposal/order fulfilled by this request basedOn : Reference [0..*] « CarePlan | ServiceRequest | MedicationRequest » The request takes the place of the referenced completed or terminated request(s) replaces : Reference [0..*] « ServiceRequest » 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 requisition : Identifier [0..1] The status of the order (this element modifies the meaning of other elements) status : code [1..1] « null (Strength=Required) RequestStatus ! » Whether the request is a proposal, plan, an original order or a reflex order (this element modifies the meaning of other elements) intent : code [1..1] « null (Strength=Required) RequestIntent ! » A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure") category : CodeableConcept [0..*] « null (Strength=Example) ServiceRequestCategoryCodes ?? » Indicates how quickly the ServiceRequest should be addressed with respect to other requests priority : code [0..1] « null (Strength=Required) RequestPriority ! » Set this to true if the record is saying that the service/procedure should NOT be performed (this element modifies the meaning of other elements) doNotPerform : boolean [0..1] A code or reference that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested code : CodeableConcept CodeableReference [0..1] « ActivityDefinition | PlanDefinition ; null (Strength=Example) ProcedureCodes(SNOMEDCT) ?? » 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 orderDetail : CodeableConcept [0..*] « null (Strength=Example) ServiceRequestOrderDetailsCod... ?? » « This element has or is affected by some invariants C » 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) quantity[x] : Element DataType [0..1] « Quantity | Ratio | Range » 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) subject : Reference [1..1] « Patient | Group | Location | Device » The actual focus of a service request when it is not the subject of record representing something or someone associated with the subject such as a spouse, parent, fetus, or donor. The focus of a service request could also be an existing condition, an intervention, the subject's diet, another service request on the subject, or a body structure such as tumor or implanted device focus : Reference [0..*] « Any » An encounter that provides additional information about the healthcare context in which this request is made encounter : Reference [0..1] « Encounter » The date/time at which the requested service should occur occurrence[x] : Element DataType [0..1] « dateTime | Period | Timing » If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc asNeeded[x] : Element DataType [0..1] « boolean | CodeableConcept ; null (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » When the request transitioned to being actionable authoredOn : dateTime [0..1] The individual who initiated the request and has responsibility for its activation requester : Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device » Desired type of performer for doing the requested service performerType : CodeableConcept [0..1] « null (Strength=Example) ActionParticipantRole ParticipantRoles ?? » The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc performer : Reference [0..*] « Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson » 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 locationCode location : CodeableConcept CodeableReference [0..*] « Location ; null (Strength=Example) ServiceDeliveryLocationRoleTy... ?? » A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center locationReference : Reference [0..*] « Location » 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` reasonCode : CodeableConcept [0..*] « null (Strength=Example) ProcedureReasonCodes ?? » Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo` reasonReference reason : Reference CodeableReference [0..*] « Condition | Observation | DiagnosticReport | DocumentReference | DetectedIssue ; null (Strength=Example) ProcedureReasonCodes ?? » Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service insurance : Reference [0..*] « Coverage | ClaimResponse » 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 supportingInfo : Reference [0..*] « Any » One or more specimens that the laboratory procedure will use specimen : Reference [0..*] « Specimen » Anatomic location where the procedure should be performed. This is the target site bodySite : CodeableConcept [0..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » Anatomic location where the procedure should be performed. This is the target site bodyStructure : Reference [0..1] « BodyStructure » Any other notes and comments made about the service request. For example, internal billing notes note : Annotation [0..*] Instructions in terms that are understood by the patient or consumer patientInstruction : string [0..1] Key events in the history of the request relevantHistory : Reference [0..*] « Provenance »

XML Template 

<ServiceRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|MedicationRequest|ServiceRequest) What request fulfills --></basedOn>
 <replaces><!-- 0..* Reference(ServiceRequest) What request replaces --></replaces>
 <requisition><!-- 0..1 Identifier Composite Request ID --></requisition>
 <status value="[code]"/><!-- 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown -->
 <

 <intent value="[code]"/><!-- 1..1 proposal | plan | directive | order + -->

 <category><!-- 0..* CodeableConcept Classification of service --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <doNotPerform value="[boolean]"/><!-- 0..1 True if service/procedure should not be performed -->
 <</code>
 <</orderDetail>

 <code><!-- 0..1 CodeableReference(ActivityDefinition|PlanDefinition) What is being requested/ordered --></code>
 <orderDetail><!-- I 0..* CodeableConcept Additional order information --></orderDetail>

 <quantity[x]><!-- 0..1 Quantity|Ratio|Range Service amount --></quantity[x]>
 <subject><!-- 1..1 Reference(Device|Group|Location|Patient) Individual or Entity the service is ordered for --></subject>
 <focus><!-- 0..* Reference(Any) What the service request is about, when it is not about the subject of record --></focus>

