INTEROPen CareConnect Base STU3 Implementation Guide
3.0.0 - CI Build

INTEROPen CareConnect Base STU3 Implementation Guide - Local Development build (v3.0.0). See the Directory of published versions

StructureDefinition: CareConnect-ReferralRequest-1 - Detailed Descriptions

Definitions for the CareConnect-ReferralRequest-1 Profile.

1. ReferralRequest
Definition

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

Control0..*
Alternate NamesReferralRequest TransferOfCare Request
InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (: contained.where(('#'+id in %resource.descendants().reference).not()).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
2. ReferralRequest.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. ReferralRequest.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
4. ReferralRequest.implicitRules
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.

Control0..1
Typeuri
Is Modifiertrue
Comments

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

5. ReferralRequest.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Max Binding: All Languages
Typecode
Comments

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).

6. ReferralRequest.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

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 in formation is added later.

7. ReferralRequest.contained
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.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

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.

8. ReferralRequest.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on ReferralRequest.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. ReferralRequest.extension:referralRequestMethod
SliceNamereferralRequestMethod
Definition

The method used to send or receive a Referral Request.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-ReferralRequestMethod-1) (Extension Type: CodeableConcept)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. ReferralRequest.extension:sourceOfReferral
SliceNamesourceOfReferral
Definition

The source of referral for a Referral Request.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-SourceOfReferral-1) (Extension Type: CodeableConcept)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
11. ReferralRequest.modifierExtension
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. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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.

12. ReferralRequest.identifier
Definition

Business identifier that uniquely identifies the referral/care transfer request instance.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
13. ReferralRequest.identifier.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
14. ReferralRequest.identifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

SlicingThis element introduces a set of slices on ReferralRequest.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
15. ReferralRequest.identifier.use
Definition

The purpose of this identifier.

Control0..1
BindingIdentifies the purpose for this identifier, if known .
The codes SHALL be taken from IdentifierUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

16. ReferralRequest.identifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingA coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

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.

17. ReferralRequest.identifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control1..1
Typeuri
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.

Example
General:http://www.acme.com/identifiers/patient
18. ReferralRequest.identifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Comments

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.

Example
General:123456
19. ReferralRequest.identifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
20. ReferralRequest.identifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(CareConnect-Organization-1)
Comments

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.

21. ReferralRequest.definition
Definition

A protocol, guideline, orderset or other definition that is adhered to in whole or in part by this request.

Control0..*
TypeReference(ActivityDefinition | PlanDefinition)
22. ReferralRequest.basedOn
Definition

Indicates any plans, proposals or orders that this request is intended to satisfy - in whole or in part.

Control0..*
TypeReference(CareConnect-CarePlan-1 | CareConnect-ProcedureRequest-1 | CareConnect-ReferralRequest-1)
Alternate Namesfulfills
23. ReferralRequest.replaces
Definition

Completed or terminated request(s) whose function is taken by this new request.

Control0..*
TypeReference(CareConnect-ReferralRequest-1)
Requirements

Allows tracing the continuation of a therapy or administrative process instantiated through multiple requests.

Alternate Namessupersedes, prior, renewed order
Comments

The replacement could be because the initial request was immediately rejected (due to an issue) or because the previous request was completed, but the need for the action described by the request remains ongoing.

24. ReferralRequest.groupIdentifier
Definition

The business identifier of the logical "grouping" request/order that this referral is a part of.

Control0..1
TypeIdentifier
Requirements

Allows multiple orders to be collected as part of a single requisition.

Alternate NamesgrouperId, requisition
25. ReferralRequest.groupIdentifier.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
26. ReferralRequest.groupIdentifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

SlicingThis element introduces a set of slices on ReferralRequest.groupIdentifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
27. ReferralRequest.groupIdentifier.use
Definition

The purpose of this identifier.

Control0..1
BindingIdentifies the purpose for this identifier, if known .
The codes SHALL be taken from IdentifierUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

28. ReferralRequest.groupIdentifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingA coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

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.

29. ReferralRequest.groupIdentifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control0..1
Typeuri
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.

Example
General:http://www.acme.com/identifiers/patient
30. ReferralRequest.groupIdentifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control0..1
Typestring
Comments

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.

Example
General:123456
31. ReferralRequest.groupIdentifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
32. ReferralRequest.groupIdentifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(CareConnect-Organization-1)
Comments

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.

33. ReferralRequest.status
Definition

The status of the authorization/intention reflected by the referral request record.

Control1..1
BindingThe status of the referral.
The codes SHALL be taken from RequestStatus
Typecode
Is Modifiertrue
Requirements

Workflow status is handled by the Task resource.

Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

34. ReferralRequest.intent
Definition

Distinguishes the "level" of authorization/demand implicit in this request.

Control1..1
BindingCodes identifying the stage lifecycle stage of a request
The codes SHALL be taken from RequestIntent
Typecode
Is Modifiertrue
Requirements

The same resource structure is used when capturing proposals/recommendations, plans and actual requests.

Alternate Namescategory
35. ReferralRequest.type
Definition

An indication of the type of referral (or where applicable the type of transfer of care) request.

