This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R3 R2
Patient Care Work Group | Maturity Level: 1 | Compartments: Patient, Practitioner |
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.
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:
ReferralRequest is also intended for use when there is 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 a skilled nursing facility).
ReferralRequest is closely related to other types of "request" resources, particularly DiagnosticRequest 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 organizational practice and by context. When it is unclear which to use, the following principles may be helpful:
Irrespective of the guidance above, systems should be prepared for some degree of overlap between these resources and should 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 DiagnosticRequest. 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. Alternatively, 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.
A ReferralRequest may be targeted (identifying a specific Practitioner or Organization to perform the requested care) or untargeted (merely identifying the type of care desired). The Task resource may be used to help manage such workflows.
A ReferralRequest might be fulfilled by a DiagnosticReport, Encounter, Procedure, or other assessment-related resource.
A ReferralRequest should not be confused with an Appointment, as appointments are intended for booking/scheduling purposes.
PLANNED CHANGE:
ReferralRequest is one of the Request resources in the FHIR Workflow specification. As such, it is expected to be adjusted to align with the Request workflow pattern which will involve adding a number of additional data elements and potentially renaming a few elements. Any concerns about performing such alignment are welcome as ballot comments and/or tracker items.
This resource is referenced by CarePlan, Claim, ClinicalImpression, DiagnosticReport, Encounter, EpisodeOfCare, ExplanationOfBenefit, ImagingStudy, Procedure and QuestionnaireResponse
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ReferralRequest | DomainResource | A request for referral or transfer of care | ||
identifier | 0..* | Identifier | Business identifier | |
basedOn | 0..* | Reference(ReferralRequest | CarePlan | DiagnosticRequest | ProcedureRequest) | Request fulfilled by this request | |
parent | Σ | 0..1 | Identifier | Composite request this is part of |
status | ?!Σ | 1..1 | code | draft | active | cancelled | completed | entered-in-error ReferralStatus (Required) |
category | ?!Σ | 1..1 | code | proposal | plan | request ReferralCategory (Required) |
type | Σ | 0..1 | CodeableConcept | Referral/Transition of care request type |
priority | Σ | 0..1 | CodeableConcept | Urgency of referral / transfer of care request RequestPriority (Example) |
patient | Σ | 0..1 | Reference(Patient) | Patient referred to care or transfer |
context | 0..1 | Reference(Encounter | EpisodeOfCare) | Originating encounter | |
fulfillmentTime | Σ | 0..1 | Period | Requested service(s) fulfillment time |
authored | Σ | 0..1 | dateTime | Date of creation/activation |
requester | Σ | 0..1 | Reference(Practitioner | Organization | Patient) | Requester of referral / transfer of care |
specialty | 0..1 | CodeableConcept | The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty (Example) | |
recipient | Σ | 0..* | Reference(Practitioner | Organization) | Receiver of referral / transfer of care request |
reason | Σ | 0..1 | CodeableConcept | Reason for referral / transfer of care request |
description | 0..1 | string | A textual description of the referral | |
serviceRequested | Σ | 0..* | CodeableConcept | Actions requested as part of the referral Practice Setting Code Value Set (Example) |
supportingInformation | Σ | 0..* | Reference(Any) | Additonal information to support referral or transfer of care request |
Documentation for this format |
UML Diagram (Legend)
XML Template
<ReferralRequest xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Business identifier --></identifier> <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|DiagnosticRequest| ProcedureRequest) Request fulfilled by this request --></basedOn> <parent><!-- 0..1 Identifier Composite request this is part of --></parent> <status value="[code]"/><!-- 1..1 draft | active | cancelled | completed | entered-in-error --> <category value="[code]"/><!-- 1..1 proposal | plan | request --> <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type> <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority> <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient> <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context> <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime> <authored value="[dateTime]"/><!-- 0..1 Date of creation/activation --> <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) Requester of referral / transfer of care --></requester> <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty> <recipient><!-- 0..* Reference(Practitioner|Organization) Receiver of referral / transfer of care request --></recipient> <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 Actions requested as part of the referral --></serviceRequested> <supportingInformation><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInformation> </ReferralRequest>
