Release
4
5
Snapshot
#1
Administration
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page
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part
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FHIR
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R4
-
Mixed
Normative
and
STU
)
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(v5.0.0-snapshot1:
R5
Snapshot
#1).
The
current
version
which
supercedes
this
version
is
5.0.0
.
For
a
full
list
of
available
versions,
see
the
Directory
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versions
.
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versions:
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R4B
R4
R3
R2
|
Patient
Administration
Work
Group
|
Maturity Level : 2 | Trial Use | Security Category : Patient | Compartments : Encounter , 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.
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 Hospitalization 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 hospitalization. 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 Hospitalization component is intended to store the extended information relating to a hospitalization 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.indication) 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.
Typically
these
are
in
order
or
the
organization's
workflow:
planned,
in-progress,
finished/cancelled.
This
status
information
is
often
used
for
other
things,
and
often
an
analysis
of
the
status
history
is
required.
This
could
be
done
by
scanning
through
all
the
versions
of
the
encounter,
checking
the
period
of
each,
and
then
doing
some
form
of
post
processing.
To
ease
the
burden
of
this
(or
where
a
system
doesn't
support
resource
histories)
a
status
history
component
is
included.
There
is
no
direct
indication
purely
by
the
status
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).
Statuses
of
"arrived",
"triaged"
or
"in
progress"
could
be
considered
the
start
of
the
admission,
and
also
have
the
presence
of
the
hospitalization
sub-component
entered.
The
"on
leave"
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.
The
location
is
also
likely
to
be
filled
in
with
a
location
status
of
"present".
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.
This
resource
is
referenced
by
AdverseEvent
,
AllergyIntolerance
,
AuditEvent
,
CarePlan
,
CareTeam
,
ChargeItem
,
Claim
,
ClinicalImpression
,
Communication
,
CommunicationRequest
,
Composition
,
Condition
,
Contract
,
DeviceDispense
,
DeviceRequest
,
DeviceUsage
,
DiagnosticReport
,
DocumentReference
,
itself,
ExplanationOfBenefit
,
Flag
,
GuidanceResponse
,
ImagingStudy
,
Immunization
,
List
,
Media
,
MedicationAdministration
,
MedicationDispense
,
MedicationRequest
,
MedicationStatement
MedicationUsage
,
NutritionIntake
,
NutritionOrder
,
Observation
,
Procedure
,
Provenance
,
QuestionnaireResponse
,
RequestGroup
,
RiskAssessment
,
ServiceRequest
,
Task
and
VisionPrescription
.
This resource implements the Event pattern.
Structure
| Name | Flags | Card. | Type |
Description
&
Constraints
|
|---|---|---|---|---|
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
|
EncounterStatus ( Required ) |
statusHistory
|
0..* | BackboneElement |
List
of
past
encounter
statuses
|
|
status
|
1..1 | code |
planned
|
EncounterStatus ( Required ) |
|
period
|
1..1 | Period | The time that the episode was in the specified status | |
|
class
|
Σ | 1..1 | Coding |
Classification
of
patient
encounter
(
Extensible
)
|
|
classHistory
|
0..* | BackboneElement |
List
of
past
encounter
classes
|
|
|
class
|
1..1 | Coding |
inpatient
|
outpatient
|
ambulatory
|
emergency
+
(
Extensible
)
|
|
|
period
|
1..1 | Period | The time that the episode was in the specified class | |
|
type
|
Σ | 0..* | CodeableConcept |
Specific
type
of
encounter
|
|
serviceType
|
Σ | 0..1 | CodeableConcept |
Specific
type
of
service
|
|
priority
|
0..1 | CodeableConcept |
Indicates
the
urgency
of
the
encounter
(
Example
)
|
|
subject
|
Σ | 0..1 | Reference ( Patient | Group ) | The patient or group present at the encounter |
|
subjectStatus
| 0..1 | CodeableConcept |
The
current
status
of
the
subject
in
relation
to
the
Encounter
EncounterSubjectStatus ( Extensible ) | |
|
episodeOfCare
|
