DSTU2 FHIR Release 3 (STU)

This page is part of the FHIR Specification (v1.0.2: DSTU (v3.0.2: STU 2). 3). 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: R3 R2 R3 R2

4.7 12.14 Resource ReferralRequest - Content

Patient Care Work Group Maturity Level : 1   Trial Use Compartments : Patient , Practitioner

Used to record and send details about a request for referral service or transfer of a patient to the care of another provider or provider organization.

4.7.1 12.14.1 Scope and Usage

ReferralRequest is one of the request resources in the FHIR workflow specification.

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

Examples include:

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

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

4.7.2 12.14.2 Boundaries and Relationships

ReferralRequest is closely related to other types of "request" resources, particularly DiagnosticOrder and ProcedureRequest . In fact, for some services, it may be appropriate to use any one of these resources to request that the service be performed. Which one is used may be driven by organizational practice and by context. When it is unclear which to use, the following principles may be helpful:

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

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

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

The details of the type of care desired as part of a referral may be conveyed using any of the "request" or "order" resources, likely with a status of "proposed". The CarePlan resource can be used to describe more sophisticated requests for combinations of services. Likewise, ReferralRequest may be referenced as part of a CarePlan.

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

A ReferralRequest might be fulfilled by a DiagnosticReport , Encounter , Procedure , or other assessment-related resource.

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

This resource is referenced by Appointment , CarePlan , Claim , ClinicalImpression , DiagnosticReport , Encounter , EpisodeOfCare and , ExplanationOfBenefit , ImagingStudy , MedicationRequest , MedicationStatement , Observation , Procedure and QuestionnaireResponse

4.7.3 12.14.3 Resource Content

Structure

1..1 draft | requested | active | cancelled | accepted Business identifier 0..1 Date of creation/activation The clinical specialty (discipline) that the 0..1 Urgency 0..1 Requester of 0..* Receiver of referral / transfer of care Originating encounter 0..1 Date referral/transfer 0..1 string A textual description of the referral Σ Actions requested as part Σ 0..1 Period Requested service(s) fulfillment time
Name Flags Card. Type Description & Constraints doco
. . ReferralRequest DomainResource A request for referral or transfer of care
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . status . identifier ?! Σ 0..* Identifier Business identifier
... definition Σ 0..* code Reference ( ActivityDefinition | PlanDefinition ) Instantiates protocol or definition
. . . basedOn Σ 0..* Reference ( ReferralRequest | rejected CarePlan | completed ProcedureRequest ) Request fulfilled by this request
ReferralStatus
. . . replaces Σ 0..* Reference ( Required ReferralRequest ) Request(s) replaced by this request
. . identifier . groupIdentifier Σ 0..* 0..1 Identifier Composite request this is part of
. . date . status ?! Σ 1..1 dateTime code draft | active | suspended | cancelled | completed | entered-in-error | unknown
RequestStatus ( Required )
. . . intent ?! Σ 1..1 code proposal | plan | order
RequestIntent ( Required )
... type Σ 0..1 CodeableConcept Referral/Transition of care request type
SNOMED CT Patient Referral ( Example )
. . specialty . priority Σ 0..1 CodeableConcept code Urgency of referral is requested for / transfer of care request
PractitionerSpecialty RequestPriority ( Example Required )
. . priority . serviceRequested Σ 0..* CodeableConcept Actions requested as part of the referral / transfer of care request
DiagnosticOrderPriority Practice Setting Code Value Set ( Example )
. . patient . subject Σ 1..1 Reference ( Patient | Group ) Patient referred to care or transfer
. . requester . context Σ 0..1 Reference ( Practitioner | Organization Encounter | Patient EpisodeOfCare ) Originating encounter
... occurrence[x] Σ 0..1 When the service(s) requested in the referral / transfer should occur
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
... authoredOn Σ 0..1 dateTime Date of care creation/activation
. . recipient . requester Σ I 0..1 BackboneElement Who/what is requesting service
+ onBehalfOf can only be specified if agent is practitioner or device
.... agent Σ 1..1 Reference ( Practitioner | Organization | Patient | RelatedPerson | Device ) Individual making the request
. . encounter . . onBehalfOf Σ I 0..1 Reference ( Encounter Organization ) Organization agent is acting for
. . dateSent . specialty 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for
PractitionerSpecialty ( Example )
... recipient Σ 0..* dateTime Reference ( Practitioner | Organization | HealthcareService ) Receiver of referral / transfer of care request is sent
. . reason . reasonCode Σ 0..* CodeableConcept Reason for referral / transfer of care request
SNOMED CT Clinical Findings ( Example )
. . description . reasonReference Σ 0..1 0..* Reference ( Condition | Observation ) Why is service needed?
. . serviceRequested . description 0..* 0..1 CodeableConcept string A textual description of the referral Practice Setting Code Value Set ( Example )
. . supportingInformation . supportingInfo 0..* Reference ( Any ) Additonal information to support referral or transfer of care request
. . fulfillmentTime . note Σ 0..* Annotation Comments made about referral request
. . . relevantHistory 0..* Reference ( Provenance ) Key events in history of request

doco Documentation for this format

UML Diagram ( Legend )