JSON Template
{ "resourceType" : "ReferralRequest", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // Business identifier "basedOn" : [{ Reference(ReferralRequest|CarePlan|DiagnosticRequest| ProcedureRequest) }], // Request fulfilled by this request "parent" : { Identifier }, // Composite request this is part of "status" : "<code>", // R! draft | active | cancelled | completed | entered-in-error "category" : "<code>", // R! proposal | plan | request "type" : { CodeableConcept }, // Referral/Transition of care request type "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request "patient" : { Reference(Patient) }, // Patient referred to care or transfer "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter "fulfillmentTime" : { Period }, // Requested service(s) fulfillment time "authored" : "<dateTime>", // Date of creation/activation "requester" : { Reference(Practitioner|Organization|Patient) }, // Requester of referral / transfer of care "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for "recipient" : [{ Reference(Practitioner|Organization) }], // Receiver of referral / transfer of care request "reason" : { CodeableConcept }, // Reason for referral / transfer of care request "description" : "<string>", // A textual description of the referral "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral "supportingInformation" : [{ Reference(Any) }] // Additonal information to support referral or transfer of care request }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:ReferralRequest; fhir:nodeRole fhir:treeRoot; # if this is the parser root # from Resource: .id, .meta, .implicitRules, and .language # from DomainResource: .text, .contained, .extension, and .modifierExtension fhir:ReferralRequest.identifier [ Identifier ], ... ; # 0..* Business identifier fhir:ReferralRequest.basedOn [ Reference(ReferralRequest|CarePlan|DiagnosticRequest|ProcedureRequest) ], ... ; # 0..* Request fulfilled by this request fhir:ReferralRequest.parent [ Identifier ]; # 0..1 Composite request this is part of fhir:ReferralRequest.status [ code ]; # 1..1 draft | active | cancelled | completed | entered-in-error fhir:ReferralRequest.category [ code ]; # 1..1 proposal | plan | request fhir:ReferralRequest.type [ CodeableConcept ]; # 0..1 Referral/Transition of care request type fhir:ReferralRequest.priority [ CodeableConcept ]; # 0..1 Urgency of referral / transfer of care request fhir:ReferralRequest.patient [ Reference(Patient) ]; # 0..1 Patient referred to care or transfer fhir:ReferralRequest.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating encounter fhir:ReferralRequest.fulfillmentTime [ Period ]; # 0..1 Requested service(s) fulfillment time fhir:ReferralRequest.authored [ dateTime ]; # 0..1 Date of creation/activation fhir:ReferralRequest.requester [ Reference(Practitioner|Organization|Patient) ]; # 0..1 Requester of referral / transfer of care fhir:ReferralRequest.specialty [ CodeableConcept ]; # 0..1 The clinical specialty (discipline) that the referral is requested for fhir:ReferralRequest.recipient [ Reference(Practitioner|Organization) ], ... ; # 0..* Receiver of referral / transfer of care request fhir:ReferralRequest.reason [ CodeableConcept ]; # 0..1 Reason for referral / transfer of care request fhir:ReferralRequest.description [ string ]; # 0..1 A textual description of the referral fhir:ReferralRequest.serviceRequested [ CodeableConcept ], ... ; # 0..* Actions requested as part of the referral fhir:ReferralRequest.supportingInformation [ Reference(Any) ], ... ; # 0..* Additonal information to support referral or transfer of care request ]
Changes since DSTU2
ReferralRequest | |
ReferralRequest.basedOn | added |
ReferralRequest.parent | added |
ReferralRequest.category | added |
ReferralRequest.context |
Renamed from encounter to context Add Reference(EpisodeOfCare) |
ReferralRequest.authored | Renamed from date to authored |
ReferralRequest.dateSent | deleted |
See the Full Difference for further information
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ReferralRequest | DomainResource | A request for referral or transfer of care | ||
