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4.7 Resource ReferralRequest - Content

This resource maintained by the Patient Care Work Group

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 organisation.

4.7.1 Scope and Usage

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

Examples include:

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

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

4.7.2 Boundaries and Relationships

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

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

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

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

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

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

This resource is referenced by CarePlan, Claim, ClinicalImpression, Encounter and EpisodeOfCare

4.7.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest DomainResourceA request for referral or transfer of care
... status ?! Σ1..1codedraft | requested | active | cancelled | accepted | rejected | completed
ReferralStatus (Required)
... identifier 0..*IdentifierIdentifier of request
... type Σ0..1CodeableConceptReferral/Transition of care request type
... specialty 0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
... priority Σ0..1CodeableConceptUrgency of referral / transfer of care request
... patient Σ0..1PatientPatient referred to care or transfer
... requester Σ0..1Practitioner | Organization | PatientRequester of referral / transfer of care
... recipient Σ0..*Practitioner | OrganizationReceiver of referral / transfer of care request
... encounter 0..1EncounterEncounter
... dateSent Σ0..1dateTimeDate referral/transfer of care request is sent
... reason Σ0..1CodeableConceptReason for referral / Transfer of care request
... description 0..1stringA textual description of the referral
... serviceRequested Σ0..*CodeableConceptService(s) requested
... supportingInformation Σ0..*AnyAdditonal information to support referral or transfer of care request
... fulfillmentTime Σ0..1PeriodRequested service(s) fulfillment time

UML Diagram

ReferralRequest (DomainResource)The workflow status of the referral or transfer of care request (this element modifies the meaning of other elements)status : code 1..1 « The status of the referralReferralStatus »Business Id that uniquely identifies the referral/care transfer request instanceidentifier : Identifier 0..*An indication of the type of referral (or where applicable the type of transfer of care) requesttype : CodeableConcept 0..1Indication of the clinical domain or discipline to which the referral or transfer of care request is sentspecialty : CodeableConcept 0..1An indication of the urgency of referral (or where applicable the type of transfer of care) requestpriority : CodeableConcept 0..1The patient who is the subject of a referral or transfer of care requestpatient : Reference(Patient) 0..1The healthcare provider or provider organization who/which initaited the referral/transfer of care request. Can also be Patient (a self referral)requester : Reference(Practitioner|Organization| Patient) 0..1The healthcare provider(s) or provider organization(s) who/which is to receive the referral/transfer of care requestrecipient : Reference(Practitioner|Organization) 0..*The encounter at which the request for referral or transfer of care is initiatedencounter : Reference(Encounter) 0..1Date/DateTime the request for referral or transfer of care is sent by the authordateSent : dateTime 0..1Description of clinical condition indicating why referral/transfer of care is requestedreason : CodeableConcept 0..1The reason gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summarydescription : string 0..1The service(s) that is/are requested to be provided to the patientserviceRequested : CodeableConcept 0..*Any additional (administrative, financial or clinical) information required to support request for referral or transfer of caresupportingInformation : Reference(Any) 0..*The period of time within which the services identified in the referral/transfer of care is specified or required to occurfulfillmentTime : Period 0..1

XML Template

<ReferralRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <status value="[code]"/><!-- 1..1 draft | requested | active | cancelled | accepted | rejected | completed -->
 <identifier><!-- 0..* Identifier Identifier of request --></identifier>
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <specialty><!-- 0..1 CodeableConcept 
     The clinical specialty (discipline) that the referral is requested for --></specialty>
 <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority>
 <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient>
 <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) 
     Requester of referral / transfer of care --></requester>
 <recipient><!-- 0..* Reference(Practitioner|Organization) 
     Receiver of referral / transfer of care request --></recipient>
 <encounter><!-- 0..1 Reference(Encounter) Encounter --></encounter>
 <dateSent value="[dateTime]"/><!-- 0..1 Date referral/transfer of care request is sent -->
 <reason><!-- 0..1 CodeableConcept Reason for referral / Transfer of care request --></reason>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <serviceRequested><!-- 0..* CodeableConcept Service(s) requested --></serviceRequested>
 <supportingInformation><!-- 0..* Reference(Any) 
     Additonal information to support referral or transfer of care request --></supportingInformation>
 <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime>
</ReferralRequest>

JSON Template

{doco
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "status" : "<code>", // R!  draft | requested | active | cancelled | accepted | rejected | completed
  "identifier" : [{ Identifier }], // Identifier of request
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "specialty" : { CodeableConcept }, // 
     The clinical specialty (discipline) that the referral is requested for
  "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request
  "patient" : { Reference(Patient) }, // Patient referred to care or transfer
  "requester" : { Reference(Practitioner|Organization|Patient) }, // 
     Requester of referral / transfer of care
  "recipient" : [{ Reference(Practitioner|Organization) }], // 
     Receiver of referral / transfer of care request
  "encounter" : { Reference(Encounter) }, // Encounter
  "dateSent" : "<dateTime>", // Date referral/transfer of care request is sent
  "reason" : { CodeableConcept }, // Reason for referral / Transfer of care request
  "description" : "<string>", // A textual description of the referral
  "serviceRequested" : [{ CodeableConcept }], // Service(s) requested
  "supportingInformation" : [{ Reference(Any) }], // 
     Additonal information to support referral or transfer of care request
  "fulfillmentTime" : { Period } // Requested service(s) fulfillment time
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest DomainResourceA request for referral or transfer of care
... status ?! Σ1..1codedraft | requested | active | cancelled | accepted | rejected | completed
ReferralStatus (Required)
... identifier 0..*IdentifierIdentifier of request
... type Σ0..1CodeableConceptReferral/Transition of care request type
... specialty 0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
... priority Σ0..1CodeableConceptUrgency of referral / transfer of care request
... patient Σ0..1PatientPatient referred to care or transfer
... requester Σ0..1Practitioner | Organization | PatientRequester of referral / transfer of care
... recipient Σ0..*Practitioner | OrganizationReceiver of referral / transfer of care request
... encounter 0..1EncounterEncounter
... dateSent Σ0..1dateTimeDate referral/transfer of care request is sent
... reason Σ0..1CodeableConceptReason for referral / Transfer of care request
... description 0..1stringA textual description of the referral
... serviceRequested Σ0..*CodeableConceptService(s) requested
... supportingInformation Σ0..*AnyAdditonal information to support referral or transfer of care request
... fulfillmentTime Σ0..1PeriodRequested service(s) fulfillment time

