{ "resourceType": "StructureDefinition", "id": "nexus-core-referral", "extension": [ { "url": "https://fhir.apps.health/StructureDefinition/effective-date", "extension": [ { "url": "paths", "valueString": "authoredOn" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/smart-exposed", "extension": [ { "url": "read", "valueString": "servicerequest:read" }, { "url": "write", "valueString": "servicerequest:write" }, { "url": "delete", "valueString": "servicerequest:delete" } ] } ], "url": "https://fhir.apps.health/StructureDefinition/nexus-core-referral", "name": "NexusCoreReferral", "title": "Referral Profile", "status": "draft", "description": "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`.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "quick", "uri": "http://siframework.org/cqf", "name": "Quality Improvement and Clinical Knowledge (QUICK)" } ], "kind": "resource", "abstract": false, "type": "ServiceRequest", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest", "derivation": "constraint", "snapshot": { "element": [ { "id": "ServiceRequest", "path": "ServiceRequest", "short": "Nexus EMR Referral", "definition": "A referral: a request that another clinician or service accept the patient, for\nconsultation, second opinion, or short- or longer-term management.\n\nThe referrer does not control whether the receiving service accepts. That is why\n`intent` is `proposal` and not `order`, and it is the substantive difference between\nthis profile and NexusEmrCoreServiceRequest.", "alias": [ "diagnostic request", "referral", "referral request", "transfer of care request" ], "min": 0, "max": "*", "base": { "path": "ServiceRequest", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "prr-1", "severity": "error", "human": "orderDetail SHALL only be present if code is present", "expression": "orderDetail.empty() or code.exists()", "xpath": "exists(f:code) or not(exists(f:orderDetail))" }, { "key": "nexus-note-extension-not-where-native", "severity": "error", "human": "The resource-note extension is not used on a resource that has a native `note` element -- that element is the home", "expression": "extension('https://fhir.apps.health/StructureDefinition/nexus-emr-resource-note').empty()", "source": "https://fhir.apps.health/StructureDefinition/nexus-core-referral" }, { "key": "referral-code-has-text", "severity": "error", "human": "When code is present it SHALL carry text, so the requested service stays legible when no coded value is recognised", "expression": "code.exists() implies code.text.exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-core-referral" }, { "key": "referral-category-coded", "severity": "warning", "human": "At least one category SHOULD carry a SNOMED CT coding identifying the receiving service or specialty (recommended, not enforced: a destination with no usable code carries text instead)", "expression": "category.coding.where(system = 'http://snomed.info/sct').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-core-referral" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Request" }, { "identity": "v2", "map": "ORC" }, { "identity": "rim", "map": "Act[moodCode<=INT]" } ] }, { "id": "ServiceRequest.id", "path": "ServiceRequest.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": true }, { "id": "ServiceRequest.meta", "path": "ServiceRequest.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "ServiceRequest.meta.id", "path": "ServiceRequest.meta.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ServiceRequest.meta.extension", "path": "ServiceRequest.meta.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ServiceRequest.meta.versionId", "path": "ServiceRequest.meta.versionId", "short": "Version specific identifier", "definition": "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.", "comment": "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.", "min": 0, "max": "1", "base": { "path": "Meta.versionId", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "ServiceRequest.meta.lastUpdated", "path": "ServiceRequest.meta.lastUpdated", "short": "When the resource version last changed", "definition": "When the resource last changed - e.g. when the version changed.", "comment": "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction.", "min": 0, "max": "1", "base": { "path": "Meta.lastUpdated", "min": 0, "max": "1" }, "type": [ { "code": "instant" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "ServiceRequest.meta.source", "path": "ServiceRequest.meta.source", "short": "Identifies EMR instance & pipeline version the resource came from", "definition": "A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.", "comment": "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.", "min": 0, "max": "1", "base": { "path": "Meta.source", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "ServiceRequest.meta.profile", "path": "ServiceRequest.meta.profile", "short": "Profiles this resource claims to conform to", "definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).", "comment": "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.", "min": 0, "max": "*", "base": { "path": "Meta.profile", "min": 0, "max": "*" }, "type": [ { "code": "canonical", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "ServiceRequest.meta.security", "path": "ServiceRequest.meta.security", "short": "Security Labels applied to this resource", "definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.", "comment": "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.", "min": 0, "max": "*", "base": { "path": "Meta.security", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SecurityLabels" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet": "http://hl7.org/fhir/ValueSet/security-labels" } }, { "id": "ServiceRequest.meta.tag", "path": "ServiceRequest.meta.tag", "short": "Tags applied to this resource", "definition": "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.", "comment": "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.", "min": 0, "max": "*", "base": { "path": "Meta.tag", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Tags" } ], "strength": "example", "description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".", "valueSet": "http://hl7.org/fhir/ValueSet/common-tags" } }, { "id": "ServiceRequest.implicitRules", "path": "ServiceRequest.