Σ | 0..* | Reference ( EpisodeOfCare ) |
Episode(s)
of
care
that
this
encounter
should
be
recorded
against
|
|
basedOn
|
0..* | Reference ( ServiceRequest ) |
The
ServiceRequest
that
initiated
this
encounter
|
|
|
participant
|
Σ | 0..* | BackboneElement |
List
of
participants
involved
in
the
encounter
|
|
type
|
Σ | 0..* | CodeableConcept |
Role
of
participant
in
encounter
|
|
period
|
0..1 | Period | Period of time during the encounter that the participant participated | |
|
actor
|
Σ | 0..1 |
Reference
(
Patient
|
Group
|
RelatedPerson
|
Practitioner
|
PractitionerRole
|
|
Persons
involved
in
the
encounter
|
|
appointment
|
Σ | 0..* | Reference ( Appointment ) |
The
appointment
that
scheduled
this
encounter
|
|
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 |
|
|
|
|
|
|
|
|
|
|
|
Σ | 0..* |
|
Reason
the
encounter
takes
place
Encounter Reason Codes ( Preferred ) |
|
diagnosis
|
Σ | 0..* | BackboneElement |
The
list
of
diagnosis
relevant
to
this
encounter
|
|
condition
|
Σ | 1..1 | Reference ( Condition | Procedure ) | The diagnosis or procedure relevant to the encounter |
|
use
|
0..1 | CodeableConcept |
Role
that
this
diagnosis
has
within
the
encounter
(e.g.
admission,
billing,
discharge
…)
DiagnosisRole ( Preferred ) |
|
|
rank
|
0..1 | positiveInt | Ranking of the diagnosis (for each role type) | |
|
account
|
0..* | Reference ( Account ) |
The
set
of
accounts
that
may
be
used
for
billing
for
this
Encounter
|
|
|
hospitalization
|
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)
|
|
|
reAdmission
|
0..1 | CodeableConcept |
The
type
of
hospital
re-admission
that
has
occurred
(if
any).
If
the
value
is
absent,
then
this
is
not
identified
as
a
readmission
(
Example
)
|
|
|
dietPreference
|
0..* | CodeableConcept |
Diet
preferences
reported
by
the
patient
Diet ( Example ) |
|
|
specialCourtesy
|
0..* | CodeableConcept |
Special
courtesies
(VIP,
board
member)
|
|
|
specialArrangement
|
0..* | CodeableConcept |
Wheelchair,
translator,
stretcher,
etc.
|
|
|
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
|
|
|
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
EncounterLocationStatus ( Required ) |
|
|
physicalType
|
0..1 | CodeableConcept |
The
physical
type
of
the
location
(usually
the
level
in
the
location
hierachy
-
bed
room
ward
etc.)
|
|
|
period
|
0..1 | Period | Time period during which the patient was present at the location | |
|
serviceProvider
|
0..1 | Reference ( Organization ) | The organization (facility) responsible for this encounter | |
|
partOf
|
0..1 | Reference ( Encounter ) | Another Encounter this encounter is part of | |
|
Documentation
for
this
format
|
||||
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 | onhold | completed | cancelled | entered-in-error | unknown --> <statusHistory> <!-- 0..* List of past encounter statuses --><<status value="[code]"/><!-- 1..1 planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown --> <period><!-- 1..1 Period The time that the episode was in the specified status --></period> </statusHistory><</class><class><!-- 1..1 Coding Classification of patient encounter<</class><class><!-- 1..1 Coding inpatient | outpatient | ambulatory | emergency +<</priority> <</subject><priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter<</individual><actor><!-- 0..1 Reference(Device|Group|HealthcareService|Patient|Practitioner| PractitionerRole|RelatedPerson) Persons involved in the encounter (including patient) --></actor> </participant> <appointment><!-- 0..* Reference(Appointment) The appointment that scheduled this encounter --></appointment><</period><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 --> <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length><</reasonCode> <| </reasonReference><reason><!-- 0..* CodeableReference(Condition|ImmunizationRecommendation| Observation|Procedure) Reason the encounter takes place (core or reference) --></reason> <diagnosis> <!-- 0..* The list of diagnosis relevant to this encounter --> <condition><!-- 1..1 Reference(Condition|Procedure) The diagnosis or procedure relevant to the encounter --></condition><</use><use><!-- 0..1 CodeableConcept Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) --></use> <rank value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each role type) --> </diagnosis> <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account> <hospitalization> <!-- 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 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