ReferralRequest ( DomainResource ) Business identifier that uniquely identifies the referral/care transfer request instance identifier : Identifier [0..*] A protocol, guideline, orderset or other definition that is adhered to in whole or in part by this request definition : Reference [0..*] ActivityDefinition | PlanDefinition Indicates any plans, proposals or orders that this request is intended to satisfy - in whole or in part basedOn : Reference [0..*] ReferralRequest | CarePlan | ProcedureRequest Completed or terminated request(s) whose function is taken by this new request replaces : Reference [0..*] ReferralRequest The business identifier of the logical "grouping" request/order that this referral is a part of groupIdentifier : Identifier [0..1] The workflow status of the authorization/intention reflected by the referral or transfer of care request record (this element modifies the meaning of other elements) status : code [1..1] « The status of the referral. (Strength=Required) ReferralStatus RequestStatus ! » Business identifier that uniquely identifies Distinguishes the referral/care transfer "level" of authorization/demand implicit in this request instance (this element modifies the meaning of other elements) identifier intent : Identifier code [0..*] [1..1] Date/DateTime of creation for draft requests and date Codes identifying the stage lifecycle stage of activation for active requests a request (Strength=Required) date : dateTime [0..1] RequestIntent ! An indication of the type of referral (or where applicable the type of transfer of care) request type : CodeableConcept [0..1] Indication of the clinical domain or discipline to which the referral or transfer of care request is sent. For example: Cardiology Gastroenterology Diabetology specialty : CodeableConcept [0..1] « Codes indicating the for types of capability the referred to service provider must have. referral; e.g. consult, transfer, temporary transfer. (Strength=Example) PractitionerSpecialty SNOMED CT Patient Referral ?? » An indication of the urgency of referral (or where applicable the type of transfer of care) request priority : CodeableConcept code [0..1] « Codes indicating the relative priority of the referral. (Strength=Required) RequestPriority ! The service(s) that is/are requested to be provided to the patient. For example: cardiac pacemaker insertion serviceRequested : CodeableConcept [0..*] Codes indicating the types of services that might be requested as part of a referral. (Strength=Example) DiagnosticOrderPriority Practice Setting Code Value S... ?? » The patient who is the subject of a referral or transfer of care request patient subject : Reference [0..1] « [1..1] Patient » | Group The healthcare provider or provider organization who/which initiated encounter at which the referral/transfer request for referral or transfer of care request. Can also be Patient (a self referral) is initiated requester context : Reference [0..1] « Practitioner | Organization Encounter | Patient EpisodeOfCare » The healthcare provider(s) or provider organization(s) who/which is to receive period of time within which the services identified in the referral/transfer of care request is specified or required to occur recipient occurrence[x] : Reference Type [0..*] « Practitioner [0..1] dateTime | Organization Period » The encounter at Date/DateTime of creation for draft requests and date of activation for active requests authoredOn : dateTime [0..1] Indication of the clinical domain or discipline to which the request for referral or transfer of care request is initiated sent. For example: Cardiology Gastroenterology Diabetology encounter specialty : Reference CodeableConcept [0..1] « Encounter Codes indicating the types of capability the referred to service provider must have. (Strength=Example) PractitionerSpecialty » ?? Date/DateTime the request for referral The healthcare provider(s) or transfer of care provider organization(s) who/which is sent by to receive the author referral/transfer of care request dateSent recipient : dateTime Reference [0..1] [0..*] Practitioner | Organization | HealthcareService Description of clinical condition indicating why referral/transfer of care is requested. For example: Pathological Anomalies, Disabled (physical or mental), Behavioral Management reason reasonCode : CodeableConcept [0..1] [0..*] Codes indicating why the referral is being requested. (Strength=Example) SNOMED CT Clinical Findings ?? Indicates another resource whose existence justifies this request reasonReference : Reference [0..*] Condition | Observation The reason element gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summary description : string [0..1] The service(s) that is/are requested to be provided to the patient. For example: cardiac pacemaker insertion serviceRequested : CodeableConcept [0..*] « Codes indicating the types of services that might be requested as part of a referral. (Strength=Example) Practice Setting Code Value S... ?? » Any additional (administrative, financial or clinical) information required to support request for referral or transfer of care. For example: Presenting problems/chief complaints Medical History Family History Alerts Allergy/Intolerance and Adverse Reactions Medications Observations/Assessments (may include cognitive and fundtional assessments) Diagnostic Reports Care Plan supportingInformation supportingInfo : Reference [0..*] « Any » The period of time within which Comments made about the services identified in referral request by any of the referral/transfer participants note : Annotation [0..*] Links to Provenance records for past versions of care is specified this resource or required fulfilling request or event resources that identify key state transitions or updates that are likely to occur be relevant to a user looking at the current version of the resource fulfillmentTime relevantHistory : Period Reference [0..*] Provenance Requester The device, practitioner, etc. who initiated the request agent : Reference [1..1] Practitioner | Organization | Patient | RelatedPerson | Device The organization the device or practitioner was acting on behalf of onBehalfOf : Reference [0..1] Organization The individual who initiated the request and has responsibility for its activation requester [0..1]