 <encounter><!-- 0..1 Reference(Encounter) Encounter in which the request was created --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period|Timing When service should occur --></occurrence[x]>
 <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Preconditions for service --></asNeeded[x]>
 <authoredOn value="[dateTime]"/><!-- 0..1 Date request signed -->
 <requester><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who/what is requesting service --></requester>
 <</performerType>

 <performerType><!-- 0..1 CodeableConcept Performer role --></performerType>

 <performer><!-- 0..* Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) Requested performer --></performer>
 <</locationCode>
 <</locationReference>
 <</reasonCode>
 <|
   </reasonReference>

 <location><!-- 0..* CodeableReference(Location) Requested location icon --></location>
 <reason><!-- 0..* CodeableReference(Condition|DetectedIssue|DiagnosticReport|
   DocumentReference|Observation) Explanation/Justification for procedure or service --></reason>
 <insurance><!-- 0..* Reference(ClaimResponse|Coverage) Associated insurance coverage --></insurance>
 <supportingInfo><!-- 0..* Reference(Any) Additional clinical information --></supportingInfo>
 <specimen><!-- 0..* Reference(Specimen) Procedure Samples --></specimen>
 <</bodySite>

 <bodySite><!-- 0..* CodeableConcept Coded location on Body --></bodySite>
 <bodyStructure><!-- 0..1 Reference(BodyStructure) BodyStructure-based location on the body --></bodyStructure>

 <note><!-- 0..* Annotation Comments --></note>
 <patientInstruction value="[string]"/><!-- 0..1 Patient or consumer-oriented instructions -->
 <relevantHistory><!-- 0..* Reference(Provenance) Request provenance --></relevantHistory>
</ServiceRequest>

JSON Template 

{doco
  "resourceType" : "ServiceRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "

  "instantiatesCanonical" : ["<canonical(ActivityDefinition|PlanDefinition)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|MedicationRequest|ServiceRequest) }], // What request fulfills
  "replaces" : [{ Reference(ServiceRequest) }], // What request replaces
  "requisition" : { Identifier }, // Composite Request ID
  "status" : "<code>", // R!  draft | active | on-hold | revoked | completed | entered-in-error | unknown
  "

  "intent" : "<code>", // R!  proposal | plan | directive | order +

  "category" : [{ CodeableConcept }], // Classification of service
  "priority" : "<code>", // routine | urgent | asap | stat
  "doNotPerform" : <boolean>, // True if service/procedure should not be performed
  "
  "

  "code" : { CodeableReference(ActivityDefinition|PlanDefinition) }, // What is being requested/ordered
  "orderDetail" : [{ CodeableConcept }], // I Additional order information

  // quantity[x]: Service amount. One of these 3:
  "quantityQuantity" : { Quantity },
  "quantityRatio" : { Ratio },
  "quantityRange" : { Range },
  "subject" : { Reference(Device|Group|Location|Patient) }, // R!  Individual or Entity the service is ordered for
  "focus" : [{ Reference(Any) }], // What the service request is about, when it is not about the subject of record

  "encounter" : { Reference(Encounter) }, // Encounter in which the request was created
  // occurrence[x]: When service should occur. One of these 3:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "occurrenceTiming" : { Timing },
  // asNeeded[x]: Preconditions for service. One of these 2:
  "asNeededBoolean" : <boolean>,
  "asNeededCodeableConcept" : { CodeableConcept },
  "authoredOn" : "<dateTime>", // Date request signed
  "requester" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who/what is requesting service
  "

  "performerType" : { CodeableConcept }, // Performer role

  "performer" : [{ Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Requested performer
  "
  "
  "
  "|
   

  "location" : [{ CodeableReference(Location) }], // Requested location icon
  "reason" : [{ CodeableReference(Condition|DetectedIssue|DiagnosticReport|
   DocumentReference|Observation) }], // Explanation/Justification for procedure or service
  "insurance" : [{ Reference(ClaimResponse|Coverage) }], // Associated insurance coverage
  "supportingInfo" : [{ Reference(Any) }], // Additional clinical information
  "specimen" : [{ Reference(Specimen) }], // Procedure Samples
  "

  "bodySite" : [{ CodeableConcept }], // Coded location on Body
  "bodyStructure" : { Reference(BodyStructure) }, // BodyStructure-based location on the body