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 | onhold | completed | cancelled | entered-in-error | unknown
"statusHistory" : [{ // List of past encounter statuses
"
"status" : "<code>", // R! planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown
"period" : { Period } // R! The time that the episode was in the specified status
}],
"
"class" : { Coding }, // R! Classification of patient encounter
"classHistory" : [{ // List of past encounter classes
"
"class" : { Coding }, // R! inpatient | outpatient | ambulatory | emergency +
"period" : { Period } // R! The time that the episode was in the specified class
}],
"type" : [{ CodeableConcept }], // Specific type of encounter
"serviceType" : { CodeableConcept }, // Specific type of service
"
"
"priority" : { CodeableConcept }, // Indicates the urgency of the encounter
"subject" : { Reference(Group|Patient) }, // The patient or group present at the 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(ServiceRequest) }], // The ServiceRequest that initiated this encounter
"participant" : [{ // List of participants involved in the encounter
"type" : [{ CodeableConcept }], // 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) } // Persons involved in the encounter (including patient)
}],
"appointment" : [{ Reference(Appointment) }], // The appointment that scheduled this encounter
"
"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
"length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
"
"|
"reason" : [{ CodeableReference(Condition|ImmunizationRecommendation|
Observation|Procedure) }], // Reason the encounter takes place (core or reference)
"diagnosis" : [{ // The list of diagnosis relevant to this encounter
"condition" : { Reference(Condition|Procedure) }, // R! The diagnosis or procedure relevant to the encounter
"
"use" : { CodeableConcept }, // Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
"rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
}],
"account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
"hospitalization" : { // 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 }, // The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
"dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
"specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
"specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc.
"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
"physicalType" : { CodeableConcept }, // The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
"period" : { Period } // Time period during which the patient was present at the location
}],
"serviceProvider" : { Reference(Organization) }, // The organization (facility) responsible for this encounter
"partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .fhir:fhir:Encounter.status [ code ]; # 1..1 planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown fhir:Encounter.statusHistory [ # 0..* List of past encounter statusesfhir:fhir:Encounter.statusHistory.status [ code ]; # 1..1 planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown fhir:Encounter.statusHistory.period [ Period ]; # 1..1 The time that the episode was in the specified status ], ...; fhir:Encounter.class [ Coding ]; # 1..1 Classification of patient encounter fhir:Encounter.classHistory [ # 0..* List of past encounter classes fhir:Encounter.classHistory.class [ Coding ]; # 1..1 inpatient | outpatient | ambulatory | emergency + fhir:Encounter.classHistory.period [ Period ]; # 1..1 The time that the episode was in the specified class ], ...; fhir:Encounter.type [ CodeableConcept ], ... ; # 0..* Specific type of encounter fhir:Encounter.serviceType [ CodeableConcept ]; # 0..1 Specific type of service fhir:Encounter.priority [ CodeableConcept ]; # 0..1 Indicates the urgency of the encounterfhir:fhir:Encounter.subject [ Reference(Group|Patient) ]; # 0..1 The patient or group present at the encounter fhir:Encounter.subjectStatus [ CodeableConcept ]; # 0..1 The current status of the subject in relation to the Encounter fhir:Encounter.episodeOfCare [ Reference(EpisodeOfCare) ], ... ; # 0..