XML Template 

<

<ReferralRequest xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <
 <</identifier>
 <
 <</type>
 <</specialty>
 <</priority>
 <</patient>
 <</requester>
 <</recipient>
 <</encounter>
 <
 <</reason>
 <
 <</serviceRequested>
 <</supportingInformation>
 <</fulfillmentTime>

 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <definition><!-- 0..* Reference(ActivityDefinition|PlanDefinition) Instantiates protocol or definition --></definition>
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|ProcedureRequest) Request fulfilled by this request --></basedOn>
 <replaces><!-- 0..* Reference(ReferralRequest) Request(s) replaced by this request --></replaces>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <status value="[code]"/><!-- 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | order -->
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <priority value="[code]"/><!-- 0..1 Urgency of referral / transfer of care request -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <subject><!-- 1..1 Reference(Patient|Group) Patient referred to care or transfer --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context>
 <occurrence[x]><!-- 0..1 dateTime|Period When the service(s) requested in the referral should occur --></occurrence[x]>
 <authoredOn value="[dateTime]"/><!-- 0..1 Date of creation/activation -->
 <requester>  <!-- 0..1 Who/what is requesting service -->
  <agent><!-- 1..1 Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) Individual making the request --></agent>

  <onBehalfOf><!-- ?? 0..1 Reference(Organization) Organization agent is acting for --></onBehalfOf>
 </requester>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>
 <recipient><!-- 0..* Reference(Practitioner|Organization|HealthcareService) Receiver of referral / transfer of care request --></recipient>
 <reasonCode><!-- 0..* CodeableConcept Reason for referral / transfer of care request --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation) Why is service needed? --></reasonReference>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <supportingInfo><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInfo>
 <note><!-- 0..* Annotation Comments made about referral request --></note>
 <relevantHistory><!-- 0..* Reference(Provenance) Key events in history of request --></relevantHistory>

</ReferralRequest>

JSON Template 

{
  "resourceType" : "",

{doco
  "resourceType" : "ReferralRequest",

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

  "identifier" : [{ Identifier }], // Business identifier
  "definition" : [{ Reference(ActivityDefinition|PlanDefinition) }], // Instantiates protocol or definition
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|ProcedureRequest) }], // Request fulfilled by this request
  "replaces" : [{ Reference(ReferralRequest) }], // Request(s) replaced by this request
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  draft | active | suspended | cancelled | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | order
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "priority" : "<code>", // Urgency of referral / transfer of care request
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "subject" : { Reference(Patient|Group) }, // R!  Patient referred to care or transfer
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter
  // occurrence[x]: When the service(s) requested in the referral should occur. One of these 2:

  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "authoredOn" : "<dateTime>", // Date of creation/activation
  "requester" : { // Who/what is requesting service
    "agent" : { Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) }, // R!  Individual making the request

    "onBehalfOf" : { Reference(Organization) } // C? Organization agent is acting for
  },
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for
  "recipient" : [{ Reference(Practitioner|Organization|HealthcareService) }], // Receiver of referral / transfer of care request
  "reasonCode" : [{ CodeableConcept }], // Reason for referral / transfer of care request
  "reasonReference" : [{ Reference(Condition|Observation) }], // Why is service needed?
  "description" : "<string>", // A textual description of the referral
  "supportingInfo" : [{ Reference(Any) }], // Additonal information to support referral or transfer of care request
  "note" : [{ Annotation }], // Comments made about referral request
  "relevantHistory" : [{ Reference(Provenance) }] // Key events in history of request