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation", "isSummary": true }, { "id": "ServiceRequest.language", "path": "ServiceRequest.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } }, { "id": "ServiceRequest.text", "path": "ServiceRequest.text", "short": "Narrative", "definition": "A human-readable narrative summary of the referral for human interpretation.", "comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Act.text?" } ] }, { "id": "ServiceRequest.contained", "path": "ServiceRequest.contained", "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "ServiceRequest.extension", "path": "ServiceRequest.extension", "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "ServiceRequest.modifierExtension", "path": "ServiceRequest.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "ServiceRequest.identifier", "path": "ServiceRequest.identifier", "short": "Business identifier(s) for the referral", "definition": "Unique identifiers for the referral.\n\nA business identifier is recommended but not required (identifier is 0..*). Where\navailable, carry the source-system identifier using the most appropriate system URI. For\na referral received over Ontario eReferral this is the sending network's referral\nreference, and preserving it is what lets a later status update or a returning consult\nletter be matched to the referral it answers.\n\nA source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "comment": "The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "v2", "map": "ORC.2, ORC.3, RF1-6 / RF1-11," }, { "identity": "rim", "map": ".identifier" }, { "identity": "quick", "map": "ClinicalStatement.identifier" } ] }, { "id": "ServiceRequest.identifier.id", "path": "ServiceRequest.identifier.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ServiceRequest.identifier.extension", "path": "ServiceRequest.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ServiceRequest.identifier.use", "path": "ServiceRequest.identifier.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "ServiceRequest.identifier.type", "path": "ServiceRequest.identifier.type", "short": "Description of identifier", "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment": "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 0, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "ServiceRequest.identifier.system", "path": "ServiceRequest.identifier.system", "short": "The namespace for the identifier value", "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.", "comment": "Identifier.system is always case sensitive.", "requirements": "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "ServiceRequest.identifier.value", "path": "ServiceRequest.identifier.value", "short": "The value that is unique", "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" } ] }, { "id": "ServiceRequest.identifier.period", "path": "ServiceRequest.identifier.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "ServiceRequest.identifier.assigner", "path": "ServiceRequest.identifier.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "ServiceRequest.instantiatesCanonical", "path": "ServiceRequest.instantiatesCanonical", "short": "Instantiates FHIR protocol or definition", "definition": "The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.", "comment": "Note: This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.instantiatesCanonical", "min": 0, "max": "*" }, "type": [ { "code": "canonical", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ActivityDefinition", "http://hl7.org/fhir/StructureDefinition/PlanDefinition" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.instantiatesCanonical" }, { "identity": "v2", "map": "Varies by domain" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=DEFN].target" } ] }, { "id": "ServiceRequest.instantiatesUri", "path": "ServiceRequest.instantiatesUri", "short": "Instantiates external protocol or definition", "definition": "The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.", "comment": "This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.instantiatesUri", "min": 0, "max": "*" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.instantiatesUri" }, { "identity": "v2", "map": "Varies by domain" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=DEFN].target" } ] }, { "id": "ServiceRequest.basedOn", "path": "ServiceRequest.basedOn", "short": "What request fulfills", "definition": "Plan/proposal/order fulfilled by this request.", "alias": [ "fulfills" ], "min": 0, "max": "*", "base": { "path": "ServiceRequest.basedOn", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/CarePlan", "http://hl7.org/fhir/StructureDefinition/ServiceRequest", "http://hl7.org/fhir/StructureDefinition/MedicationRequest" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.basedOn" }, { "identity": "v2", "map": "ORC.8 (plus others)" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=FLFS].target" } ] }, { "id": "ServiceRequest.replaces", "path": "ServiceRequest.replaces", "short": "What request replaces", "definition": "The request takes the place of the referenced completed or terminated request(s).", "alias": [ "supersedes", "prior", "renewed order" ], "min": 0, "max": "*", "base": { "path": "ServiceRequest.replaces", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.replaces" }, { "identity": "v2", "map": "Handled by message location of ORC (ORC.1=RO or RU)" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=RPLC].target" } ] }, { "id": "ServiceRequest.requisition", "path": "ServiceRequest.requisition", "short": "Composite Request ID", "definition": "A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.", "comment": "Requests are linked either by a \"basedOn\" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.", "requirements": "Some business processes need to know if multiple items were ordered as part of the same \"requisition\" for billing or other purposes.", "alias": [ "grouperId", "groupIdentifier" ], "min": 0, "max": "1", "base": { "path": "ServiceRequest.requisition", "min": 0, "max": "1" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.groupIdentifier" }, { "identity": "v2", "map": "ORC.4" }, { "identity": "rim", "map": ".inboundRelationship(typeCode=COMP].source[moodCode=INT].identifier" } ] }, { "id": "ServiceRequest.status", "path": "ServiceRequest.status", "short": "draft | active | on-hold | revoked | completed | entered-in-error", "definition": "The state of the referral. `draft` written but not sent, `active` sent and awaiting the consult, `on-hold` waiting on something (imaging, bloodwork, patient contact), `revoked` declined or withdrawn, `completed` the consult happened.", "comment": "This is a modifier element. A worklist showing what has been sent and not yet answered reads this element.", "min": 1, "max": "1", "base": { "path": "ServiceRequest.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/request-status" }, "mapping": [ { "identity": "workflow", "map": "Request.status" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "v2", "map": "ORC.5,RF1-1" }, { "identity": "rim", "map": ".status" }, { "identity": "quick", "map": "Action.currentStatus" } ] }, { "id": "ServiceRequest.intent", "path": "ServiceRequest.intent", "short": "proposal", "definition": "Fixed to `proposal`: a referral asks a receiving service to accept the patient and carries no authorization to act. Matches CA-eReC and the Ontario eReferral profile.", "comment": "A request the requester DOES have authority to have carried out is an order, not a referral, and belongs on NexusEmrCoreServiceRequest.", "min": 1, "max": "1", "base": { "path": "ServiceRequest.intent", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "fixedCode": "proposal", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "This element changes the interpretation of all descriptive attributes. For example \"the time the request is recommended to occur\" vs. \"the time the request is authorized to occur\" or \"who is recommended to perform the request\" vs. \"who is authorized to perform the request", "isSummary": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/request-intent" }, "mapping": [ { "identity": "workflow", "map": "Request.intent" }, { "identity": "w5", "map": "FiveWs.class" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": ".moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)" } ] }, { "id": "ServiceRequest.category", "path": "ServiceRequest.category", "short": "Receiving service or specialty", "definition": "The healthcare service or clinical specialty the referral is directed to. This is the\nrouting information: it is what decides which service receives the referral, so a wrong\nvalue here sends the patient to the wrong place.\n\nThe binding is EXTENSIBLE, not required, and that is deliberate. Live Ontario traffic\nincludes concepts outside this value set -- Ocean sends 17561000 |Cardiologist|, an\nOCCUPATION concept, where the value set carries services and specialties -- and a required\nbinding would make the referrals we actually receive non-conformant.\n\nPreserve the raw coding exactly as received and add the Nexus coding alongside it in\nthe same element. Do not rewrite or drop the original: it is the evidence of what the\nsending system meant, and normalising it away loses the only record of that.", "comment": "There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.", "requirements": "Used for filtering what service request are retrieved and displayed.", "min": 1, "max": "*", "base": { "path": "ServiceRequest.category", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-referral-service-type" }, "mapping": [ { "identity": "w5", "map": "FiveWs.class" }, { "identity": "v2", "map": "RF1-5" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"INT\"].code" } ] }, { "id": "ServiceRequest.priority", "path": "ServiceRequest.priority", "short": "routine | urgent | asap | stat", "definition": "How quickly the referral should be actioned. A referral worklist sorts on this: a suspected-cancer referral and a routine dermatology one do not wait in the same queue.", "min": 0, "max": "1", "base": { "path": "ServiceRequest.priority", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "meaningWhenMissing": "If