  "note" : [{ Annotation }], // Comments
  "patientInstruction" : "<string>", // Patient or consumer-oriented instructions
  "relevantHistory" : [{ Reference(Provenance) }] // Request provenance
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ServiceRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ServiceRequest.identifier [ Identifier ], ... ; # 0..* Identifiers assigned to this order
  fhir:ServiceRequest.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:ServiceRequest.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:ServiceRequest.basedOn [ Reference(CarePlan|MedicationRequest|ServiceRequest) ], ... ; # 0..* What request fulfills
  fhir:ServiceRequest.replaces [ Reference(ServiceRequest) ], ... ; # 0..* What request replaces
  fhir:ServiceRequest.requisition [ Identifier ]; # 0..1 Composite Request ID
  fhir:ServiceRequest.status [ code ]; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:

  fhir:ServiceRequest.intent [ code ]; # 1..1 proposal | plan | directive | order +

  fhir:ServiceRequest.category [ CodeableConcept ], ... ; # 0..* Classification of service
  fhir:ServiceRequest.priority [ code ]; # 0..1 routine | urgent | asap | stat
  fhir:ServiceRequest.doNotPerform [ boolean ]; # 0..1 True if service/procedure should not be performed
  fhir:
  fhir:

  fhir:ServiceRequest.code [ CodeableReference(ActivityDefinition|PlanDefinition) ]; # 0..1 What is being requested/ordered
  fhir:ServiceRequest.orderDetail [ CodeableConcept ], ... ; # 0..* I Additional order information

  # ServiceRequest.quantity[x] : 0..1 Service amount. One of these 3
    fhir:ServiceRequest.quantityQuantity [ Quantity ]
    fhir:ServiceRequest.quantityRatio [ Ratio ]
    fhir:ServiceRequest.quantityRange [ Range ]
  fhir:ServiceRequest.subject [ Reference(Device|Group|Location|Patient) ]; # 1..1 Individual or Entity the service is ordered for
  fhir:ServiceRequest.focus [ Reference(Any) ], ... ; # 0..* What the service request is about, when it is not about the subject of record

  fhir:ServiceRequest.encounter [ Reference(Encounter) ]; # 0..1 Encounter in which the request was created
  # ServiceRequest.occurrence[x] : 0..1 When service should occur. One of these 3
    fhir:ServiceRequest.occurrenceDateTime [ dateTime ]
    fhir:ServiceRequest.occurrencePeriod [ Period ]
    fhir:ServiceRequest.occurrenceTiming [ Timing ]
  # ServiceRequest.asNeeded[x] : 0..1 Preconditions for service. One of these 2
    fhir:ServiceRequest.asNeededBoolean [ boolean ]
    fhir:ServiceRequest.asNeededCodeableConcept [ CodeableConcept ]
  fhir:ServiceRequest.authoredOn [ dateTime ]; # 0..1 Date request signed
  fhir:ServiceRequest.requester [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who/what is requesting service
  fhir:ServiceRequest.performerType [ CodeableConcept ]; # 0..1 Performer role
  fhir:ServiceRequest.performer [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ], ... ; # 0..* Requested performer
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:ServiceRequest.location [ CodeableReference(Location) ], ... ; # 0..* Requested location
  fhir:ServiceRequest.reason [ CodeableReference(Condition|DetectedIssue|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Explanation/Justification for procedure or service

  fhir:ServiceRequest.insurance [ Reference(ClaimResponse|Coverage) ], ... ; # 0..* Associated insurance coverage
  fhir:ServiceRequest.supportingInfo [ Reference(Any) ], ... ; # 0..* Additional clinical information
  fhir:ServiceRequest.specimen [ Reference(Specimen) ], ... ; # 0..* Procedure Samples
  fhir:

  fhir:ServiceRequest.bodySite [ CodeableConcept ], ... ; # 0..* Coded location on Body
  fhir:ServiceRequest.bodyStructure [ Reference(BodyStructure) ]; # 0..1 BodyStructure-based location on the body

  fhir:ServiceRequest.note [ Annotation ], ... ; # 0..* Comments
  fhir:ServiceRequest.patientInstruction [ string ]; # 0..1 Patient or consumer-oriented instructions
  fhir:ServiceRequest.relevantHistory [ Reference(Provenance) ], ... ; # 0..* Request provenance
]

Changes since R4

ServiceRequest
ServiceRequest.code
  • No Changes Type changed from CodeableConcept to CodeableReference
  • Type changed from CodeableConcept to CodeableReference
ServiceRequest.focus
  • Added Element
ServiceRequest.location
  • Added Element
ServiceRequest.reason
  • Added Element
ServiceRequest.bodyStructure
  • Added Element
ServiceRequest.locationCode
  • deleted
ServiceRequest.locationReference
  • deleted
ServiceRequest.reasonCode
  • deleted
ServiceRequest.reasonReference
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4