* Episode(s) of care that this encounter should be recorded against fhir:Encounter.basedOn [ Reference(ServiceRequest) ], ... ; # 0..* The ServiceRequest that initiated this encounter fhir:Encounter.participant [ # 0..* List of participants involved in the encounter fhir:Encounter.participant.type [ CodeableConcept ], ... ; # 0..* Role of participant in encounter fhir:Encounter.participant.period [ Period ]; # 0..1 Period of time during the encounter that the participant participatedfhir:fhir:Encounter.participant.actor [ Reference(Device|Group|HealthcareService|Patient|Practitioner|PractitionerRole| RelatedPerson) ]; # 0..1 Persons involved in the encounter (including patient) ], ...; fhir:Encounter.appointment [ Reference(Appointment) ], ... ; # 0..* The appointment that scheduled this encounterfhir:fhir:Encounter.actualPeriod [ Period ]; # 0..1 The actual start and end time of the encounter fhir:Encounter.plannedStartDate [ dateTime ]; # 0..1 The planned start date/time (or admission date) of the encounter fhir:Encounter.plannedEndDate [ dateTime ]; # 0..1 The planned end date/time (or discharge date) of the encounter fhir:Encounter.length [ Duration ]; # 0..1 Quantity of time the encounter lasted (less time absent)fhir: fhir:fhir:Encounter.reason [ CodeableReference(Condition|ImmunizationRecommendation|Observation|Procedure) ], ... ; # 0..* Reason the encounter takes place (core or reference) fhir:Encounter.diagnosis [ # 0..* The list of diagnosis relevant to this encounter fhir:Encounter.diagnosis.condition [ Reference(Condition|Procedure) ]; # 1..1 The diagnosis or procedure relevant to the encounterfhir:fhir:Encounter.diagnosis.use [ CodeableConcept ]; # 0..1 Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) fhir:Encounter.diagnosis.rank [ positiveInt ]; # 0..1 Ranking of the diagnosis (for each role type) ], ...; fhir:Encounter.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this Encounter fhir:Encounter.hospitalization [ # 0..1 Details about the admission to a healthcare service fhir:Encounter.hospitalization.preAdmissionIdentifier [ Identifier ]; # 0..1 Pre-admission identifier fhir:Encounter.hospitalization.origin [ Reference(Location|Organization) ]; # 0..1 The location/organization from which the patient came before admission fhir:Encounter.hospitalization.admitSource [ CodeableConcept ]; # 0..1 From where patient was admitted (physician referral, transfer) fhir:Encounter.hospitalization.reAdmission [ CodeableConcept ]; # 0..1 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission fhir:Encounter.hospitalization.dietPreference [ CodeableConcept ], ... ; # 0..* Diet preferences reported by the patient fhir:Encounter.hospitalization.specialCourtesy [ CodeableConcept ], ... ; # 0..* Special courtesies (VIP, board member) fhir:Encounter.hospitalization.specialArrangement [ CodeableConcept ], ... ; # 0..* Wheelchair, translator, stretcher, etc. fhir:Encounter.hospitalization.destination [ Reference(Location|Organization) ]; # 0..1 Location/organization to which the patient is discharged fhir:Encounter.hospitalization.dischargeDisposition [ CodeableConcept ]; # 0..1 Category or kind of location after discharge ]; fhir:Encounter.location [ # 0..* List of locations where the patient has been fhir:Encounter.location.location [ Reference(Location) ]; # 1..1 Location the encounter takes place fhir:Encounter.location.status [ code ]; # 0..1 planned | active | reserved | completed fhir:Encounter.location.physicalType [ CodeableConcept ]; # 0..1 The physical type of the location (usually the level in the location hierachy - bed room ward etc.) fhir:Encounter.location.period [ Period ]; # 0..1 Time period during which the patient was present at the location ], ...; fhir:Encounter.serviceProvider [ Reference(Organization) ]; # 0..1 The organization (facility) responsible for this encounter fhir:Encounter.partOf [ Reference(Encounter) ]; # 0..1 Another Encounter this encounter is part of ]
Changes since R3
| Encounter | |
| Encounter.status |
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See the Full Difference for further information
This analysis is available as XML or JSON .
