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8.15 Resource Encounter - Content

Patient Administration

Work Group

Maturity Level: 1

Compartments: Encounter, Patient, Practitioner, RelatedPerson

An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.

8.15.1 Scope and Usage

A patient encounter is further characterized by the setting in which it takes place. Amongst them are ambulatory, emergency, home health, inpatient and virtual encounters. An Encounter encompasses the lifecycle from pre-admission, the actual encounter (for ambulatory encounters), and admission, stay and discharge (for inpatient encounters). During the encounter the patient may move from practitioner to practitioner and location to location.

Because of the broad scope of Encounter, not all elements will be relevant in all settings. For this reason, admission/discharge related information is kept in a separate Hospitalization component within Encounter. The class element is used to distinguish between these settings, which will guide further validation and application of business rules.

There is also substantial variance from organization to organization (and between jurisdictions and countries) on which business events translate to the start of a new Encounter, or what level of aggregation is used for Encounter. For example, each single visit of a practitioner during a hospitalization may lead to a new instance of Encounter, but depending on local practice and the systems involved, it may well be that this is aggregated to a single instance for a whole hospitalization. Even more aggregation may occur where jurisdictions introduce groups of Encounters for financial or other reasons. Encounters can be aggregated or grouped under other Encounters using the partOf element. See below for examples.

Encounter instances may exist before the actual encounter takes place to convey pre-admission information, including using Encounters elements to reflect the planned start date or planned encounter locations. In this case the status element is set to 'planned'.

The Hospitalization component is intended to store the extended information relating to a hospitalization event. This is always expected to be the same period as the encounter itself, where this is different then another encounter is entered which captures this information which is a partOf this encounter instance.

The Procedure and encounter have references to each other, and these should be to different procedures; one for the procedure that was performed during the encounter (stored in Prodecure.encounter), and another for cases where an encounter is a result of another procedure (stored in Encounter.indication) such as a followup encounter to resolve complications from an earlier procedure.

8.15.1.1 Status Management

During the life-cycle of an encounter it will pass through many statuses. Typically these are in order or the organizations workflow: planned, in-progress, finished/cancelled.
This status information is often used for other things, and often an analysis of the status history is required. This could be done by scanning through all the versions of the encounter and then checking the period of each, and doing some form of post processing. To ease the burden of this (or where a system doesn't support resource histories) a status history component is included.

There is no direct indication purely by the status field as to if an encounter is considered "admitted".
The context of the encounter and business practices/policies/workflows/types can influence this definition. (e.g., acute care facility, aged care center, outpatient clinic, emergency department, community based clinic).
Statuses of "arrived" or "in progress" could be considered the start of the admission, and also have the presence of the hospitalization sub-component entered.

The "on leave" status may or may not be a part of the admission, for example if the patient was permitted to go home for a weekend or some other form of external event.
The location is also likely to be filled in with a location status of "present".
For other examples such as an outpatient visit (Day Procedure - colonoscopy), the patient could also be considered to be admitted, hence the encounter doesn't have a fixed definition of admitted. At a minimum, we do believe that a patient IS admitted when the status is in-progress.

8.15.2 Boundaries and Relationships

The Encounter resource is not to be used to store appointment information, the Appointment resource is intended to be used for that. Note that in many systems outpatient encounters (which are in scope for Encounter) and Appointment are used concurrently. In FHIR, Appointment is used for establishing a date for the encounter, while Encounter is applicable to information about the actual Encounter, i.e. the patient showing up.
As such an encounter in the "planned" status is not identical to the appointment that scheduled it, but it is the encounter prior to its actual occurrence, with the expectation that encounter will be updated as it progresses to completion. Patient arrival at a location does not necessarily mean the start of the encounter (e.g. a patient arrives an hour earlier than he is actually seen by a practitioner).

An appointment is normally used for the planning stage of an appointment, searching, locating an available time, then making the appointment. Once this process is completed and the appointment is about to start, then the appointment will be marked as fulfilled, and linked to the newly created encounter.
This new encounter may start in an "arrived" status when they are admitted with a location of the facility, and then will move to the ward where another part-of encounter may begin.