Structure

Requested performer locationCode Σ 0..* CodeableConcept
Name Flags Card. Type Description & Constraints doco
. . ServiceRequest TU DomainResource A request for a service to be performed
+ Rule: orderDetail SHALL only be present if code is present

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Identifiers assigned to this order

. . . instantiatesCanonical Σ 0..* canonical ( ActivityDefinition | PlanDefinition ) Instantiates FHIR protocol or definition

. . . instantiatesUri Σ 0..* uri Instantiates external protocol or definition

. . . basedOn Σ 0..* Reference ( CarePlan | ServiceRequest | MedicationRequest ) What request fulfills

. . . replaces Σ 0..* Reference ( ServiceRequest ) What request replaces

. . . requisition Σ 0..1 Identifier Composite Request ID
. . . status ?! Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
RequestStatus ( Required )
. . . intent ?! Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option +
RequestIntent ( Required )
. . . category Σ 0..* CodeableConcept Classification of service
Service Request Category Codes ( Example )

. . . priority Σ 0..1 code routine | urgent | asap | stat
RequestPriority ( Required )
. . . doNotPerform ?! Σ 0..1 boolean True if service/procedure should not be performed
. . . code Σ 0..1 CodeableConcept CodeableReference ( ActivityDefinition | PlanDefinition ) What is being requested/ordered
Procedure Codes (SNOMED CT) ( Example )
. . . orderDetail Σ I C 0..* CodeableConcept Additional order information
Service Request Order Details Codes ( Example )

. . . quantity[x] Σ 0..1 Service amount
. . . . quantityQuantity Quantity
. . . . quantityRatio Ratio
. . . . quantityRange Range
. . . subject Σ 1..1 Reference ( Patient | Group | Location | Device ) Individual or Entity the service is ordered for
. . . focus Σ 0..* Reference ( Any ) What the service request is about, when it is not about the subject of record

... encounter Σ 0..1 Reference ( Encounter ) Encounter in which the request was created
. . . occurrence[x] Σ 0..1 When service should occur
. . . . occurrenceDateTime dateTime
. . . . occurrencePeriod Period
. . . . occurrenceTiming Timing
. . . asNeeded[x] Σ 0..1 Preconditions for service
SNOMED CT Medication As Needed Reason Codes ( Example )
. . . . asNeededBoolean boolean
. . . . asNeededCodeableConcept CodeableConcept
. . . authoredOn Σ 0..1 dateTime Date request signed
. . . requester Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device ) Who/what is requesting service
. . . performerType Σ 0..1 CodeableConcept Performer role
ActionParticipantRole Participant Roles ( Example )
. . . performer Σ 0..* Reference ( Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson ) Requested location performer
ServiceDeliveryLocationRoleType ( Example )
. . . locationReference location Σ 0..* Reference CodeableReference ( Location ) Requested location
ServiceDeliveryLocationRoleType icon ( Example )

. . reasonCode . reason Σ 0..* CodeableConcept CodeableReference ( Condition | Observation | DiagnosticReport | DocumentReference | DetectedIssue ) Explanation/Justification for procedure or service
Procedure Reason Codes ( Example )

. . . reasonReference insurance Σ 0..* Reference ( Condition | Observation | DiagnosticReport Coverage | DocumentReference ClaimResponse ) Explanation/Justification for service or service Associated insurance coverage

. . . insurance supportingInfo 0..* Reference ( Coverage | ClaimResponse Any ) Associated insurance coverage Additional clinical information

. . . supportingInfo specimen Σ 0..* Reference ( Any Specimen ) Additional clinical information Procedure Samples

. . specimen . bodySite Σ 0..* Reference CodeableConcept Coded location on Body
SNOMED CT Body Structures ( Specimen Example )
Procedure Samples
. . bodySite . bodyStructure Σ C 0..* 0..1 CodeableConcept Reference ( BodyStructure ) Location BodyStructure-based location on Body the body
SNOMED CT Body Structures ( Example ) + Rule: bodyStructure SHALL only be present if bodySite is not present
. . . note 0..* Annotation Comments

. . . patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
. . . relevantHistory 0..* Reference ( Provenance ) Request provenance


doco Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

ServiceRequest ( DomainResource ) Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller identifier : Identifier [0..*] 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 instantiatesCanonical : canonical [0..*] « ActivityDefinition | PlanDefinition » 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 instantiatesUri : uri [0..*] Plan/proposal/order fulfilled by this request basedOn : Reference [0..*] « CarePlan | ServiceRequest | MedicationRequest » The request takes the place of the referenced completed or terminated request(s) replaces : Reference [0..*] « ServiceRequest » 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 requisition : Identifier [0..1] The status of the order (this element modifies the meaning of other elements) status : code [1..1] « null (Strength=Required) RequestStatus ! » Whether the request is a proposal, plan, an original order or a reflex order (this element modifies the meaning of other elements) intent : code [1..1] « null (Strength=Required) RequestIntent ! » A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure") category : CodeableConcept [0..*] « null (Strength=Example) ServiceRequestCategoryCodes ?? » Indicates how quickly the ServiceRequest should be addressed with respect to other requests priority : code [0..1] « null (Strength=Required) RequestPriority ! » Set this to true if the record is saying that the service/procedure should NOT be performed (this element modifies the meaning of other elements) doNotPerform : boolean [0..1] A code or reference that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested code : CodeableConcept CodeableReference [0..1] « ActivityDefinition | PlanDefinition ; null (Strength=Example) ProcedureCodes(SNOMEDCT) ?? » 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 orderDetail : CodeableConcept [0..*] « null (Strength=Example) ServiceRequestOrderDetailsCod... ?? » « This element has or is affected by some invariants C » 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) quantity[x] : Element DataType [0..1] « Quantity | Ratio | Range » 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) subject : Reference [1..1] « Patient | Group | Location | Device » The actual focus of a service request when it is not the subject of record representing something or someone associated with the subject such as a spouse, parent, fetus, or donor. The focus of a service request could also be an existing condition, an intervention, the subject's diet, another service request on the subject, or a body structure such as tumor or implanted device focus : Reference [0..*] « Any » An encounter that provides additional information about the healthcare context in which this request is made encounter : Reference [0..1] « Encounter » The date/time at which the requested service should occur occurrence[x] : Element DataType [0..1] « dateTime | Period | Timing » If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc asNeeded[x] : Element DataType [0..1] « boolean | CodeableConcept ; null (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » When the request transitioned to being actionable authoredOn : dateTime [0..1] The individual who initiated the request and has responsibility for its activation requester : Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device » Desired type of performer for doing the requested service performerType : CodeableConcept [0..1] « null (Strength=Example) ActionParticipantRole ParticipantRoles ?? » The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc performer : Reference [0..*] « Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson » 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 locationCode location : CodeableConcept CodeableReference [0..*] « Location ; null (Strength=Example) ServiceDeliveryLocationRoleTy... ?? » A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center locationReference : Reference [0..*] « Location » 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` reasonCode : CodeableConcept [0..*] « null (Strength=Example) ProcedureReasonCodes ?? » Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo` reasonReference reason : Reference CodeableReference [0..*] « Condition | Observation | DiagnosticReport | DocumentReference | DetectedIssue ; null (Strength=Example) ProcedureReasonCodes ?? » Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service insurance : Reference [0..*] « Coverage | ClaimResponse » 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 supportingInfo : Reference [0..*] « Any » One or more specimens that the laboratory procedure will use specimen : Reference [0..*] « Specimen » Anatomic location where the procedure should be performed. This is the target site bodySite : CodeableConcept [0..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » Anatomic location where the procedure should be performed. This is the target site bodyStructure : Reference [0..1] « BodyStructure » Any other notes and comments made about the service request. For example, internal billing notes note : Annotation [0..*] Instructions in terms that are understood by the patient or consumer patientInstruction : string [0..1] Key events in the history of the request relevantHistory : Reference [0..*] « Provenance »

XML Template 

<ServiceRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|MedicationRequest|ServiceRequest) What request fulfills --></basedOn>
 <replaces><!-- 0..* Reference(ServiceRequest) What request replaces --></replaces>
 <requisition><!-- 0..1 Identifier Composite Request ID --></requisition>
 <status value="[code]"/><!-- 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown -->
 <

 <intent value="[code]"/><!-- 1..1 proposal | plan | directive | order + -->

 <category><!-- 0..* CodeableConcept Classification of service --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <doNotPerform value="[boolean]"/><!-- 0..1 True if service/procedure should not be performed -->
 <</code>
 <</orderDetail>

 <code><!-- 0..1 CodeableReference(ActivityDefinition|PlanDefinition) What is being requested/ordered --></code>
 <orderDetail><!-- I 0..* CodeableConcept Additional order information --></orderDetail>

 <quantity[x]><!-- 0..1 Quantity|Ratio|Range Service amount --></quantity[x]>
 <subject><!-- 1..1 Reference(Device|Group|Location|Patient) Individual or Entity the service is ordered for --></subject>
 <focus><!-- 0..* Reference(Any) What the service request is about, when it is not about the subject of record --></focus>