missing, this task should be performed with normal priority", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceRequestPriority" } ], "strength": "required", "description": "Identifies the level of importance to be assigned to actioning the request.", "valueSet": "http://hl7.org/fhir/ValueSet/request-priority|4.0.1" }, "mapping": [ { "identity": "workflow", "map": "Request.priority" }, { "identity": "w5", "map": "FiveWs.grade" }, { "identity": "v2", "map": "TQ1.9, RF1-2" }, { "identity": "rim", "map": ".priorityCode" } ] }, { "id": "ServiceRequest.doNotPerform", "path": "ServiceRequest.doNotPerform", "short": "True if service/procedure should not be performed", "definition": "Set this to true if the record is saying that the service/procedure should NOT be performed.", "comment": "In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.", "requirements": "Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.", "min": 0, "max": "1", "base": { "path": "ServiceRequest.doNotPerform", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "meaningWhenMissing": "If missing, the request is a positive request e.g. \"do perform\"", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "If true this element negates the specified action. For Example, instead of a request for a procedure, it is a request for the procedure to not occur.", "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.doNotPerform" }, { "identity": "rim", "map": ".actionNegationInd" } ] }, { "id": "ServiceRequest.code", "path": "ServiceRequest.code", "short": "Specific requested service, when more precise than category", "definition": "The particular service, procedure or question being requested, when it is known and more\nspecific than `category`.\n\nOptional: the Ontario eReferral contract carries the routing information in `category` and\nsends no `code`. Where Nexus authors a referral itself, populate this from the reason for\nreferral so the receiving clinician can see what is being asked without opening the letter.\n\nWhere this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "comment": "Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.", "alias": [ "service requested" ], "min": 0, "max": "1", "base": { "path": "ServiceRequest.code", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceRequestCode" } ], "strength": "example", "description": "Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available [here](valueset-diagnostic-requests.html).", "valueSet": "http://hl7.org/fhir/ValueSet/procedure-code" }, "mapping": [ { "identity": "workflow", "map": "Request.code" }, { "identity": "w5", "map": "FiveWs.what[x]" }, { "identity": "v2", "map": "PR1-3 / OBR-4 (varies by domain)" }, { "identity": "rim", "map": ".code" }, { "identity": "quick", "map": "Procedure.procedureCode" } ] }, { "id": "ServiceRequest.orderDetail", "path": "ServiceRequest.orderDetail", "short": "Additional order information", "definition": "Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.", "comment": "For information from the medical record intended to support the delivery of the requested services, use the `supportingInformation` element.", "alias": [ "detailed instructions" ], "min": 0, "max": "*", "base": { "path": "ServiceRequest.orderDetail", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "prr-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "OrderDetail" } ], "strength": "example", "description": "Codified order entry details which are based on order context.", "valueSet": "http://hl7.org/fhir/ValueSet/servicerequest-orderdetail" }, "mapping": [ { "identity": "v2", "map": "NTE" }, { "identity": "rim", "map": ".code" }, { "identity": "quick", "map": "Procedure.procedureCode" } ] }, { "id": "ServiceRequest.quantity[x]", "path": "ServiceRequest.quantity[x]", "short": "Service amount", "definition": "An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).", "requirements": "When ordering a service the number of service items may need to be specified separately from the the service item.", "min": 0, "max": "1", "base": { "path": "ServiceRequest.quantity[x]", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" }, { "code": "Ratio" }, { "code": "Range" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "NTE" }, { "identity": "rim", "map": ".quantity" } ] }, { "id": "ServiceRequest.subject", "path": "ServiceRequest.subject", "short": "The patient being referred", "definition": "The patient for whom the referral is being made. Must reference using Nexus EMR patient identifier.", "min": 1, "max": "1", "base": { "path": "ServiceRequest.subject", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.subject" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "v2", "map": "PID" }, { "identity": "rim", "map": ".participation[typeCode=SBJ].role" }, { "identity": "quick", "map": "ClinicalStatement.subject" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "ServiceRequest.encounter", "path": "ServiceRequest.encounter", "short": "Encounter in which the referral was created", "definition": "The encounter during which this referral was created. Optional but provides important clinical context.", "alias": [ "context" ], "min": 0, "max": "1", "base": { "path": "ServiceRequest.encounter", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-encounter" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.encounter" }, { "identity": "w5", "map": "FiveWs.context" }, { "identity": "v2", "map": "PV1" }, { "identity": "rim", "map": ".inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]" }, { "identity": "quick", "map": "ClinicalStatement.encounter" } ] }, { "id": "ServiceRequest.occurrence[x]", "path": "ServiceRequest.occurrence[x]", "short": "When