UML Diagram

ReferralRequest (DomainResource)The workflow status of the referral or transfer of care request (this element modifies the meaning of other elements)status : code 1..1 « The status of the referralReferralStatus »Business Id that uniquely identifies the referral/care transfer request instanceidentifier : Identifier 0..*An indication of the type of referral (or where applicable the type of transfer of care) requesttype : CodeableConcept 0..1Indication of the clinical domain or discipline to which the referral or transfer of care request is sentspecialty : CodeableConcept 0..1An indication of the urgency of referral (or where applicable the type of transfer of care) requestpriority : CodeableConcept 0..1The patient who is the subject of a referral or transfer of care requestpatient : Reference(Patient) 0..1The healthcare provider or provider organization who/which initaited the referral/transfer of care request. Can also be Patient (a self referral)requester : Reference(Practitioner|Organization| Patient) 0..1The healthcare provider(s) or provider organization(s) who/which is to receive the referral/transfer of care requestrecipient : Reference(Practitioner|Organization) 0..*The encounter at which the request for referral or transfer of care is initiatedencounter : Reference(Encounter) 0..1Date/DateTime the request for referral or transfer of care is sent by the authordateSent : dateTime 0..1Description of clinical condition indicating why referral/transfer of care is requestedreason : CodeableConcept 0..1The reason gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summarydescription : string 0..1The service(s) that is/are requested to be provided to the patientserviceRequested : CodeableConcept 0..*Any additional (administrative, financial or clinical) information required to support request for referral or transfer of caresupportingInformation : Reference(Any) 0..*The period of time within which the services identified in the referral/transfer of care is specified or required to occurfulfillmentTime : Period 0..1

XML Template

<ReferralRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <status value="[code]"/><!-- 1..1 draft | requested | active | cancelled | accepted | rejected | completed -->
 <identifier><!-- 0..* Identifier Identifier of request --></identifier>
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <specialty><!-- 0..1 CodeableConcept 
     The clinical specialty (discipline) that the referral is requested for --></specialty>
 <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority>
 <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient>
 <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) 
     Requester of referral / transfer of care --></requester>
 <recipient><!-- 0..* Reference(Practitioner|Organization) 
     Receiver of referral / transfer of care request --></recipient>
 <encounter><!-- 0..1 Reference(Encounter) Encounter --></encounter>
 <dateSent value="[dateTime]"/><!-- 0..1 Date referral/transfer of care request is sent -->
 <reason><!-- 0..1 CodeableConcept Reason for referral / Transfer of care request --></reason>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <serviceRequested><!-- 0..* CodeableConcept Service(s) requested --></serviceRequested>
 <supportingInformation><!-- 0..* Reference(Any) 
     Additonal information to support referral or transfer of care request --></supportingInformation>
 <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime>
</ReferralRequest>

JSON Template

{doco
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "status" : "<code>", // R!  draft | requested | active | cancelled | accepted | rejected | completed
  "identifier" : [{ Identifier }], // Identifier of request
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "specialty" : { CodeableConcept }, // 
     The clinical specialty (discipline) that the referral is requested for
  "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request
  "patient" : { Reference(Patient) }, // Patient referred to care or transfer
  "requester" : { Reference(Practitioner|Organization|Patient) }, // 
     Requester of referral / transfer of care
  "recipient" : [{ Reference(Practitioner|Organization) }], // 
     Receiver of referral / transfer of care request
  "encounter" : { Reference(Encounter) }, // Encounter
  "dateSent" : "<dateTime>", // Date referral/transfer of care request is sent
  "reason" : { CodeableConcept }, // Reason for referral / Transfer of care request
  "description" : "<string>", // A textual description of the referral
  "serviceRequested" : [{ CodeableConcept }], // Service(s) requested
  "supportingInformation" : [{ Reference(Any) }], // 
     Additonal information to support referral or transfer of care request
  "fulfillmentTime" : { Period } // Requested service(s) fulfillment time
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON)

4.7.3.1 Terminology Bindings

PathDefinitionTypeReference
ReferralRequest.status The status of the referralRequiredhttp://hl7.org/fhir/referralstatus

4.7.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
patientreferenceWho the referral is aboutReferralRequest.patient
(Patient)
prioritytokenThe priority assigned to the referralReferralRequest.priority
recipientreferenceThe person that the referral was sent toReferralRequest.recipient
(Organization, Practitioner)
requesterreferenceRequester of referral / transfer of careReferralRequest.requester
(Patient, Organization, Practitioner)
specialtytokenThe specialty that the referral is forReferralRequest.specialty
statustokenThe status of the referralReferralRequest.status
typetokenThe type of the referralReferralRequest.type