identifier | 0..* | Identifier | Business identifier | |
basedOn | 0..* | Reference(ReferralRequest | CarePlan | DiagnosticRequest | ProcedureRequest) | Request fulfilled by this request | |
parent | Σ | 0..1 | Identifier | Composite request this is part of |
status | ?!Σ | 1..1 | code | draft | active | cancelled | completed | entered-in-error ReferralStatus (Required) |
category | ?!Σ | 1..1 | code | proposal | plan | request ReferralCategory (Required) |
type | Σ | 0..1 | CodeableConcept | Referral/Transition of care request type |
priority | Σ | 0..1 | CodeableConcept | Urgency of referral / transfer of care request RequestPriority (Example) |
patient | Σ | 0..1 | Reference(Patient) | Patient referred to care or transfer |
context | 0..1 | Reference(Encounter | EpisodeOfCare) | Originating encounter | |
fulfillmentTime | Σ | 0..1 | Period | Requested service(s) fulfillment time |
authored | Σ | 0..1 | dateTime | Date of creation/activation |
requester | Σ | 0..1 | Reference(Practitioner | Organization | Patient) | Requester of referral / transfer of care |
specialty | 0..1 | CodeableConcept | The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty (Example) | |
recipient | Σ | 0..* | Reference(Practitioner | Organization) | Receiver of referral / transfer of care request |
reason | Σ | 0..1 | CodeableConcept | Reason for referral / transfer of care request |
description | 0..1 | string | A textual description of the referral | |
serviceRequested | Σ | 0..* | CodeableConcept | Actions requested as part of the referral Practice Setting Code Value Set (Example) |
supportingInformation | Σ | 0..* | Reference(Any) | Additonal information to support referral or transfer of care request |
Documentation for this format |
XML Template
<ReferralRequest xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Business identifier --></identifier> <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|DiagnosticRequest| ProcedureRequest) Request fulfilled by this request --></basedOn> <parent><!-- 0..1 Identifier Composite request this is part of --></parent> <status value="[code]"/><!-- 1..1 draft | active | cancelled | completed | entered-in-error --> <category value="[code]"/><!-- 1..1 proposal | plan | request --> <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type> <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority> <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient> <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context> <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime> <authored value="[dateTime]"/><!-- 0..1 Date of creation/activation --> <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) Requester of referral / transfer of care --></requester> <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty> <recipient><!-- 0..* Reference(Practitioner|Organization) Receiver of referral / transfer of care request --></recipient> <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 Actions requested as part of the referral --></serviceRequested> <supportingInformation><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInformation> </ReferralRequest>
JSON Template
{ "resourceType" : "ReferralRequest", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // Business identifier "basedOn" : [{ Reference(ReferralRequest|CarePlan|DiagnosticRequest| ProcedureRequest) }], // Request fulfilled by this request "parent" : { Identifier }, // Composite request this is part of "status" : "<code>", // R! draft | active | cancelled | completed | entered-in-error "category" : "<code>", // R! proposal | plan | request "type" : { CodeableConcept }, // Referral/Transition of care request type "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request "patient" : { Reference(Patient) }, // Patient referred to care or transfer "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter "fulfillmentTime" : { Period }, // Requested service(s) fulfillment time "authored" : "<dateTime>", // Date of creation/activation "requester" : { Reference(Practitioner|Organization|Patient) }, // Requester of referral / transfer of care "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for "recipient" : [{ Reference(Practitioner|Organization) }], // Receiver of referral / transfer of care request "reason" : { CodeableConcept }, // Reason for referral / transfer of care request "description" : "<string>", // A textual description of the referral "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral "supportingInformation" : [{ Reference(Any) }] // Additonal information to support referral or transfer of care request }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:ReferralRequest; fhir:nodeRole fhir:treeRoot; # if this is the parser root # from Resource: .id, .meta, .implicitRules, and .language # from DomainResource: .text, .contained, .extension, and .modifierExtension fhir:ReferralRequest.identifier [ Identifier ], ... ; # 0..