the referred service should occur", "definition": "The date/time or period when the referred service should occur, where a timeframe has been specified.", "alias": [ "schedule" ], "min": 0, "max": "1", "base": { "path": "ServiceRequest.occurrence[x]", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" }, { "code": "Period" }, { "code": "Timing" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.planned" }, { "identity": "v2", "map": "TQ1/TQ2, OBR-7/OBR-8" }, { "identity": "rim", "map": ".effectiveTime" }, { "identity": "quick", "map": "Procedure.procedureSchedule" } ] }, { "id": "ServiceRequest.asNeeded[x]", "path": "ServiceRequest.asNeeded[x]", "short": "Preconditions for service", "definition": "If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example \"pain\", \"on flare-up\", etc.", "min": 0, "max": "1", "base": { "path": "ServiceRequest.asNeeded[x]", "min": 0, "max": "1" }, "type": [ { "code": "boolean" }, { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProcedureAsNeededReason" } ], "strength": "example", "description": "A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example \"pain\", \"on flare-up\", etc.", "valueSet": "http://hl7.org/fhir/ValueSet/medication-as-needed-reason" }, "mapping": [ { "identity": "rim", "map": "boolean: precondition.negationInd (inversed - so negationInd = true means asNeeded=false CodeableConcept: precondition.observationEventCriterion[code=\"Assertion\"].value" }, { "identity": "quick", "map": "Proposal.prnReason.reason" } ] }, { "id": "ServiceRequest.authoredOn", "path": "ServiceRequest.authoredOn", "short": "Date the referral was authored", "definition": "When the referral was originally authored/created in the system.", "comment": "This is the creation date, not when the referred service should be performed.", "alias": [ "orderedOn" ], "min": 1, "max": "1", "base": { "path": "ServiceRequest.authoredOn", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.authoredOn" }, { "identity": "w5", "map": "FiveWs.recorded" }, { "identity": "v2", "map": "ORC.9, RF1-7 / RF1-9" }, { "identity": "rim", "map": ".participation[typeCode=AUT].time" }, { "identity": "quick", "map": "Proposal.proposedAtTime" } ] }, { "id": "ServiceRequest.requester", "path": "ServiceRequest.requester", "short": "Who is making the referral", "definition": "The clinician or organization making the referral. Required: a referral with no referrer cannot be answered, and loop closure has nothing to close against.", "comment": "This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.", "alias": [ "author", "orderer" ], "min": 1, "max": "1", "base": { "path": "ServiceRequest.requester", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/StructureDefinition/Device" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.requester" }, { "identity": "w5", "map": "FiveWs.author" }, { "identity": "v2", "map": "ORC.12, PRT" }, { "identity": "rim", "map": ".participation[typeCode=AUT].role" }, { "identity": "quick", "map": "ClinicalStatement.statementAuthor" } ] }, { "id": "ServiceRequest.performerType", "path": "ServiceRequest.performerType", "short": "Performer role", "definition": "Desired type of performer for doing the requested service.", "comment": "This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.", "alias": [ "specialty" ], "min": 0, "max": "1", "base": { "path": "ServiceRequest.performerType", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceRequestParticipantRole" } ], "strength": "example", "description": "Indicates specific responsibility of an individual within the care team, such as \"Primary physician\", \"Team coordinator\", \"Caregiver\", etc.", "valueSet": "http://hl7.org/fhir/ValueSet/participant-role" }, "mapping": [ { "identity": "workflow", "map": "Request.performerType" }, { "identity": "w5", "map": "FiveWs.actor" }, { "identity": "v2", "map": "PRT, RF!-3" }, { "identity": "rim", "map": ".participation[typeCode=PRF].role[scoper.determinerCode=KIND].code" } ] }, { "id": "ServiceRequest.performer", "path": "ServiceRequest.performer", "short": "The service or clinician the referral is directed to", "definition": "The receiving service, clinician or organization. Optional rather than CA-eReC's 1..*, because Nexus also records referrals that were never sent electronically and referrals whose destination is not yet chosen. Populate it whenever the destination is known.", "comment": "If multiple performers are present, it is interpreted as a list of *alternative* performers without any preference regardless of order. If order of preference is needed use the [request-performerOrder extension](extension-request-performerorder.html). Use CareTeam to represent a group of performers (for example, Practitioner A *and* Practitioner B).", "alias": [ "request recipient" ], "min": 0, "max": "*", "base": { "path": "ServiceRequest.performer", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/CareTeam", "http://hl7.org/fhir/StructureDefinition/HealthcareService", "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/Device", "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.performer" }, { "identity": "w5", "map": "FiveWs.actor" }, { "identity": "v2", "map": "PRT, Practitioner: PRD-2/PRD-7 where PRD-3 = RT; Organization: PRD-10 where PRD-3 = RT" }, { "identity": "rim", "map": ".participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]" } ] }, { "id": "ServiceRequest.locationCode", "path": "ServiceRequest.locationCode", "short": "Requested location", "definition": "The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.locationCode", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceRequestLocation" } ], "strength": "example", "description": "A location type where services are delivered.", "valueSet": "http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType" }, "mapping": [ { "identity": "w5", "map": "FiveWs.actor" }, { "identity": "rim", "map": ".participation[typeCode=LOC].role[scoper.determinerCode=KIND].code" } ] }, { "id": "ServiceRequest.locationReference", "path": "ServiceRequest.locationReference", "short": "Requested location", "definition": "A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.locationReference", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.actor" }, { "identity": "rim", "map": ".participation[typeCode=LOC].role[scoper.determinerCode=INSTANCE]" } ] }, { "id": "ServiceRequest.reasonCode", "path": "ServiceRequest.reasonCode", "short": "Why the referral is being made", "definition": "The clinical reason for the referral -- the question being asked of the receiving service. Where this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "comment": "This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use `CodeableConcept.text` element if the data is free (uncoded) text as shown in the [CT Scan example](servicerequest-example-di.html).", "min": 0, "max": "*", "base": { "path": "ServiceRequest.reasonCode", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceRequestReason" } ], "strength": "example", "description": "Diagnosis or problem codes justifying the reason for requesting the service investigation.", "valueSet": "http://hl7.org/fhir/ValueSet/procedure-reason" }, "mapping": [ { "identity": "workflow", "map": "Request.reasonCode" }, { "identity": "w5", "map": "FiveWs.why[x]" }, { "identity": "v2", "map": "ORC.16, RF1-10" }, { "identity": "rim", "map": ".reasonCode" } ] }, { "id": "ServiceRequest.reasonReference", "path": "ServiceRequest.reasonReference", "short": "Explanation/Justification for service or service", "definition": "Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo`.", "comment": "This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to *Observation* or *Condition* should be used if available. Otherwise when referencing *DiagnosticReport* it should contain a finding in `DiagnosticReport.conclusion` and/or `DiagnosticReport.conclusionCode`. When using a reference to *DocumentReference*, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in `ServiceRequest.reasonCode` if the data is free (uncoded) text as shown in the [CT Scan example](servicerequest-example-di.html).", "min": 0, "max": "*", "base": { "path": "ServiceRequest.reasonReference", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Condition", "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/DiagnosticReport", "http://hl7.org/fhir/StructureDefinition/DocumentReference" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Request.reasonReference" }, { "identity": "w5", "map": "FiveWs.why[x]" }, { "identity": "v2", "map": "ORC.16" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=RSON].target" } ] }, { "id": "ServiceRequest.insurance", "path": "ServiceRequest.insurance", "short": "Associated insurance coverage", "definition": "Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.insurance", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Coverage", "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Request.insurance" }, { "identity": "v2", "map": "IN1/IN2" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=COVBY].target" } ] }, { "id": "ServiceRequest.supportingInfo", "path": "ServiceRequest.supportingInfo", "short": "Prior results, notes and documents sent with the referral", "definition": "Resources sent alongside the referral to support it: prior investigations, relevant notes, the referral letter itself.", "comment": "To represent information about how the services are to be delivered use the `instructions` element.", "alias": [ "Ask at order entry question", "AOE" ], "min": 0, "max": "*", "base": { "path": "ServiceRequest.supportingInfo", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Request.supportingInfo" }, { "identity": "v2", "map": "Accompanying segments" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=PERT].target" } ] }, { "id": "ServiceRequest.specimen", "path": "ServiceRequest.specimen", "short": "Procedure Samples", "definition": "One or more specimens that the laboratory procedure will use.", "comment": "Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the [Specimen](specimen.html) resource points to the ServiceRequest.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.specimen", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Specimen" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "SPM" }, { "identity": "rim", "map": ".participation[typeCode=SPC].role" } ] }, { "id": "ServiceRequest.bodySite", "path": "ServiceRequest.bodySite", "short": "Location on Body", "definition": "Anatomic location where the procedure should be performed. This is the target site.", "comment": "Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension [procedure-targetBodyStructure](extension-procedure-targetbodystructure.html).", "requirements": "Knowing where the procedure is performed is important for tracking if multiple sites are possible.", "alias": [ "location" ], "min": 0, "max": "*", "base": { "path": "ServiceRequest.bodySite", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BodySite" } ], "strength": "example", "description": "Codes describing anatomical locations. May include laterality.", "valueSet": "http://hl7.org/fhir/ValueSet/body-site" }, "mapping": [ { "identity": "v2", "map": "SPM" }, { "identity": "rim", "map": "targetSiteCode" }, { "identity": "quick", "map": "Procedure.targetBodySite" } ] }, { "id": "ServiceRequest.note", "path": "ServiceRequest.note", "short": "Free-text notes on the referral", "definition": "Any other notes and comments made about the service request. For example, internal billing notes.