}

Turtle Template 


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


[ a fhir:ReferralRequest;
  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:ReferralRequest.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ReferralRequest.definition [ Reference(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates protocol or definition
  fhir:ReferralRequest.basedOn [ Reference(ReferralRequest|CarePlan|ProcedureRequest) ], ... ; # 0..* Request fulfilled by this request
  fhir:ReferralRequest.replaces [ Reference(ReferralRequest) ], ... ; # 0..* Request(s) replaced by this request
  fhir:ReferralRequest.groupIdentifier [ Identifier ]; # 0..1 Composite request this is part of
  fhir:ReferralRequest.status [ code ]; # 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown
  fhir:ReferralRequest.intent [ code ]; # 1..1 proposal | plan | order
  fhir:ReferralRequest.type [ CodeableConcept ]; # 0..1 Referral/Transition of care request type
  fhir:ReferralRequest.priority [ code ]; # 0..1 Urgency of referral / transfer of care request
  fhir:ReferralRequest.serviceRequested [ CodeableConcept ], ... ; # 0..* Actions requested as part of the referral
  fhir:ReferralRequest.subject [ Reference(Patient|Group) ]; # 1..1 Patient referred to care or transfer
  fhir:ReferralRequest.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating encounter
  # ReferralRequest.occurrence[x] : 0..1 When the service(s) requested in the referral should occur. One of these 2
    fhir:ReferralRequest.occurrenceDateTime [ dateTime ]
    fhir:ReferralRequest.occurrencePeriod [ Period ]
  fhir:ReferralRequest.authoredOn [ dateTime ]; # 0..1 Date of creation/activation
  fhir:ReferralRequest.requester [ # 0..1 Who/what is requesting service
    fhir:ReferralRequest.requester.agent [ Reference(Practitioner|Organization|Patient|RelatedPerson|Device) ]; # 1..1 Individual making the request
    fhir:ReferralRequest.requester.onBehalfOf [ Reference(Organization) ]; # 0..1 Organization agent is acting for
  ];
  fhir:ReferralRequest.specialty [ CodeableConcept ]; # 0..1 The clinical specialty (discipline) that the referral is requested for
  fhir:ReferralRequest.recipient [ Reference(Practitioner|Organization|HealthcareService) ], ... ; # 0..* Receiver of referral / transfer of care request
  fhir:ReferralRequest.reasonCode [ CodeableConcept ], ... ; # 0..* Reason for referral / transfer of care request
  fhir:ReferralRequest.reasonReference [ Reference(Condition|Observation) ], ... ; # 0..* Why is service needed?
  fhir:ReferralRequest.description [ string ]; # 0..1 A textual description of the referral
  fhir:ReferralRequest.supportingInfo [ Reference(Any) ], ... ; # 0..* Additonal information to support referral or transfer of care request
  fhir:ReferralRequest.note [ Annotation ], ... ; # 0..* Comments made about referral request
  fhir:ReferralRequest.relevantHistory [ Reference(Provenance) ], ... ; # 0..* Key events in history of request
]

Changes since DSTU2

ReferralRequest
ReferralRequest.definition
  • Added Element
ReferralRequest.basedOn
  • Added Element
ReferralRequest.replaces
  • Added Element
ReferralRequest.groupIdentifier
  • Added Element
ReferralRequest.status
  • Change value set from http://hl7.org/fhir/ValueSet/referralstatus to http://hl7.org/fhir/ValueSet/request-status
ReferralRequest.intent
  • Added Element
ReferralRequest.priority
  • Type changed from CodeableConcept to code
  • Add Binding http://hl7.org/fhir/ValueSet/request-priority (required)
ReferralRequest.subject
  • Renamed from patient to subject
  • Min Cardinality changed from 0 to 1
  • Add Reference(Group)
ReferralRequest.context
  • Renamed from encounter to context
  • Add Reference(EpisodeOfCare)
ReferralRequest.occurrence[x]
  • Added Element
ReferralRequest.authoredOn
  • Renamed from date to authoredOn
ReferralRequest.requester
  • Remove Reference(Practitioner), Remove Reference(Organization), Remove Reference(Patient)
ReferralRequest.requester.agent
  • Added Element
ReferralRequest.requester.onBehalfOf
  • Added Element
ReferralRequest.recipient
  • Add Reference(HealthcareService)
ReferralRequest.reasonCode
  • Renamed from reason to reasonCode
  • Max Cardinality changed from 1 to *
ReferralRequest.reasonReference
  • Added Element
ReferralRequest.supportingInfo
  • Renamed from supportingInformation to supportingInfo
ReferralRequest.note
  • Added Element
ReferralRequest.relevantHistory
  • Added Element
ReferralRequest.dateSent
  • deleted
ReferralRequest.fulfillmentTime
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and 2 r3 resources are invalid (2 errors). ).