Communication resources are used for a direct simultaneous interaction between a practitioner and a patient where there is no direct contact. Such as phone message, or transmission of some correspondence documentation.
There is no duration recorded for a communication resource, but could contain sent and received times.

Standard Extension: Associated Encounter
This extension should be used to reference an encounter where there is no property that already defines this association on the resource.

This resource is referenced by CarePlan, ClinicalImpression, Communication, CommunicationRequest, Composition, Condition, DeviceUseRequest, DiagnosticReport, DiagnosticRequest, DocumentReference, Flag, GuidanceResponse, ImagingStudy, Immunization, List, MedicationAdministration, MedicationRequest, NutritionRequest, Observation, Procedure, ProcedureRequest, QuestionnaireResponse, ReferralRequest, RequestGroup, RiskAssessment, Task and VisionPrescription

Structure

Name	Flags	Card.	Type	Description & Constraints
Encounter			DomainResource	An interaction during which services are provided to the patient
identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!Σ	1..1	code	planned \| arrived \| in-progress \| onleave \| finished \| cancelled \| entered-in-error EncounterStatus (Required)
statusHistory		0..*	BackboneElement	List of past encounter statuses
status		1..1	code	planned \| arrived \| in-progress \| onleave \| finished \| cancelled \| entered-in-error EncounterStatus (Required)
period		1..1	Period	The time that the episode was in the specified status
class	Σ	0..1	Coding	inpatient \| outpatient \| ambulatory \| emergency + ActEncounterCode (Extensible)
type	Σ	0..*	CodeableConcept	Specific type of encounter EncounterType (Example)
priority		0..1	CodeableConcept	Indicates the urgency of the encounter v3 Code System ActPriority (Example)
patient	Σ	0..1	Reference(Patient)	The patient present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
incomingReferral		0..*	Reference(ReferralRequest)	The ReferralRequest that initiated this encounter
participant	Σ	0..*	BackboneElement	List of participants involved in the encounter
type	Σ	0..*	CodeableConcept	Role of participant in encounter ParticipantType (Extensible)
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner \| RelatedPerson)	Persons involved in the encounter other than the patient
appointment	Σ	0..1	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reason	Σ	0..*	CodeableConcept	Reason the encounter takes place (code) Encounter Reason Codes (Example)
indication		0..*	Reference(Condition \| Procedure)	Reason the encounter takes place (resource)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization		0..1	BackboneElement	Details about the admission to a healthcare service
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location)	The location from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) AdmitSource (Preferred)
admittingDiagnosis		0..*	Reference(Condition)	The admitting diagnosis as reported by admitting practitioner
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission v2 Re-Admission Indicator (Example)
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Diet (Example)
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) SpecialCourtesy (Preferred)
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. SpecialArrangements (Preferred)
destination		0..1	Reference(Location)	Location to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge DischargeDisposition (Example)
dischargeDiagnosis		0..*	Reference(Condition)	The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
location		0..*	BackboneElement	List of locations where the patient has been
location		1..1	Reference(Location)	Location the encounter takes place
status		0..1	code	planned \| active \| reserved \| completed EncounterLocationStatus (Required)
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization)	The custodian organization of this Encounter record
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

UML Diagram (Legend)