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.note", "min": 0, "max": "*" }, "type": [ { "code": "Annotation" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Request.note" }, { "identity": "v2", "map": "NTE" }, { "identity": "rim", "map": ".inboundRelationship(typeCode=SUBJ].source[classCode=ANNGEN, moodCode=EVN].value[xsi:type=ST]" }, { "identity": "quick", "map": "ClinicalStatement.additionalText" } ] }, { "id": "ServiceRequest.patientInstruction", "path": "ServiceRequest.patientInstruction", "short": "Patient or consumer-oriented instructions", "definition": "Instructions in terms that are understood by the patient or consumer.", "min": 0, "max": "1", "base": { "path": "ServiceRequest.patientInstruction", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "NTE" }, { "identity": "rim", "map": ".text" } ] }, { "id": "ServiceRequest.relevantHistory", "path": "ServiceRequest.relevantHistory", "short": "Request provenance", "definition": "Key events in the history of the request.", "comment": "This might not include provenances for all versions of the request – only those deemed “relevant” or important.\rThis SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude\rAll Provenances should have some historical version of this Request as their subject.", "min": 0, "max": "*", "base": { "path": "ServiceRequest.relevantHistory", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Provenance" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Request.relevantHistory" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": ".inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]" } ] } ] }, "differential": { "element": [ { "id": "ServiceRequest", "path": "ServiceRequest", "short": "Nexus EMR Referral", "definition": "A referral: a request that another clinician or service accept the patient, for\nconsultation, second opinion, or short- or longer-term management.\n\nThe referrer does not control whether the receiving service accepts. That is why\n`intent` is `proposal` and not `order`, and it is the substantive difference between\nthis profile and NexusEmrCoreServiceRequest.", "constraint": [ { "key": "nexus-note-extension-not-where-native", "severity": "error", "human": "The resource-note extension is not used on a resource that has a native `note` element -- that element is the home", "expression": "extension('https://fhir.apps.health/StructureDefinition/nexus-emr-resource-note').empty()", "source": "https://fhir.apps.health/StructureDefinition/nexus-core-referral" }, { "key": "referral-code-has-text", "severity": "error", "human": "When code is present it SHALL carry text, so the requested service stays legible when no coded value is recognised", "expression": "code.exists() implies code.text.exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-core-referral" }, { "key": "referral-category-coded", "severity": "warning", "human": "At least one category SHOULD carry a SNOMED CT coding identifying the receiving service or specialty (recommended, not enforced: a destination with no usable code carries text instead)", "expression": "category.coding.where(system = 'http://snomed.info/sct').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-core-referral" } ] }, { "id": "ServiceRequest.meta.source", "path": "ServiceRequest.meta.source", "short": "Identifies EMR instance & pipeline version the resource came from", "definition": "A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.", "mustSupport": true }, { "id": "ServiceRequest.text", "path": "ServiceRequest.text", "short": "Narrative", "definition": "A human-readable narrative summary of the referral for human interpretation.", "mustSupport": true }, { "id": "ServiceRequest.identifier", "path": "ServiceRequest.identifier", "short": "Business identifier(s) for the referral", "definition": "Unique identifiers for the referral.\n\nA business identifier is recommended but not required (identifier is 0..*). Where\navailable, carry the source-system identifier using the most appropriate system URI. For\na referral received over Ontario eReferral this is the sending network's referral\nreference, and preserving it is what lets a later status update or a returning consult\nletter be matched to the referral it answers.