Structure

1..1 draft | requested | active | cancelled | accepted Business identifier 0..1 Date of creation/activation The clinical specialty (discipline) that the 0..1 Urgency 0..1 Requester of 0..* Receiver of referral / transfer of care Originating encounter 0..1 Date referral/transfer 0..1 string A textual description of the referral Σ Actions requested as part Σ 0..1 Period Requested service(s) fulfillment time
Name Flags Card. Type Description & Constraints doco
. . ReferralRequest DomainResource A request for referral or transfer of care
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . status . identifier ?! Σ 0..* Identifier Business identifier
... definition Σ 0..* code Reference ( ActivityDefinition | PlanDefinition ) Instantiates protocol or definition
. . . basedOn Σ 0..* Reference ( ReferralRequest | rejected CarePlan | completed ProcedureRequest ) Request fulfilled by this request
ReferralStatus
. . . replaces Σ 0..* Reference ( Required ReferralRequest ) Request(s) replaced by this request
. . identifier . groupIdentifier Σ 0..* 0..1 Identifier Composite request this is part of
. . date . status ?! Σ 1..1 dateTime code draft | active | suspended | cancelled | completed | entered-in-error | unknown
RequestStatus ( Required )
. . . intent ?! Σ 1..1 code proposal | plan | order
RequestIntent ( Required )
... type Σ 0..1 CodeableConcept Referral/Transition of care request type
SNOMED CT Patient Referral ( Example )
. . specialty . priority Σ 0..1 CodeableConcept code Urgency of referral is requested for / transfer of care request
PractitionerSpecialty RequestPriority ( Example Required )
. . priority . serviceRequested Σ 0..* CodeableConcept Actions requested as part of the referral / transfer of care request
DiagnosticOrderPriority Practice Setting Code Value Set ( Example )
. . patient . subject Σ 1..1 Reference ( Patient | Group ) Patient referred to care or transfer
. . requester . context Σ 0..1 Reference ( Practitioner | Organization Encounter | Patient EpisodeOfCare ) Originating encounter
... occurrence[x] Σ 0..1 When the service(s) requested in the referral / transfer should occur
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
... authoredOn Σ 0..1 dateTime Date of care creation/activation
. . recipient . requester Σ I 0..1 BackboneElement Who/what is requesting service
+ onBehalfOf can only be specified if agent is practitioner or device
.... agent Σ 1..1 Reference ( Practitioner | Organization | Patient | RelatedPerson | Device ) Individual making the request
. . encounter . . onBehalfOf Σ I 0..1 Reference ( Encounter Organization ) Organization agent is acting for
. . dateSent . specialty 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for
PractitionerSpecialty ( Example )
... recipient Σ 0..* dateTime Reference ( Practitioner | Organization | HealthcareService ) Receiver of referral / transfer of care request is sent
. . reason . reasonCode Σ 0..* CodeableConcept Reason for referral / transfer of care request
SNOMED CT Clinical Findings ( Example )
. . description . reasonReference Σ 0..1 0..* Reference ( Condition | Observation ) Why is service needed?
. . serviceRequested . description 0..* 0..1 CodeableConcept string A textual description of the referral Practice Setting Code Value Set ( Example )
. . supportingInformation . supportingInfo 0..* Reference ( Any ) Additonal information to support referral or transfer of care request
. . fulfillmentTime . note Σ 0..* Annotation Comments made about referral request
. . . relevantHistory 0..* Reference ( Provenance ) Key events in history of request

doco Documentation for this format

UML Diagram ( Legend )