See R3 <--> R4 Conversion Maps (status = 10 tests that all execute ok. All tests pass round-trip testing and 3 r3 resources are invalid (0 errors). )
Structure
| Name | Flags | Card. | Type |
Description
&
Constraints
|
|---|---|---|---|---|
|
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
|
EncounterStatus ( Required ) |
|
statusHistory
|
0..* | BackboneElement |
List
of
past
encounter
statuses
|
|
|
status
|
1..1 | code |
planned
|
EncounterStatus ( Required ) |
|
|
period
|
1..1 | Period | The time that the episode was in the specified status | |
|
class
|
Σ | 1..1 | Coding |
Classification
of
patient
encounter
(
Extensible
)
|
|
classHistory
|
0..* | BackboneElement |
List
of
past
encounter
classes
|
|
|
class
|
1..1 | Coding |
inpatient
|
outpatient
|
ambulatory
|
emergency
+
(
Extensible
)
|
|
|
period
|
1..1 | Period | The time that the episode was in the specified class | |
|
type
|
Σ | 0..* | CodeableConcept |
Specific
type
of
encounter
|
|
serviceType
|
Σ | 0..1 | CodeableConcept |
Specific
type
of
service
|
|
priority
|
0..1 | CodeableConcept |
Indicates
the
urgency
of
the
encounter
(
Example
)
|
|
|
subject
|
Σ | 0..1 | Reference ( Patient | Group ) | The patient or group present at the encounter |
|
subjectStatus
| 0..1 | CodeableConcept |
The
current
status
of
the
subject
in
relation
to
the
Encounter
EncounterSubjectStatus ( Extensible ) | |
|
episodeOfCare
|
Σ | 0..* | Reference ( EpisodeOfCare ) |
Episode(s)
of
care
that
this
encounter
should
be
recorded
against
|
|
basedOn
|
0..* | Reference ( ServiceRequest ) |
The
ServiceRequest
that
initiated
this
encounter
|
|
|
participant
|
Σ | 0..* | BackboneElement |
List
of
participants
involved
in
the
encounter
|
|
type
|
Σ | 0..* | CodeableConcept |
Role
of
participant
in
encounter
|
|
period
|
0..1 | Period | Period of time during the encounter that the participant participated | |
|
actor
|
Σ | 0..1 |
Reference
(
Patient
|
Group
|
RelatedPerson
|
Practitioner
|
PractitionerRole
|
|
Persons
involved
in
the
encounter
|
|
appointment
|
Σ | 0..* | Reference ( Appointment ) |
The
appointment
that
scheduled
this
encounter
|
|
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 |
|
|
|
|
|
|
|
|
|
|
|
Σ | 0..* |
|
Reason
the
encounter
takes
place
Encounter Reason Codes ( Preferred ) |
|
diagnosis
|
Σ | 0..* | BackboneElement |
The
list
of
diagnosis
relevant
to
this
encounter
|
|
condition
|
Σ | 1..1 | Reference ( Condition | Procedure ) | The diagnosis or procedure relevant to the encounter |
|
use
|
0..1 | CodeableConcept |
Role
that
this
diagnosis
has
within
the
encounter
(e.g.
admission,
billing,
discharge
…)
DiagnosisRole ( Preferred ) |
|
|
rank
|
0..1 | positiveInt | Ranking of the diagnosis (for each role type) | |
|
account
|
0..* | Reference ( Account ) |
The
set
of
accounts
that
may
be
used
for
billing
for
this
Encounter
|
|
|
hospitalization
|
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)
|
|
|
reAdmission
|
0..1 | CodeableConcept |
The
type
of
hospital
re-admission
that
has
occurred
(if
any).
If
the
value
is
absent,
then
this
is
not
identified
as
a
readmission
(
Example
)
|
|
|
dietPreference
|
0..* | CodeableConcept |
Diet
preferences
reported
by
the
patient
Diet ( Example ) |
|
|
specialCourtesy
|
0..* | CodeableConcept |
Special
courtesies
(VIP,
board
member)
|
|
|
specialArrangement
|
0..* | CodeableConcept |
Wheelchair,
translator,
stretcher,
etc.
|
|
|
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
|
|
|
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
EncounterLocationStatus ( Required ) |
|
|
physicalType
|
0..1 | CodeableConcept |
The
physical
type
of
the
location
(usually
the
level
in
the
location
hierachy
-
bed
room
ward
etc.)