Control0..1
BindingCodes for types of referral; e.g. consult, transfer, temporary transfer.
For example codes, see SNOMED CT Patient Referral
TypeCodeableConcept
36. ReferralRequest.priority
Definition

An indication of the urgency of referral (or where applicable the type of transfer of care) request.

Control0..1
BindingCodes indicating the relative priority of the referral.
The codes SHALL be taken from RequestPriority
Typecode
37. ReferralRequest.serviceRequested
Definition

The service(s) that is/are requested to be provided to the patient. For example: cardiac pacemaker insertion.

Control0..*
BindingCodes indicating the types of services that might be requested as part of a referral.
For example codes, see Practice Setting Code Value Set
TypeCodeableConcept
38. ReferralRequest.subject
Definition

The patient who is the subject of a referral or transfer of care request.

Control1..1
TypeReference(Group | CareConnect-Patient-1)
Comments

Referral of family, group or community is to be catered for by profiles.

39. ReferralRequest.context
Definition

The encounter at which the request for referral or transfer of care is initiated.

Control0..1
TypeReference(CareConnect-Encounter-1 | CareConnect-EpisodeOfCare-1)
Alternate Namesencounter
40. ReferralRequest.occurrence[x]
Definition

The period of time within which the services identified in the referral/transfer of care is specified or required to occur.

Control0..1
TypeChoice of: dateTime, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

Use cases: (1) to indicate that the requested service is not to happen before a specified date, and saving the start date in Period.start; (2) to indicate that the requested service must happen before a specified date, and saving the end date in Period.end; (3) to indicate that the requested service must happen during the specified dates ("start" and "end" values).

Alternate Namestiming
Comments

When the occurrenceDateTime is used, then it is indicating that the requested service must happen before the specified date.

41. ReferralRequest.authoredOn
Definition

Date/DateTime of creation for draft requests and date of activation for active requests.

Control0..1
TypedateTime
Alternate NamescreatedOn
42. ReferralRequest.requester
Definition

The individual who initiated the request and has responsibility for its activation.

Control0..1
TypeBackboneElement
Alternate Namesauthor
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
rfr-1: onBehalfOf can only be specified if agent is practitioner or device (: (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())
43. ReferralRequest.requester.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
44. ReferralRequest.requester.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

45. ReferralRequest.requester.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

46. ReferralRequest.requester.agent
Definition

The device, practitioner, etc. who initiated the request.

Control1..1
TypeReference(Device | CareConnect-Organization-1 | CareConnect-Patient-1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)
47. ReferralRequest.requester.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control0..1 This element is affected by the following invariants: rfr-1
TypeReference(CareConnect-Organization-1)
Requirements

Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.

48. ReferralRequest.specialty
Definition

Indication of the clinical domain or discipline to which the referral or transfer of care request is sent. For example: Cardiology Gastroenterology Diabetology.

Control0..1
BindingCodes indicating the types of capability the referred to service provider must have.
For example codes, see PractitionerSpecialty
TypeCodeableConcept
49. ReferralRequest.recipient
Definition

The healthcare provider(s) or provider organization(s) who/which is to receive the referral/transfer of care request.

Control0..*
TypeReference(CareConnect-Organization-1 | CareConnect-Practitioner-1 | CareConnect-HealthcareService-1)
Comments

There will be a primary receiver. But the request can be received by any number of "copied to" providers or organizations.

50. ReferralRequest.reasonCode
Definition

Description of clinical condition indicating why referral/transfer of care is requested. For example: Pathological Anomalies, Disabled (physical or mental), Behavioral Management.

Control0..*
BindingCodes indicating why the referral is being requested.
For example codes, see SNOMED CT Clinical Findings
TypeCodeableConcept
51. ReferralRequest.reasonReference
Definition

Indicates another resource whose existence justifies this request.

Control0..*
TypeReference(CareConnect-Condition-1 | CareConnect-Observation-1)
52. ReferralRequest.description
Definition

The reason element gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summary.

Control0..1
Typestring
53. ReferralRequest.supportingInfo
Definition

Any additional (administrative, financial or clinical) information required to support request for referral or transfer of care. For example: Presenting problems/chief complaints Medical History Family History Alerts Allergy/Intolerance and Adverse Reactions Medications Observations/Assessments (may include cognitive and fundtional assessments) Diagnostic Reports Care Plan.

Control0..*
TypeReference(Resource)
54. ReferralRequest.note
Definition

Comments made about the referral request by any of the participants.

Control0..*
TypeAnnotation
55. ReferralRequest.note.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
56. ReferralRequest.note.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

SlicingThis element introduces a set of slices on ReferralRequest.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
57. ReferralRequest.note.author[x]
Definition

The individual responsible for making the annotation.

Control0..1
TypeChoice of: string, Reference(CareConnect-Patient-1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)
[x] NoteSee Choice of Data Types for further information about how to use [x]
58. ReferralRequest.note.time
Definition

Indicates when this particular annotation was made.

Control0..1
TypedateTime
59. ReferralRequest.note.text
Definition

The text of the annotation.

Control1..1
Typestring
60. ReferralRequest.relevantHistory
Definition

Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.

Control0..*
TypeReference(Provenance)
Alternate NameseventHistory
Comments

This element does not point to the Provenance associated with the current version of the resource - as it would be created after this version existed. The Provenance for the current version can be retrieved with a _revinclude.