 <encounter><!-- 0..1 Reference(Encounter) Encounter in which the request was created --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period|Timing When service should occur --></occurrence[x]>
 <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Preconditions for service --></asNeeded[x]>
 <authoredOn value="[dateTime]"/><!-- 0..1 Date request signed -->
 <requester><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who/what is requesting service --></requester>
 <</performerType>

 <performerType><!-- 0..1 CodeableConcept Performer role --></performerType>

 <performer><!-- 0..* Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) Requested performer --></performer>
 <</locationCode>
 <</locationReference>
 <</reasonCode>
 <|
   </reasonReference>

 <location><!-- 0..* CodeableReference(Location) Requested location icon --></location>
 <reason><!-- 0..* CodeableReference(Condition|DetectedIssue|DiagnosticReport|
   DocumentReference|Observation) Explanation/Justification for procedure or service --></reason>
 <insurance><!-- 0..* Reference(ClaimResponse|Coverage) Associated insurance coverage --></insurance>
 <supportingInfo><!-- 0..* Reference(Any) Additional clinical information --></supportingInfo>
 <specimen><!-- 0..* Reference(Specimen) Procedure Samples --></specimen>
 <</bodySite>

 <bodySite><!-- 0..* CodeableConcept Coded location on Body --></bodySite>
 <bodyStructure><!-- 0..1 Reference(BodyStructure) BodyStructure-based location on the body --></bodyStructure>

 <note><!-- 0..* Annotation Comments --></note>
 <patientInstruction value="[string]"/><!-- 0..1 Patient or consumer-oriented instructions -->
 <relevantHistory><!-- 0..* Reference(Provenance) Request provenance --></relevantHistory>
</ServiceRequest>

JSON Template 

{doco
  "resourceType" : "ServiceRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "

  "instantiatesCanonical" : ["<canonical(ActivityDefinition|PlanDefinition)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|MedicationRequest|ServiceRequest) }], // What request fulfills
  "replaces" : [{ Reference(ServiceRequest) }], // What request replaces
  "requisition" : { Identifier }, // Composite Request ID
  "status" : "<code>", // R!  draft | active | on-hold | revoked | completed | entered-in-error | unknown
  "

  "intent" : "<code>", // R!  proposal | plan | directive | order +

  "category" : [{ CodeableConcept }], // Classification of service
  "priority" : "<code>", // routine | urgent | asap | stat
  "doNotPerform" : <boolean>, // True if service/procedure should not be performed
  "
  "

  "code" : { CodeableReference(ActivityDefinition|PlanDefinition) }, // What is being requested/ordered
  "orderDetail" : [{ CodeableConcept }], // I Additional order information

  // quantity[x]: Service amount. One of these 3:
  "quantityQuantity" : { Quantity },
  "quantityRatio" : { Ratio },
  "quantityRange" : { Range },
  "subject" : { Reference(Device|Group|Location|Patient) }, // R!  Individual or Entity the service is ordered for
  "focus" : [{ Reference(Any) }], // What the service request is about, when it is not about the subject of record

  "encounter" : { Reference(Encounter) }, // Encounter in which the request was created
  // occurrence[x]: When service should occur. One of these 3:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "occurrenceTiming" : { Timing },
  // asNeeded[x]: Preconditions for service. One of these 2:
  "asNeededBoolean" : <boolean>,
  "asNeededCodeableConcept" : { CodeableConcept },
  "authoredOn" : "<dateTime>", // Date request signed
  "requester" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who/what is requesting service
  "

  "performerType" : { CodeableConcept }, // Performer role

  "performer" : [{ Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Requested performer
  "
  "
  "
  "|
   

  "location" : [{ CodeableReference(Location) }], // Requested location icon
  "reason" : [{ CodeableReference(Condition|DetectedIssue|DiagnosticReport|
   DocumentReference|Observation) }], // Explanation/Justification for procedure or service
  "insurance" : [{ Reference(ClaimResponse|Coverage) }], // Associated insurance coverage
  "supportingInfo" : [{ Reference(Any) }], // Additional clinical information
  "specimen" : [{ Reference(Specimen) }], // Procedure Samples
  "

  "bodySite" : [{ CodeableConcept }], // Coded location on Body
  "bodyStructure" : { Reference(BodyStructure) }, // BodyStructure-based location on the body