|
|
|
period
|
0..1 | Period | Time period during which the patient was present at the location | |
|
serviceProvider
|
0..1 | Reference ( Organization ) | The organization (facility) responsible for this encounter | |
|
partOf
|
0..1 | Reference ( Encounter ) | Another Encounter this encounter is part of | |
|
Documentation
for
this
format
|
||||
XML Template
<Encounter xmlns="http://hl7.org/fhir"><<status value="[code]"/><!-- 1..1 planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown --> <statusHistory> <!-- 0..* List of past encounter statuses --><<status value="[code]"/><!-- 1..1 planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown --> <period><!-- 1..1 Period The time that the episode was in the specified status --></period> </statusHistory><</class><class><!-- 1..1 Coding Classification of patient encounter<</class><class><!-- 1..1 Coding inpatient | outpatient | ambulatory | emergency +<</priority> <</subject><priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter<</individual><actor><!-- 0..1 Reference(Device|Group|HealthcareService|Patient|Practitioner| PractitionerRole|RelatedPerson) Persons involved in the encounter (including patient) --></actor> </participant> <appointment><!-- 0..* Reference(Appointment) The appointment that scheduled this encounter --></appointment><</period><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 --> <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length><</reasonCode> <| </reasonReference><reason><!-- 0..* CodeableReference(Condition|ImmunizationRecommendation| Observation|Procedure) Reason the encounter takes place (core or reference) --></reason> <diagnosis> <!-- 0..* The list of diagnosis relevant to this encounter --> <condition><!-- 1..1 Reference(Condition|Procedure) The diagnosis or procedure relevant to the encounter --></condition><</use><use><!-- 0..1 CodeableConcept Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) --></use> <rank value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each role type) --> </diagnosis> <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account> <hospitalization> <!-- 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 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
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 | onhold | completed | cancelled | entered-in-error | unknown
"statusHistory" : [{ // List of past encounter statuses
"
"status" : "<code>", // R! planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown
"period" : { Period } // R! The time that the episode was in the specified status
}],
"
"class" : { Coding }, // R! Classification of patient encounter
"classHistory" : [{ // List of past encounter classes
"
"class" : { Coding }, // R! inpatient | outpatient | ambulatory | emergency +
"period" : { Period } // R! The time that the episode was in the specified class
}],
"type" : [{ CodeableConcept }], // Specific type of encounter
"serviceType" : { CodeableConcept }, // Specific type of service
"
"
"priority" : { CodeableConcept }, // Indicates the urgency of the encounter
"subject" : { Reference(Group|Patient) }, // The patient or group present at the 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(ServiceRequest) }], // The ServiceRequest that initiated this encounter
"participant" : [{ // List of participants involved in the encounter
"type" : [{ CodeableConcept }], // 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) } // Persons involved in the encounter (including patient)
}],
"appointment" : [{ Reference(Appointment) }], // The appointment that scheduled this encounter
"
"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
"length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
"
"|
"reason" : [{ CodeableReference(Condition|ImmunizationRecommendation|
Observation|Procedure) }], // Reason the encounter takes place (core or reference)
"diagnosis" : [{ // The list of diagnosis relevant to this encounter
"condition" : { Reference(Condition|Procedure) }, // R! The diagnosis or procedure relevant to the encounter
"
"use" : { CodeableConcept }, // Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
"rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
}],
"account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
"hospitalization" : { // 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 }, // The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
"dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
"specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
"specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc.