XML Template

<Encounter xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known --></identifier>
 <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error -->
 <statusHistory>  <!-- 0..* List of past encounter statuses -->
  <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error -->
  <period><!-- 1..1 Period The time that the episode was in the specified status --></period>
 </statusHistory>
 <class><!-- 0..1 Coding inpatient | outpatient | ambulatory | emergency + --></class>
 <type><!-- 0..* CodeableConcept Specific type of encounter --></type>
 <priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter --></priority>
 <patient><!-- 0..1 Reference(Patient) The patient present at the encounter --></patient>
 <episodeOfCare><!-- 0..* Reference(EpisodeOfCare) Episode(s) of care that this encounter should be recorded against --></episodeOfCare>
 <incomingReferral><!-- 0..* Reference(ReferralRequest) The ReferralRequest that initiated this encounter --></incomingReferral>
 <participant>  <!-- 0..* List of participants involved in the encounter -->
  <type><!-- 0..* CodeableConcept Role of participant in encounter --></type>
  <period><!-- 0..1 Period Period of time during the encounter that the participant participated --></period>
  <individual><!-- 0..1 Reference(Practitioner|RelatedPerson) Persons involved in the encounter other than the patient --></individual>
 </participant>
 <appointment><!-- 0..1 Reference(Appointment) The appointment that scheduled this encounter --></appointment>
 <period><!-- 0..1 Period The start and end time of the encounter --></period>
 <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length>
 <reason><!-- 0..* CodeableConcept Reason the encounter takes place (code) --></reason>
 <indication><!-- 0..* Reference(Condition|Procedure) Reason the encounter takes place (resource) --></indication>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account>
 <hospitalization>  <!-- 0..1 Details about the admission to a healthcare service -->
  <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier>
  <origin><!-- 0..1 Reference(Location) The location from which the patient came before admission --></origin>
  <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource>
  <admittingDiagnosis><!-- 0..* Reference(Condition) The admitting diagnosis as reported by admitting practitioner --></admittingDiagnosis>
  <reAdmission><!-- 0..1 CodeableConcept The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission --></reAdmission>
  <dietPreference><!-- 0..* CodeableConcept Diet preferences reported by the patient --></dietPreference>
  <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy>
  <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc. --></specialArrangement>
  <destination><!-- 0..1 Reference(Location) Location to which the patient is discharged --></destination>
  <dischargeDisposition><!-- 0..1 CodeableConcept Category or kind of location after discharge --></dischargeDisposition>
  <dischargeDiagnosis><!-- 0..* Reference(Condition) The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete --></dischargeDiagnosis>
 </hospitalization>
 <location>  <!-- 0..* List of locations where the patient has been -->
  <location><!-- 1..1 Reference(Location) Location the encounter takes place --></location>
  <status value="[code]"/><!-- 0..1 planned | active | reserved | completed -->
  <period><!-- 0..1 Period Time period during which the patient was present at the location --></period>
 </location>
 <serviceProvider><!-- 0..1 Reference(Organization) The custodian organization of this Encounter record --></serviceProvider>
 <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf>
</Encounter>