  "note" : [{ Annotation }], // Comments
  "patientInstruction" : "<string>", // Patient or consumer-oriented instructions
  "relevantHistory" : [{ Reference(Provenance) }] // Request provenance
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ServiceRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ServiceRequest.identifier [ Identifier ], ... ; # 0..* Identifiers assigned to this order
  fhir:ServiceRequest.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:ServiceRequest.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:ServiceRequest.basedOn [ Reference(CarePlan|MedicationRequest|ServiceRequest) ], ... ; # 0..* What request fulfills
  fhir:ServiceRequest.replaces [ Reference(ServiceRequest) ], ... ; # 0..* What request replaces
  fhir:ServiceRequest.requisition [ Identifier ]; # 0..1 Composite Request ID
  fhir:ServiceRequest.status [ code ]; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:

  fhir:ServiceRequest.intent [ code ]; # 1..1 proposal | plan | directive | order +

  fhir:ServiceRequest.category [ CodeableConcept ], ... ; # 0..* Classification of service
  fhir:ServiceRequest.priority [ code ]; # 0..1 routine | urgent | asap | stat
  fhir:ServiceRequest.doNotPerform [ boolean ]; # 0..1 True if service/procedure should not be performed
  fhir:
  fhir:

  fhir:ServiceRequest.code [ CodeableReference(ActivityDefinition|PlanDefinition) ]; # 0..1 What is being requested/ordered
  fhir:ServiceRequest.orderDetail [ CodeableConcept ], ... ; # 0..* I Additional order information

  # ServiceRequest.quantity[x] : 0..1 Service amount. One of these 3
    fhir:ServiceRequest.quantityQuantity [ Quantity ]
    fhir:ServiceRequest.quantityRatio [ Ratio ]
    fhir:ServiceRequest.quantityRange [ Range ]
  fhir:ServiceRequest.subject [ Reference(Device|Group|Location|Patient) ]; # 1..1 Individual or Entity the service is ordered for
  fhir:ServiceRequest.focus [ Reference(Any) ], ... ; # 0..* What the service request is about, when it is not about the subject of record

  fhir:ServiceRequest.encounter [ Reference(Encounter) ]; # 0..1 Encounter in which the request was created
  # ServiceRequest.occurrence[x] : 0..1 When service should occur. One of these 3
    fhir:ServiceRequest.occurrenceDateTime [ dateTime ]
    fhir:ServiceRequest.occurrencePeriod [ Period ]
    fhir:ServiceRequest.occurrenceTiming [ Timing ]
  # ServiceRequest.asNeeded[x] : 0..1 Preconditions for service. One of these 2
    fhir:ServiceRequest.asNeededBoolean [ boolean ]
    fhir:ServiceRequest.asNeededCodeableConcept [ CodeableConcept ]
  fhir:ServiceRequest.authoredOn [ dateTime ]; # 0..1 Date request signed
  fhir:ServiceRequest.requester [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who/what is requesting service
  fhir:ServiceRequest.performerType [ CodeableConcept ]; # 0..1 Performer role
  fhir:ServiceRequest.performer [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ], ... ; # 0..* Requested performer
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:ServiceRequest.location [ CodeableReference(Location) ], ... ; # 0..* Requested location
  fhir:ServiceRequest.reason [ CodeableReference(Condition|DetectedIssue|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Explanation/Justification for procedure or service

  fhir:ServiceRequest.insurance [ Reference(ClaimResponse|Coverage) ], ... ; # 0..* Associated insurance coverage
  fhir:ServiceRequest.supportingInfo [ Reference(Any) ], ... ; # 0..* Additional clinical information
  fhir:ServiceRequest.specimen [ Reference(Specimen) ], ... ; # 0..* Procedure Samples
  fhir:

  fhir:ServiceRequest.bodySite [ CodeableConcept ], ... ; # 0..* Coded location on Body
  fhir:ServiceRequest.bodyStructure [ Reference(BodyStructure) ]; # 0..1 BodyStructure-based location on the body

  fhir:ServiceRequest.note [ Annotation ], ... ; # 0..* Comments
  fhir:ServiceRequest.patientInstruction [ string ]; # 0..1 Patient or consumer-oriented instructions
  fhir:ServiceRequest.relevantHistory [ Reference(Provenance) ], ... ; # 0..* Request provenance
]

Changes since Release 4

ServiceRequest
ServiceRequest.code
  • No Changes Type changed from CodeableConcept to CodeableReference
  • Type changed from CodeableConcept to CodeableReference
ServiceRequest.focus
  • Added Element
ServiceRequest.location
  • Added Element
ServiceRequest.reason
  • Added Element
ServiceRequest.bodyStructure
  • Added Element
ServiceRequest.locationCode
  • deleted
ServiceRequest.locationReference
  • deleted
ServiceRequest.reasonCode
  • deleted
ServiceRequest.reasonReference
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4

 

See the Profiles & Extensions and the alternate Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

12.14.4.1 12.18.4.1 Terminology Bindings

Path Definition Type Reference
ServiceRequest.status

Codes identifying the lifecycle stage of a request.

Required RequestStatus
ServiceRequest.intent

Codes indicating the degree of authority/intentionality associated with a request.