\n\nA source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "mustSupport": true }, { "id": "ServiceRequest.identifier.system", "path": "ServiceRequest.identifier.system", "min": 1 }, { "id": "ServiceRequest.identifier.value", "path": "ServiceRequest.identifier.value", "min": 1 }, { "id": "ServiceRequest.status", "path": "ServiceRequest.status", "short": "draft | active | on-hold | revoked | completed | entered-in-error", "definition": "The state of the referral. `draft` written but not sent, `active` sent and awaiting the consult, `on-hold` waiting on something (imaging, bloodwork, patient contact), `revoked` declined or withdrawn, `completed` the consult happened.", "comment": "This is a modifier element. A worklist showing what has been sent and not yet answered reads this element.", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/request-status" } }, { "id": "ServiceRequest.intent", "path": "ServiceRequest.intent", "short": "proposal", "definition": "Fixed to `proposal`: a referral asks a receiving service to accept the patient and carries no authorization to act. Matches CA-eReC and the Ontario eReferral profile.", "comment": "A request the requester DOES have authority to have carried out is an order, not a referral, and belongs on NexusEmrCoreServiceRequest.", "fixedCode": "proposal", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/request-intent" } }, { "id": "ServiceRequest.category", "path": "ServiceRequest.category", "short": "Receiving service or specialty", "definition": "The healthcare service or clinical specialty the referral is directed to. This is the\nrouting information: it is what decides which service receives the referral, so a wrong\nvalue here sends the patient to the wrong place.\n\nThe binding is EXTENSIBLE, not required, and that is deliberate. Live Ontario traffic\nincludes concepts outside this value set -- Ocean sends 17561000 |Cardiologist|, an\nOCCUPATION concept, where the value set carries services and specialties -- and a required\nbinding would make the referrals we actually receive non-conformant.\n\nPreserve the raw coding exactly as received and add the Nexus coding alongside it in\nthe same element. Do not rewrite or drop the original: it is the evidence of what the\nsending system meant, and normalising it away loses the only record of that.", "min": 1, "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-referral-service-type" } }, { "id": "ServiceRequest.priority", "path": "ServiceRequest.priority", "definition": "How quickly the referral should be actioned. A referral worklist sorts on this: a suspected-cancer referral and a routine dermatology one do not wait in the same queue.", "mustSupport": true }, { "id": "ServiceRequest.code", "path": "ServiceRequest.code", "short": "Specific requested service, when more precise than category", "definition": "The particular service, procedure or question being requested, when it is known and more\nspecific than `category`.\n\nOptional: the Ontario eReferral contract carries the routing information in `category` and\nsends no `code`. Where Nexus authors a referral itself, populate this from the reason for\nreferral so the receiving clinician can see what is being asked without opening the letter.\n\nWhere this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "mustSupport": true }, { "id": "ServiceRequest.subject", "path": "ServiceRequest.subject", "short": "The patient being referred", "definition": "The patient for whom the referral is being made. Must reference using Nexus EMR patient identifier.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "mustSupport": true }, { "id": "ServiceRequest.encounter", "path": "ServiceRequest.encounter", "short": "Encounter in which the referral was created", "definition": "The encounter during which this referral was created. Optional but provides important clinical context.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-encounter" ] } ], "mustSupport": true }, { "id": "ServiceRequest.occurrence[x]", "path": "ServiceRequest.occurrence[x]", "short": "When the referred service should occur", "definition": "The date/time or period when the referred service should occur, where a timeframe has been specified.", "mustSupport": true }, { "id": "ServiceRequest.authoredOn", "path": "ServiceRequest.authoredOn", "short": "Date the referral was authored", "definition": "When the referral was originally authored/created in the system.", "comment": "This is the creation date, not when the referred service should be performed.", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.requester", "path": "ServiceRequest.requester", "short": "Who is making the referral", "definition": "The clinician or organization making the referral. Required: a referral with no referrer cannot be answered, and loop closure has nothing to close against.", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.performer", "path": "ServiceRequest.performer", "short": "The service or clinician the referral is directed to", "definition": "The receiving service, clinician or organization. Optional rather than CA-eReC's 1..*, because Nexus also records referrals that were never sent electronically and referrals whose destination is not yet chosen. Populate it whenever the destination is known.", "mustSupport": true }, { "id": "ServiceRequest.reasonCode", "path": "ServiceRequest.reasonCode", "short": "Why the referral is being made", "definition": "The clinical reason for the referral -- the question being asked of the receiving service. Where this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "mustSupport": true }, { "id": "ServiceRequest.supportingInfo", "path": "ServiceRequest.supportingInfo", "short": "Prior results, notes and documents sent with the referral", "definition": "Resources sent alongside the referral to support it: prior investigations, relevant notes, the referral letter itself.", "mustSupport": true }, { "id": "ServiceRequest.note", "path": "ServiceRequest.note", "short": "Free-text notes on the referral", "mustSupport": true } ] } }