HL7 Electronic Health Record System Functional Model, Release 2.1.1
2.1.1-ballot - Normative Ballot

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## : CPS.4.6.1 Support for Referral Process (Function) - XML Representation

Page standards status: Informative

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    <Requirements xmlns="http://hl7.org/fhir">
      <id value="EHRSFMR2-CPS.4.6.1"/>
      <meta>
        <profile
                 value="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/FMFunction"/>
      </meta>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml">
        <span id="description"><b>Statement <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b> <div><p>Evaluate referrals within the context of a patient's healthcare data.</p>
    </div></span>

        <span id="purpose"><b>Description <a href="https://hl7.org/fhir/versions.html#std-process" title="Informative Content" class="informative-flag">I</a>:</b> <div><p>The system assists with patient referrals, including compilation of relevant clinical and behavioral health results, demographic and insurance information (if available). Standardized or evidence based protocols for workup prior to referral may also be presented.</p>
    </div></span>

        <span id="actors"><b>Actors:</b><br/> ehr</span>

        <span id="requirements"><b>Criteria <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b></span>

        <table id="statements" class="grid dict">

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#01</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>SHALL</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system SHALL provide the ability to capture and render clinical and administrative data (e.g., insurance information) as part of the referral process.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#02</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>SHOULD</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system SHOULD provide the ability to capture and render test and procedure results with a referral.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#03</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>MAY</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system MAY provide the ability to capture and render standardized or evidence based protocols (e.g., AHRQ evidence-based practice guidelines) with the referral.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#04</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>SHALL</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system SHALL provide the ability to render clinical and administrative data, as well as test and procedure results to the referred-to provider.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#05</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>SHALL</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system SHALL provide the ability to capture and render referral orders with detail adequate for correct routing to the referred-to provider.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#06</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>SHOULD</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system SHOULD provide the ability to transmit clinical and administrative data, as well as test and procedure results to the referred-to provider.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#07</span>

                </td>
                <td style="padding-left: 4px;">

                    <i>dependent</i>

                    <span>SHALL</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system SHALL provide the ability to capture and render age appropriate data as part of the referral process according to scope of practice. (e.g., inclusion of growth chart in pediatric referral).</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#08</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>SHOULD</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system SHOULD provide the ability to capture a provider's schedule for receiving referrals.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#09</span>

                </td>
                <td style="padding-left: 4px;">

                    <i>conditional</i>

                    <span>SHOULD</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>IF the system provides the ability to capture provider schedules for receiving referrals, THEN the system SHOULD determine and render available provider appointments based on their schedules at the time of referral order entry.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>CPS.4.6.1#10</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>MAY</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system MAY provide the ability to transmit a referral to multiple providers.</p>
    </div></span>

                </td>
            </tr>

        </table>
    </div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="ehr"/>
      </extension>
      <url
           value="http://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-CPS.4.6.1"/>
      <version value="2.1.1-ballot"/>
      <name value="CPS_4_6_1_Support_for_Referral_Process"/>
      <title value="CPS.4.6.1 Support for Referral Process (Function)"/>
      <status value="active"/>
      <date value="2025-04-04T11:04:36+11:00"/>
      <publisher value="HL7 International / Electronic Health Records"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/ehr"/>
        </telecom>
      </contact>
      <description
                   value="Evaluate referrals within the context of a patient's healthcare data."/>
      <jurisdiction>
        <coding>
          <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
          <code value="001"/>
          <display value="World"/>
        </coding>
      </jurisdiction>
      <purpose
               value="The system assists with patient referrals, including compilation of relevant clinical and behavioral health results, demographic and insurance information (if available). Standardized or evidence based protocols for workup prior to referral may also be presented."/>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-01"/>
        <label value="CPS.4.6.1#01"/>
        <conformance value="SHALL"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHALL provide the ability to capture and render clinical and administrative data (e.g., insurance information) as part of the referral process."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.2.4.4.1#1"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-02"/>
        <label value="CPS.4.6.1#02"/>
        <conformance value="SHOULD"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHOULD provide the ability to capture and render test and procedure results with a referral."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.2.4.4.1#2"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-03"/>
        <label value="CPS.4.6.1#03"/>
        <conformance value="MAY"/>
        <conditionality value="false"/>
        <requirement
                     value="The system MAY provide the ability to capture and render standardized or evidence based protocols (e.g., AHRQ evidence-based practice guidelines) with the referral."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.2.4.4.1#3"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-04"/>
        <label value="CPS.4.6.1#04"/>
        <conformance value="SHALL"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHALL provide the ability to render clinical and administrative data, as well as test and procedure results to the referred-to provider."/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-05"/>
        <label value="CPS.4.6.1#05"/>
        <conformance value="SHALL"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHALL provide the ability to capture and render referral orders with detail adequate for correct routing to the referred-to provider."/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-06"/>
        <label value="CPS.4.6.1#06"/>
        <conformance value="SHOULD"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHOULD provide the ability to transmit clinical and administrative data, as well as test and procedure results to the referred-to provider."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.2.4.4.1#4"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="true"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-07"/>
        <label value="CPS.4.6.1#07"/>
        <conformance value="SHALL"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHALL provide the ability to capture and render age appropriate data as part of the referral process according to scope of practice. (e.g., inclusion of growth chart in pediatric referral)."/>
        <derivedFrom value="PHFP DC.2.4.4.1#6"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-08"/>
        <label value="CPS.4.6.1#08"/>
        <conformance value="SHOULD"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHOULD provide the ability to capture a provider's schedule for receiving referrals."/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-09"/>
        <label value="CPS.4.6.1#09"/>
        <conformance value="SHOULD"/>
        <conditionality value="true"/>
        <requirement
                     value="IF the system provides the ability to capture provider schedules for receiving referrals, THEN the system SHOULD determine and render available provider appointments based on their schedules at the time of referral order entry."/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-CPS.4.6.1-10"/>
        <label value="CPS.4.6.1#10"/>
        <conformance value="MAY"/>
        <conditionality value="false"/>
        <requirement
                     value="The system MAY provide the ability to transmit a referral to multiple providers."/>
      </statement>
    </Requirements>