"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
"physicalType" : { CodeableConcept }, // The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
"period" : { Period } // Time period during which the patient was present at the location
}],
"serviceProvider" : { Reference(Organization) }, // The organization (facility) responsible for this encounter
"partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .fhir:fhir:Encounter.status [ code ]; # 1..1 planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown fhir:Encounter.statusHistory [ # 0..* List of past encounter statusesfhir:fhir:Encounter.statusHistory.status [ code ]; # 1..1 planned | in-progress | onhold | completed | cancelled | entered-in-error | unknown fhir:Encounter.statusHistory.period [ Period ]; # 1..1 The time that the episode was in the specified status ], ...; fhir:Encounter.class [ Coding ]; # 1..1 Classification of patient encounter fhir:Encounter.classHistory [ # 0..* List of past encounter classes fhir:Encounter.classHistory.class [ Coding ]; # 1..1 inpatient | outpatient | ambulatory | emergency + fhir:Encounter.classHistory.period [ Period ]; # 1..1 The time that the episode was in the specified class ], ...; fhir:Encounter.type [ CodeableConcept ], ... ; # 0..* Specific type of encounter fhir:Encounter.serviceType [ CodeableConcept ]; # 0..1 Specific type of service fhir:Encounter.priority [ CodeableConcept ]; # 0..1 Indicates the urgency of the encounterfhir:fhir:Encounter.subject [ Reference(Group|Patient) ]; # 0..1 The patient or group present at the encounter fhir:Encounter.subjectStatus [ CodeableConcept ]; # 0..1 The current status of the subject in relation to the Encounter fhir:Encounter.episodeOfCare [ Reference(EpisodeOfCare) ], ... ; # 0..* Episode(s) of care that this encounter should be recorded against fhir:Encounter.basedOn [ Reference(ServiceRequest) ], ... ; # 0..* The ServiceRequest that initiated this encounter fhir:Encounter.participant [ # 0..* List of participants involved in the encounter fhir:Encounter.participant.type [ CodeableConcept ], ... ; # 0..* Role of participant in encounter fhir:Encounter.participant.period [ Period ]; # 0..1 Period of time during the encounter that the participant participatedfhir:fhir:Encounter.participant.actor [ Reference(Device|Group|HealthcareService|Patient|Practitioner|PractitionerRole| RelatedPerson) ]; # 0..1 Persons involved in the encounter (including patient) ], ...; fhir:Encounter.appointment [ Reference(Appointment) ], ... ; # 0..* The appointment that scheduled this encounterfhir:fhir:Encounter.actualPeriod [ Period ]; # 0..1 The actual start and end time of the encounter fhir:Encounter.plannedStartDate [ dateTime ]; # 0..1 The planned start date/time (or admission date) of the encounter fhir:Encounter.plannedEndDate [ dateTime ]; # 0..1 The planned end date/time (or discharge date) of the encounter fhir:Encounter.length [ Duration ]; # 0..1 Quantity of time the encounter lasted (less time absent)fhir: fhir:fhir:Encounter.reason [ CodeableReference(Condition|ImmunizationRecommendation|Observation|Procedure) ], ... ; # 0..* Reason the encounter takes place (core or reference) fhir:Encounter.diagnosis [ # 0..* The list of diagnosis relevant to this encounter fhir:Encounter.diagnosis.condition [ Reference(Condition|Procedure) ]; # 1..1 The diagnosis or procedure relevant to the encounterfhir:fhir:Encounter.diagnosis.use [ CodeableConcept ]; # 0..1 Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) fhir:Encounter.diagnosis.rank [ positiveInt ]; # 0..1 Ranking of the diagnosis (for each role type) ], ...; fhir:Encounter.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this Encounter fhir:Encounter.hospitalization [ # 0..1 Details about the admission to a healthcare service fhir:Encounter.hospitalization.preAdmissionIdentifier [ Identifier ]; # 0..1 Pre-admission identifier fhir:Encounter.hospitalization.origin [ Reference(Location|Organization) ]; # 0..1 The location/organization from which the patient came before admission fhir:Encounter.hospitalization.admitSource [ CodeableConcept ]; # 0..1 From where patient was admitted (physician referral, transfer) fhir:Encounter.hospitalization.reAdmission [ CodeableConcept ]; # 0..1 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission fhir:Encounter.hospitalization.dietPreference [ CodeableConcept ], ... ; # 0..* Diet preferences reported by the patient fhir:Encounter.hospitalization.specialCourtesy [ CodeableConcept ], ... ; # 0..* Special courtesies (VIP, board member) fhir:Encounter.hospitalization.specialArrangement [ CodeableConcept ], ... ; # 0..* Wheelchair, translator, stretcher, etc. fhir:Encounter.hospitalization.destination [ Reference(Location|Organization) ]; # 0..1 Location/organization to which the patient is discharged fhir:Encounter.hospitalization.dischargeDisposition [ CodeableConcept ]; # 0..1 Category or kind of location after discharge ]; fhir:Encounter.location [ # 0..* List of locations where the patient has been fhir:Encounter.location.location [ Reference(Location) ]; # 1..1 Location the encounter takes place fhir:Encounter.location.status [ code ]; # 0..1 planned | active | reserved | completed fhir:Encounter.location.physicalType [ CodeableConcept ]; # 0..1 The physical type of the location (usually the level in the location hierachy - bed room ward etc.) fhir:Encounter.location.period [ Period ]; # 0..1 Time period during which the patient was present at the location ], ...; fhir:Encounter.serviceProvider [ Reference(Organization) ]; # 0..1 The organization (facility) responsible for this encounter fhir:Encounter.partOf [ Reference(Encounter) ]; # 0..1 Another Encounter this encounter is part of ]
Changes since Release 3
| Encounter | |
| Encounter.status |
|
| Encounter.statusHistory.status |
|
|
|
|
|
|
|
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|
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|
See the Full Difference for further information
This analysis is available as XML or JSON .