* Business identifier fhir:ReferralRequest.basedOn [ Reference(ReferralRequest|CarePlan|DiagnosticRequest|ProcedureRequest) ], ... ; # 0..* Request fulfilled by this request fhir:ReferralRequest.parent [ Identifier ]; # 0..1 Composite request this is part of fhir:ReferralRequest.status [ code ]; # 1..1 draft | active | cancelled | completed | entered-in-error fhir:ReferralRequest.category [ code ]; # 1..1 proposal | plan | request fhir:ReferralRequest.type [ CodeableConcept ]; # 0..1 Referral/Transition of care request type fhir:ReferralRequest.priority [ CodeableConcept ]; # 0..1 Urgency of referral / transfer of care request fhir:ReferralRequest.patient [ Reference(Patient) ]; # 0..1 Patient referred to care or transfer fhir:ReferralRequest.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating encounter fhir:ReferralRequest.fulfillmentTime [ Period ]; # 0..1 Requested service(s) fulfillment time fhir:ReferralRequest.authored [ dateTime ]; # 0..1 Date of creation/activation fhir:ReferralRequest.requester [ Reference(Practitioner|Organization|Patient) ]; # 0..1 Requester of referral / transfer of care fhir:ReferralRequest.specialty [ CodeableConcept ]; # 0..1 The clinical specialty (discipline) that the referral is requested for fhir:ReferralRequest.recipient [ Reference(Practitioner|Organization) ], ... ; # 0..* Receiver of referral / transfer of care request fhir:ReferralRequest.reason [ CodeableConcept ]; # 0..1 Reason for referral / transfer of care request fhir:ReferralRequest.description [ string ]; # 0..1 A textual description of the referral fhir:ReferralRequest.serviceRequested [ CodeableConcept ], ... ; # 0..* Actions requested as part of the referral fhir:ReferralRequest.supportingInformation [ Reference(Any) ], ... ; # 0..* Additonal information to support referral or transfer of care request ]
Changes since DSTU2
ReferralRequest | |
ReferralRequest.basedOn | added |
ReferralRequest.parent | added |
ReferralRequest.category | added |
ReferralRequest.context |
Renamed from encounter to context Add Reference(EpisodeOfCare) |
ReferralRequest.authored | Renamed from date to authored |
ReferralRequest.dateSent | deleted |
See the Full Difference for further information
Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)
Path | Definition | Type | Reference |
---|---|---|---|
ReferralRequest.status | The status of the referral. | Required | ReferralStatus |
ReferralRequest.category | Identifies the degree of intention/authorization associated with the request | Required | ReferralCategory |
ReferralRequest.type | Codes for types of referral; e.g. consult, transfer, temporary transfer. | Unknown | No details provided yet |
ReferralRequest.priority | Codes indicating the relative priority of the referral. | Example | RequestPriority |
ReferralRequest.specialty | Codes indicating the types of capability the referred to service provider must have. | Example | PractitionerSpecialty |
ReferralRequest.reason | Codes indicating why the referral is being requested. | Unknown | No details provided yet |
ReferralRequest.serviceRequested | Codes indicating the types of services that might be requested as part of a referral. | Example | Practice Setting Code Value Set |
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
Name | Type | Description | Paths |
basedon | reference | Request being fulfilled | ReferralRequest.basedOn (ReferralRequest, CarePlan, ProcedureRequest, DiagnosticRequest) |
category | token | Proposal, plan or request | ReferralRequest.category |
context | reference | Part of encounter or episode of care | ReferralRequest.context (EpisodeOfCare, Encounter) |
date | date | Creation or activation date | ReferralRequest.authored |
parent | token | Part of common request | ReferralRequest.parent |
patient | reference | Who the referral is about | ReferralRequest.patient (Patient) |
priority | token | The priority assigned to the referral | ReferralRequest.priority |
recipient | reference | The person that the referral was sent to | ReferralRequest.recipient (Practitioner, Organization) |
requester | reference | Requester of referral / transfer of care | ReferralRequest.requester (Practitioner, Organization, Patient) |
specialty | token | The specialty that the referral is for | ReferralRequest.specialty |
status | token | The status of the referral | ReferralRequest.status |
type | token | The type of the referral | ReferralRequest.type |