Required RequestIntent
ServiceRequest.category

An example value set of SNOMED CT concepts that can classify a requested service

Example ServiceRequestCategoryCodes
ServiceRequest.priority

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

Required RequestPriority
ServiceRequest.code

Procedure Code: All SNOMED CT procedure codes.

Example ProcedureCodes(SNOMEDCT)
ServiceRequest.orderDetail

An example value set of Codified order entry details concepts. These concepts only make sense in the context of what is being ordered. This example is for a patient ventilation order

Example ServiceRequestOrderDetailsCodes
ServiceRequest.asNeeded[x]

This value set includes all clinical findings from SNOMED CT - provided as an exemplar value set.

Example SNOMEDCTMedicationAsNeededReasonCodes
ServiceRequest.performerType

Roles of participants that may be included in a care team. Defined as: Healthcare professional (occupation) or Services (qualifier value).

Example ActionParticipantRole ParticipantRoles
ServiceRequest.locationCode ServiceRequest.location

A role of a place that further classifies the setting (e.g., accident site, road side, work site, community location) in which services are delivered.

Example ServiceDeliveryLocationRoleType icon
ServiceRequest.reasonCode ServiceRequest.reason

This example value set defines the set of codes that can be used to indicate a reason for a procedure.

Example ProcedureReasonCodes
ServiceRequest.bodySite

This value set includes all codes from SNOMED CT icon where concept is-a 442083009 (Anatomical or acquired body site (body structure)).

Example SNOMEDCTBodyStructures

12.14.4.2 12.18.4.2 Constraints

id UniqueKey Level Location Description Expression
prr-1 img  bdystr-1 Rule ServiceRequest.bodyStructure bodyStructure SHALL only be present if bodySite is not present bodySite.exists() or bodyStructure.exists()
img  prr-1 Rule (base) orderDetail SHALL only be present if code is present orderDetail.empty() or code.exists()

12.14.5 12.18.5 Notes:

  • Many service requests will create a need to specify a specimen, body site, or body system. The request code will often have this information embedded in it - for example, 'serum glucose' or 'chest x-ray'. Alternatively, the specimen or bodysite element may be used to specify it.
  • The ServiceRequest should only reference the Specimen resource directly when the diagnostic investigation is requested on already existing specimens. Conversely, if the request is entered first with an uncollected specimen, the Specimen resource will reference the ServiceRequest resource when it is created.
  • The reasonCode element is often for billing purposes. It may relate to the resources referred to in supportingInfo element and may be used to decide how a procedure or diagnostic investigation will be performed, or even if it will be performed at all

12.14.6 12.18.6 Search Parameters

Search parameters for 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
authored N date Date request signed ServiceRequest.authoredOn
based-on reference What request fulfills ServiceRequest.basedOn
( CarePlan , MedicationRequest , ServiceRequest )
body-site token Where procedure is going to be done ServiceRequest.bodySite
body-structure reference Body structure Where procedure is going to be done ServiceRequest.bodyStructure
( BodyStructure )
category token Classification of service ServiceRequest.category
code code-concept token What is being requested/ordered ServiceRequest.code ServiceRequest.code.concept
code-reference reference What is being requested/ordered ServiceRequest.code.reference
encounter reference An encounter in which this request is made ServiceRequest.encounter
( Encounter )
identifier token Identifiers assigned to this order ServiceRequest.identifier
instantiates-canonical N reference Instantiates FHIR protocol or definition ServiceRequest.instantiatesCanonical
( PlanDefinition , ActivityDefinition )
instantiates-uri N uri Instantiates external protocol or definition ServiceRequest.instantiatesUri
intent N token proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option + ServiceRequest.intent
occurrence date When service should occur ServiceRequest.occurrence
patient reference Search by subject - a patient ServiceRequest.subject.where(resolve() is Patient)
( Patient )
performer reference Requested performer ServiceRequest.performer
( Practitioner , Organization , CareTeam , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson )
performer-type token Performer role ServiceRequest.performerType
priority N token routine | urgent | asap | stat ServiceRequest.priority
replaces reference What request replaces ServiceRequest.replaces
( ServiceRequest )
requester reference Who/what is requesting service ServiceRequest.requester
( Practitioner , Organization , Device , Patient , PractitionerRole , RelatedPerson )
requisition token Composite Request ID ServiceRequest.requisition
specimen reference Specimen to be tested ServiceRequest.specimen
( Specimen )
status N token draft | active | on-hold | revoked | completed | entered-in-error | unknown ServiceRequest.status
subject reference Search by subject ServiceRequest.subject
( Group , Device , Patient , Location )