ReferralRequest ( DomainResource ) Business identifier that uniquely identifies the referral/care transfer request instance identifier : Identifier [0..*] A protocol, guideline, orderset or other definition that is adhered to in whole or in part by this request definition : Reference [0..*] ActivityDefinition | PlanDefinition Indicates any plans, proposals or orders that this request is intended to satisfy - in whole or in part basedOn : Reference [0..*] ReferralRequest | CarePlan | ProcedureRequest Completed or terminated request(s) whose function is taken by this new request replaces : Reference [0..*] ReferralRequest The business identifier of the logical "grouping" request/order that this referral is a part of groupIdentifier : Identifier [0..1] The workflow status of the authorization/intention reflected by the referral or transfer of care request record (this element modifies the meaning of other elements) status : code [1..1] « The status of the referral. (Strength=Required) ReferralStatus RequestStatus ! » Business identifier that uniquely identifies Distinguishes the referral/care transfer "level" of authorization/demand implicit in this request instance (this element modifies the meaning of other elements) identifier intent : Identifier code [0..*] [1..1] Date/DateTime of creation for draft requests and date Codes identifying the stage lifecycle stage of activation for active requests a request (Strength=Required) date : dateTime [0..1] RequestIntent ! An indication of the type of referral (or where applicable the type of transfer of care) request type : CodeableConcept [0..1] Indication of the clinical domain or discipline to which the referral or transfer of care request is sent. For example: Cardiology Gastroenterology Diabetology specialty : CodeableConcept [0..1] « Codes indicating the for types of capability the referred to service provider must have. referral; e.g. consult, transfer, temporary transfer. (Strength=Example) PractitionerSpecialty SNOMED CT Patient Referral ?? » An indication of the urgency of referral (or where applicable the type of transfer of care) request priority : CodeableConcept code [0..1] « Codes indicating the relative priority of the referral. (Strength=Required) RequestPriority ! The service(s) that is/are requested to be provided to the patient. For example: cardiac pacemaker insertion serviceRequested : CodeableConcept [0..*] Codes indicating the types of services that might be requested as part of a referral. (Strength=Example) DiagnosticOrderPriority Practice Setting Code Value S... ?? » The patient who is the subject of a referral or transfer of care request patient subject : Reference [0..1] « [1..1] Patient » | Group The healthcare provider or provider organization who/which initiated encounter at which the referral/transfer request for referral or transfer of care request. Can also be Patient (a self referral) is initiated requester context : Reference [0..1] « Practitioner | Organization Encounter | Patient EpisodeOfCare » The healthcare provider(s) or provider organization(s) who/which is to receive period of time within which the services identified in the referral/transfer of care request is specified or required to occur recipient occurrence[x] : Reference Type [0..*] « Practitioner [0..1] dateTime | Organization Period » The encounter at Date/DateTime of creation for draft requests and date of activation for active requests authoredOn : dateTime [0..1] Indication of the clinical domain or discipline to which the request for referral or transfer of care request is initiated sent. For example: Cardiology Gastroenterology Diabetology encounter specialty : Reference CodeableConcept [0..1] « Encounter Codes indicating the types of capability the referred to service provider must have. (Strength=Example) PractitionerSpecialty » ?? Date/DateTime the request for referral The healthcare provider(s) or transfer of care provider organization(s) who/which is sent by to receive the author referral/transfer of care request dateSent recipient : dateTime Reference [0..1] [0..*] Practitioner | Organization | HealthcareService Description of clinical condition indicating why referral/transfer of care is requested. For example: Pathological Anomalies, Disabled (physical or mental), Behavioral Management reason reasonCode : CodeableConcept [0..1] [0..*] Codes indicating why the referral is being requested. (Strength=Example) SNOMED CT Clinical Findings ?? Indicates another resource whose existence justifies this request reasonReference : Reference [0..*] Condition | Observation The reason element gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summary description : string [0..1] The service(s) that is/are requested to be provided to the patient. For example: cardiac pacemaker insertion serviceRequested : CodeableConcept [0..*] « Codes indicating the types of services that might be requested as part of a referral. (Strength=Example) Practice Setting Code Value S... ?? » Any additional (administrative, financial or clinical) information required to support request for referral or transfer of care. For example: Presenting problems/chief complaints Medical History Family History Alerts Allergy/Intolerance and Adverse Reactions Medications Observations/Assessments (may include cognitive and fundtional assessments) Diagnostic Reports Care Plan supportingInformation supportingInfo : Reference [0..*] « Any » The period of time within which Comments made about the services identified in referral request by any of the referral/transfer participants note : Annotation [0..*] Links to Provenance records for past versions of care is specified this resource or required fulfilling request or event resources that identify key state transitions or updates that are likely to occur be relevant to a user looking at the current version of the resource fulfillmentTime relevantHistory : Period Reference [0..*] Provenance Requester The device, practitioner, etc. who initiated the request agent : Reference [1..1] Practitioner | Organization | Patient | RelatedPerson | Device The organization the device or practitioner was acting on behalf of onBehalfOf : Reference [0..1] Organization The individual who initiated the request and has responsibility for its activation requester [0..1]

XML Template 

<

<ReferralRequest xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <
 <</identifier>
 <
 <</type>
 <</specialty>
 <</priority>
 <</patient>
 <</requester>
 <</recipient>
 <</encounter>
 <
 <</reason>
 <
 <</serviceRequested>
 <</supportingInformation>
 <</fulfillmentTime>

 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <definition><!-- 0..* Reference(ActivityDefinition|PlanDefinition) Instantiates protocol or definition --></definition>
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|ProcedureRequest) Request fulfilled by this request --></basedOn>
 <replaces><!-- 0..* Reference(ReferralRequest) Request(s) replaced by this request --></replaces>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <status value="[code]"/><!-- 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | order -->
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <priority value="[code]"/><!-- 0..1 Urgency of referral / transfer of care request -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <subject><!-- 1..1 Reference(Patient|Group) Patient referred to care or transfer --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context>
 <occurrence[x]><!-- 0..1 dateTime|Period When the service(s) requested in the referral should occur --></occurrence[x]>
 <authoredOn value="[dateTime]"/><!-- 0..1 Date of creation/activation -->
 <requester>  <!-- 0..1 Who/what is requesting service -->
  <agent><!-- 1..1 Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) Individual making the request --></agent>

  <onBehalfOf><!-- ?? 0..1 Reference(Organization) Organization agent is acting for --></onBehalfOf>
 </requester>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>
 <recipient><!-- 0..* Reference(Practitioner|Organization|HealthcareService) Receiver of referral / transfer of care request --></recipient>
 <reasonCode><!-- 0..* CodeableConcept Reason for referral / transfer of care request --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation) Why is service needed? --></reasonReference>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <supportingInfo><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInfo>
 <note><!-- 0..* Annotation Comments made about referral request --></note>
 <relevantHistory><!-- 0..* Reference(Provenance) Key events in history of request --></relevantHistory>