See R3 <--> R4 Conversion Maps (status = 10 tests that all execute ok. All tests pass round-trip testing and 3 r3 resources are invalid (0 errors). )
See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis a
| Path | Definition | Type | Reference |
|---|---|---|---|
| Encounter.status | Required | EncounterStatus | |
| Encounter.statusHistory.status |
|
Required | EncounterStatus |
| Encounter.class | Extensible |
ActEncounterCode
| |
| Encounter.classHistory.class |
|
Extensible |
|
| Encounter.type |
|
Example | EncounterType |
| Encounter.serviceType |
|
Example | ServiceType |
| Encounter.priority |
|
Example |
|
| Encounter.subjectStatus | Extensible | EncounterSubjectStatus | |
| Encounter.participant.type |
|
Extensible | ParticipantType |
|
|
|
Preferred | EncounterReasonCodes |
| Encounter.diagnosis.use |
|
Preferred | DiagnosisRole |
| Encounter.hospitalization.admitSource |
|
Preferred | AdmitSource |
| Encounter.hospitalization.reAdmission |
|
Example |
|
| Encounter.hospitalization.dietPreference |
|
Example | Diet |
| Encounter.hospitalization.specialCourtesy |
|
Preferred | SpecialCourtesy |
| Encounter.hospitalization.specialArrangement |
|
Preferred | SpecialArrangements |
| Encounter.hospitalization.dischargeDisposition |
|
Example | DischargeDisposition |
| Encounter.location.status |
|
Required | EncounterLocationStatus |
| Encounter.location.physicalType |
|
Example | LocationType |
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. 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
( ServiceRequest ) |
|
| class | token | Classification of patient encounter | Encounter.class | |
| date | date |
A
date
within
the
|
|
|
| diagnosis | reference | The diagnosis or procedure relevant to the encounter |
Encounter.diagnosis.condition
( Condition , Procedure ) |
|
| 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 the location | Encounter.location.period | |
| part-of | reference | Another Encounter this encounter is part of |
Encounter.partOf
( Encounter ) |
|
| participant | reference | Persons involved in the encounter other than the patient |
( Practitioner , Group , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson ) |
|
| participant-type | token | Role of participant in encounter | Encounter.participant.type | |
| patient | reference |
The
patient
|
Encounter.subject.where(resolve()
is
Patient)
( Group , Patient ) |
|
| practitioner | reference | Persons involved in the encounter other than the patient |
( Practitioner , Group , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson ) |
|
| reason-code D | token |
|
|
|
| reason-reference D | reference |
|
|
|
| service-provider | reference | The organization (facility) responsible for this encounter |
Encounter.serviceProvider
( Organization ) |
|
| special-arrangement | token | Wheelchair, translator, stretcher, etc. | Encounter.hospitalization.specialArrangement | |
| status N | token |
planned
|
|
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 |
|
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FHIR
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(Technical
Correction
#1)
(v4.0.1)
R5
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hl7.fhir.core#5.0.0-snapshot1
generated
on
Fri,
Nov
1,
2019
09:35+1100.
QA
Page
Sun,
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