JSON Template

{
  "resourceType" : "Encounter",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
  "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
  "statusHistory" : [{ // List of past encounter statuses
    "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
    "period" : { Period } // R!  The time that the episode was in the specified status
  }],
  "class" : { Coding }, // inpatient | outpatient | ambulatory | emergency +
  "type" : [{ CodeableConcept }], // Specific type of encounter
  "priority" : { CodeableConcept }, // Indicates the urgency of the encounter
  "patient" : { Reference(Patient) }, // The patient present at the encounter
  "episodeOfCare" : [{ Reference(EpisodeOfCare) }], // Episode(s) of care that this encounter should be recorded against
  "incomingReferral" : [{ Reference(ReferralRequest) }], // The ReferralRequest that initiated this encounter
  "participant" : [{ // List of participants involved in the encounter
    "type" : [{ CodeableConcept }], // Role of participant in encounter
    "period" : { Period }, // Period of time during the encounter that the participant participated
    "individual" : { Reference(Practitioner|RelatedPerson) } // Persons involved in the encounter other than the patient
  }],
  "appointment" : { Reference(Appointment) }, // The appointment that scheduled this encounter
  "period" : { Period }, // The start and end time of the encounter
  "length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
  "reason" : [{ CodeableConcept }], // Reason the encounter takes place (code)
  "indication" : [{ Reference(Condition|Procedure) }], // Reason the encounter takes place (resource)
  "account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
  "hospitalization" : { // Details about the admission to a healthcare service
    "preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
    "origin" : { Reference(Location) }, // The location from which the patient came before admission
    "admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
    "admittingDiagnosis" : [{ Reference(Condition) }], // The admitting diagnosis as reported by admitting practitioner
    "reAdmission" : { CodeableConcept }, // The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
    "dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
    "specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
    "specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc.
    "destination" : { Reference(Location) }, // Location to which the patient is discharged
    "dischargeDisposition" : { CodeableConcept }, // Category or kind of location after discharge
    "dischargeDiagnosis" : [{ Reference(Condition) }] // The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
  },
  "location" : [{ // List of locations where the patient has been
    "location" : { Reference(Location) }, // R!  Location the encounter takes place
    "status" : "<code>", // planned | active | reserved | completed
    "period" : { Period } // Time period during which the patient was present at the location
  }],
  "serviceProvider" : { Reference(Organization) }, // The custodian organization of this Encounter record
  "partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Encounter;
  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:Encounter.identifier [ Identifier ], ... ; # 0..* Identifier(s) by which this encounter is known
  fhir:Encounter.status [ code ]; # 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
  fhir:Encounter.statusHistory [ # 0..* List of past encounter statuses
    fhir:Encounter.statusHistory.status [ code ]; # 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
    fhir:Encounter.statusHistory.period [ Period ]; # 1..1 The time that the episode was in the specified status
  ], ...;
  fhir:Encounter.class [ Coding ]; # 0..1 inpatient | outpatient | ambulatory | emergency +
  fhir:Encounter.type [ CodeableConcept ], ... ; # 0..* Specific type of encounter
  fhir:Encounter.priority [ CodeableConcept ]; # 0..1 Indicates the urgency of the encounter
  fhir:Encounter.patient [ Reference(Patient) ]; # 0..1 The patient present at the encounter
  fhir:Encounter.episodeOfCare [ Reference(EpisodeOfCare) ], ... ; # 0..* Episode(s) of care that this encounter should be recorded against
  fhir:Encounter.incomingReferral [ Reference(ReferralRequest) ], ... ; # 0..* The ReferralRequest that initiated this encounter
  fhir:Encounter.participant [ # 0..* List of participants involved in the encounter
    fhir:Encounter.participant.type [ CodeableConcept ], ... ; # 0..* Role of participant in encounter
    fhir:Encounter.participant.period [ Period ]; # 0..1 Period of time during the encounter that the participant participated
    fhir:Encounter.participant.individual [ Reference(Practitioner|RelatedPerson) ]; # 0..1 Persons involved in the encounter other than the patient
  ], ...;
  fhir:Encounter.appointment [ Reference(Appointment) ]; # 0..1 The appointment that scheduled this encounter
  fhir:Encounter.period [ Period ]; # 0..1 The start and end time of the encounter
  fhir:Encounter.length [ Duration ]; # 0..1 Quantity of time the encounter lasted (less time absent)
  fhir:Encounter.reason [ CodeableConcept ], ... ; # 0..* Reason the encounter takes place (code)
  fhir:Encounter.indication [ Reference(Condition|Procedure) ], ... ; # 0..* Reason the encounter takes place (resource)
  fhir:Encounter.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this Encounter
  fhir:Encounter.hospitalization [ # 0..1 Details about the admission to a healthcare service
    fhir:Encounter.hospitalization.preAdmissionIdentifier [ Identifier ]; # 0..1 Pre-admission identifier
    fhir:Encounter.hospitalization.origin [ Reference(Location) ]; # 0..1 The location from which the patient came before admission
    fhir:Encounter.hospitalization.admitSource [ CodeableConcept ]; # 0..1 From where patient was admitted (physician referral, transfer)
    fhir:Encounter.hospitalization.admittingDiagnosis [ Reference(Condition) ], ... ; # 0..* The admitting diagnosis as reported by admitting practitioner
    fhir:Encounter.hospitalization.reAdmission [ CodeableConcept ]; # 0..1 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
    fhir:Encounter.hospitalization.dietPreference [ CodeableConcept ], ... ; # 0..* Diet preferences reported by the patient
    fhir:Encounter.hospitalization.specialCourtesy [ CodeableConcept ], ... ; # 0..* Special courtesies (VIP, board member)
    fhir:Encounter.hospitalization.specialArrangement [ CodeableConcept ], ... ; # 0..* Wheelchair, translator, stretcher, etc.
    fhir:Encounter.hospitalization.destination [ Reference(Location) ]; # 0..1 Location to which the patient is discharged
    fhir:Encounter.hospitalization.dischargeDisposition [ CodeableConcept ]; # 0..1 Category or kind of location after discharge
    fhir:Encounter.hospitalization.dischargeDiagnosis [ Reference(Condition) ], ... ; # 0..* The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
  ];
  fhir:Encounter.location [ # 0..* List of locations where the patient has been
    fhir:Encounter.location.location [ Reference(Location) ]; # 1..1 Location the encounter takes place
    fhir:Encounter.location.status [ code ]; # 0..1 planned | active | reserved | completed
    fhir:Encounter.location.period [ Period ]; # 0..1 Time period during which the patient was present at the location
  ], ...;
  fhir:Encounter.serviceProvider [ Reference(Organization) ]; # 0..1 The custodian organization of this Encounter record
  fhir:Encounter.partOf [ Reference(Encounter) ]; # 0..1 Another Encounter this encounter is part of
]