</ReferralRequest>

JSON Template 

{
  "resourceType" : "",

{doco
  "resourceType" : "ReferralRequest",

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

  "identifier" : [{ Identifier }], // Business identifier
  "definition" : [{ Reference(ActivityDefinition|PlanDefinition) }], // Instantiates protocol or definition
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|ProcedureRequest) }], // Request fulfilled by this request
  "replaces" : [{ Reference(ReferralRequest) }], // Request(s) replaced by this request
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  draft | active | suspended | cancelled | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | order
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "priority" : "<code>", // Urgency of referral / transfer of care request
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "subject" : { Reference(Patient|Group) }, // R!  Patient referred to care or transfer
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter
  // occurrence[x]: When the service(s) requested in the referral should occur. One of these 2:

  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "authoredOn" : "<dateTime>", // Date of creation/activation
  "requester" : { // Who/what is requesting service
    "agent" : { Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) }, // R!  Individual making the request

    "onBehalfOf" : { Reference(Organization) } // C? Organization agent is acting for
  },
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for
  "recipient" : [{ Reference(Practitioner|Organization|HealthcareService) }], // Receiver of referral / transfer of care request
  "reasonCode" : [{ CodeableConcept }], // Reason for referral / transfer of care request
  "reasonReference" : [{ Reference(Condition|Observation) }], // Why is service needed?
  "description" : "<string>", // A textual description of the referral
  "supportingInfo" : [{ Reference(Any) }], // Additonal information to support referral or transfer of care request
  "note" : [{ Annotation }], // Comments made about referral request
  "relevantHistory" : [{ Reference(Provenance) }] // Key events in history of request

}

Turtle Template 


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


[ a fhir:ReferralRequest;
  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:ReferralRequest.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ReferralRequest.definition [ Reference(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates protocol or definition
  fhir:ReferralRequest.basedOn [ Reference(ReferralRequest|CarePlan|ProcedureRequest) ], ... ; # 0..* Request fulfilled by this request
  fhir:ReferralRequest.replaces [ Reference(ReferralRequest) ], ... ; # 0..* Request(s) replaced by this request
  fhir:ReferralRequest.groupIdentifier [ Identifier ]; # 0..1 Composite request this is part of
  fhir:ReferralRequest.status [ code ]; # 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown
  fhir:ReferralRequest.intent [ code ]; # 1..1 proposal | plan | order
  fhir:ReferralRequest.type [ CodeableConcept ]; # 0..1 Referral/Transition of care request type
  fhir:ReferralRequest.priority [ code ]; # 0..1 Urgency of referral / transfer of care request
  fhir:ReferralRequest.serviceRequested [ CodeableConcept ], ... ; # 0..* Actions requested as part of the referral
  fhir:ReferralRequest.subject [ Reference(Patient|Group) ]; # 1..1 Patient referred to care or transfer
  fhir:ReferralRequest.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating encounter
  # ReferralRequest.occurrence[x] : 0..1 When the service(s) requested in the referral should occur. One of these 2
    fhir:ReferralRequest.occurrenceDateTime [ dateTime ]
    fhir:ReferralRequest.occurrencePeriod [ Period ]
  fhir:ReferralRequest.authoredOn [ dateTime ]; # 0..1 Date of creation/activation
  fhir:ReferralRequest.requester [ # 0..1 Who/what is requesting service
    fhir:ReferralRequest.requester.agent [ Reference(Practitioner|Organization|Patient|RelatedPerson|Device) ]; # 1..1 Individual making the request
    fhir:ReferralRequest.requester.onBehalfOf [ Reference(Organization) ]; # 0..1 Organization agent is acting for
  ];
  fhir:ReferralRequest.specialty [ CodeableConcept ]; # 0..1 The clinical specialty (discipline) that the referral is requested for
  fhir:ReferralRequest.recipient [ Reference(Practitioner|Organization|HealthcareService) ], ... ; # 0..* Receiver of referral / transfer of care request
  fhir:ReferralRequest.reasonCode [ CodeableConcept ], ... ; # 0..* Reason for referral / transfer of care request
  fhir:ReferralRequest.reasonReference [ Reference(Condition|Observation) ], ... ; # 0..* Why is service needed?
  fhir:ReferralRequest.description [ string ]; # 0..1 A textual description of the referral
  fhir:ReferralRequest.supportingInfo [ Reference(Any) ], ... ; # 0..* Additonal information to support referral or transfer of care request
  fhir:ReferralRequest.note [ Annotation ], ... ; # 0..* Comments made about referral request
  fhir:ReferralRequest.relevantHistory [ Reference(Provenance) ], ... ; # 0..* Key events in history of request
]

