Referral Profile

Canonical	../StructureDefinition/nexus-core-referral
Status	draft · 1.26.0
Base	ServiceRequest (constraint)
Source	FSH · JSON

Defines the Nexus EMR FHIR profile for referrals: a request that another clinician or service accept the patient, for consultation, second opinion, or ongoing management. Aligned to the pan-Canadian CA-eReC / Ontario eReferral contract, which is the shape Nexus already exchanges with Ocean. Distinct from NexusEmrCoreServiceRequest, which governs laboratory, imaging and procedure ORDERS and fixes intent to order.

Examples

Received Over Ontario eReferral

A cardiology referral as it arrives from Ocean -- intent proposal, the destination in category and no code element, which is the shape the Ontario eReferral contract sends. Demonstrates the dual-coding pattern the profile asks for. The raw coding (17561000 Cardiologist, an occupation concept, which is what Ocean sends) is preserved exactly as received and the Nexus specialty coding (394579002 Cardiology) is added alongside it rather than replacing it

ServiceRequest/referral-cardiology-inbound — claims conformance to Referral Profile

{
  "resourceType": "ServiceRequest",
  "id": "referral-cardiology-inbound",
  "meta": {
    "profile": [
      "../StructureDefinition/nexus-core-referral"
    ]
  },
  "identifier": [
    {
      "use": "secondary",
      "system": "https://test.cognisantmd.com/svc/fhir/v1/NamingSystem/id-ereferral-reference",
      "value": "e7d41c9a-6b52-4f18-9c33-2a5e8f0b4d17"
    }
  ],
  "text": {
    "status": "generated",
    "div": "<div xmlns='http://www.w3.org/1999/xhtml'><p>Routine cardiology referral received over Ontario eReferral on March 7, 2025, for assessment of exertional chest pain. Awaiting the consult.</p><p><strong>The two Ocean identifier systems in this example name a SANDBOX host</strong> (<code>test.cognisantmd.com</code>) and are illustrative only. They show the SHAPE an Ocean-assigned identifier takes, not an address to write. A producer uses the Ocean environment its own tenant is provisioned against, and this specification does not govern or publish those addresses.</p></div>"
  },
  "status": "active",
  "intent": "proposal",
  "category": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "17561000",
          "display": "Cardiologist"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "394579002",
          "display": "Cardiology"
        }
      ],
      "text": "Cardiology"
    }
  ],
  "priority": "routine",
  "subject": {
    "reference": "Patient/avery-linwood"
  },
  "authoredOn": "2025-03-07T16:14:13-05:00",
  "requester": {
    "identifier": {
      "system": "../NamingSystem/on-ohip-billing-number",
      "value": "123456"
    },
    "display": "Dr. Amrita Nayar"
  },
  "performer": [
    {
      "identifier": {
        "system": "https://test.cognisantmd.com/svc/fhir/v1/NamingSystem/id-referral-target-external-service",
        "value": "123123123123"
      },
      "display": "Cedarbrook Regional Cardiology"
    }
  ],
  "reasonCode": [
    {
      "text": "Exertional chest pain, abnormal resting ECG"
    }
  ],
  "note": [
    {
      "time": "2025-03-07T16:14:13-05:00",
      "text": "Prior ECG and troponin attached. Patient advised to attend ED if symptoms occur at rest."
    }
  ]
}

Referenced by: Inbound eReferral Routing Envelope