  Changes since DSTU2

ReferralRequest
ReferralRequest.definition
  • Added Element
ReferralRequest.basedOn
  • Added Element
ReferralRequest.replaces
  • Added Element
ReferralRequest.groupIdentifier
  • Added Element
ReferralRequest.status
  • Change value set from http://hl7.org/fhir/ValueSet/referralstatus to http://hl7.org/fhir/ValueSet/request-status
ReferralRequest.intent
  • Added Element
ReferralRequest.priority
  • Type changed from CodeableConcept to code
  • Add Binding http://hl7.org/fhir/ValueSet/request-priority (required)
ReferralRequest.subject
  • Renamed from patient to subject
  • Min Cardinality changed from 0 to 1
  • Add Reference(Group)
ReferralRequest.context
  • Renamed from encounter to context
  • Add Reference(EpisodeOfCare)
ReferralRequest.occurrence[x]
  • Added Element
ReferralRequest.authoredOn
  • Renamed from date to authoredOn
ReferralRequest.requester
  • Remove Reference(Practitioner), Remove Reference(Organization), Remove Reference(Patient)
ReferralRequest.requester.agent
  • Added Element
ReferralRequest.requester.onBehalfOf
  • Added Element
ReferralRequest.recipient
  • Add Reference(HealthcareService)
ReferralRequest.reasonCode
  • Renamed from reason to reasonCode
  • Max Cardinality changed from 1 to *
ReferralRequest.reasonReference
  • Added Element
ReferralRequest.supportingInfo
  • Renamed from supportingInformation to supportingInfo
ReferralRequest.note
  • Added Element
ReferralRequest.relevantHistory
  • Added Element
ReferralRequest.dateSent
  • deleted
ReferralRequest.fulfillmentTime
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and 2 r3 resources are invalid (2 errors). ).

 

Alternate definitions: Schema / Schematron , Resource Profile Master Definition ( XML , JSON ), Questionnaire XML Schema / Schematron (for ) + JSON Schema , ShEx (for Turtle )

4.7.3.1 12.14.3.1 Terminology Bindings

ReferralRequest.specialty ReferralRequest.priority ReferralRequest.reason ReferralRequest.serviceRequested
Path Definition Type Reference
ReferralRequest.status The status of the referral. Required ReferralStatus RequestStatus
ReferralRequest.intent Codes identifying the stage lifecycle stage of a request Required RequestIntent
ReferralRequest.type Codes for types of referral; e.g. consult, transfer, temporary transfer. Unknown Example No details provided yet SNOMED CT Patient Referral
ReferralRequest.priority Codes indicating the types relative priority of capability the referred to service provider must have. referral. Example Required PractitionerSpecialty RequestPriority
ReferralRequest.serviceRequested Codes indicating the relative priority types of the services that might be requested as part of a referral. Example DiagnosticOrderPriority Practice Setting Code Value Set
ReferralRequest.specialty Codes indicating why the referral is being requested. types of capability the referred to service provider must have. Unknown Example No details provided yet PractitionerSpecialty
ReferralRequest.reasonCode Codes indicating why the types of services that might be requested as part of a referral. referral is being requested. Example Practice Setting Code Value Set SNOMED CT Clinical Findings

12.14.3.2 Constraints

  • rfr-1 : On ReferralRequest.requester: onBehalfOf can only be specified if agent is practitioner or device ( expression on ReferralRequest.requester: (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not() )

4.7.4 12.14.4 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 Paths Expression In Common
date authored-on date Creation or activation date ReferralRequest.date ReferralRequest.authoredOn
based-on reference Request being fulfilled ReferralRequest.basedOn
( ReferralRequest , CarePlan , ProcedureRequest )
context reference Part of encounter or episode of care ReferralRequest.context
( EpisodeOfCare , Encounter )
definition reference Instantiates protocol or definition ReferralRequest.definition
( PlanDefinition , ActivityDefinition )
encounter reference Originating encounter ReferralRequest.context
( Encounter )
group-identifier token Part of common request ReferralRequest.groupIdentifier
identifier token Business identifier ReferralRequest.identifier
intent token Proposal, plan or order ReferralRequest.intent
occurrence-date date When the service(s) requested in the referral should occur ReferralRequest.occurrence
patient reference Who the referral is about ReferralRequest.patient ReferralRequest.subject
( Patient ) 		31 Resources
priority token The priority assigned to the referral ReferralRequest.priority
recipient reference The person that the referral was sent to ReferralRequest.recipient
( Practitioner , Organization , Practitioner HealthcareService )
replaces reference Request(s) replaced by this request ReferralRequest.replaces
( ReferralRequest )
requester reference Requester of referral / transfer of care Individual making the request ReferralRequest.requester ReferralRequest.requester.agent
( Patient Practitioner , Organization , Practitioner Device , Patient , RelatedPerson )
service token Actions requested as part of the referral ReferralRequest.serviceRequested
specialty token The specialty that the referral is for ReferralRequest.specialty
status token The status of the referral ReferralRequest.status
subject reference Patient referred to care or transfer ReferralRequest.subject
( Group , Patient )
type token The type of the referral ReferralRequest.type 6 Resources