Changes since DSTU2

Encounter

Encounter.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-state to http://hl7.org/fhir/ValueSet/encounter-status

Encounter.statusHistory.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-state to http://hl7.org/fhir/ValueSet/encounter-status

Encounter.class

Type changed from code to Coding
Change binding strength from required to extensible, Change value set from http://hl7.org/fhir/ValueSet/encounter-class to http://hl7.org/fhir/ValueSet/v3-ActEncounterCode

Encounter.length

Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Duration} to Duration

Encounter.account

added Element

See the Full Difference for further information

Structure

Name	Flags	Card.	Type	Description & Constraints
Encounter			DomainResource	An interaction during which services are provided to the patient
identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!Σ	1..1	code	planned \| arrived \| in-progress \| onleave \| finished \| cancelled \| entered-in-error EncounterStatus (Required)
statusHistory		0..*	BackboneElement	List of past encounter statuses
status		1..1	code	planned \| arrived \| in-progress \| onleave \| finished \| cancelled \| entered-in-error EncounterStatus (Required)
period		1..1	Period	The time that the episode was in the specified status
class	Σ	0..1	Coding	inpatient \| outpatient \| ambulatory \| emergency + ActEncounterCode (Extensible)
type	Σ	0..*	CodeableConcept	Specific type of encounter EncounterType (Example)
priority		0..1	CodeableConcept	Indicates the urgency of the encounter v3 Code System ActPriority (Example)
patient	Σ	0..1	Reference(Patient)	The patient present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
incomingReferral		0..*	Reference(ReferralRequest)	The ReferralRequest that initiated this encounter
participant	Σ	0..*	BackboneElement	List of participants involved in the encounter
type	Σ	0..*	CodeableConcept	Role of participant in encounter ParticipantType (Extensible)
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner \| RelatedPerson)	Persons involved in the encounter other than the patient
appointment	Σ	0..1	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reason	Σ	0..*	CodeableConcept	Reason the encounter takes place (code) Encounter Reason Codes (Example)
indication		0..*	Reference(Condition \| Procedure)	Reason the encounter takes place (resource)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization		0..1	BackboneElement	Details about the admission to a healthcare service
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location)	The location from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) AdmitSource (Preferred)
admittingDiagnosis		0..*	Reference(Condition)	The admitting diagnosis as reported by admitting practitioner
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission v2 Re-Admission Indicator (Example)
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Diet (Example)
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) SpecialCourtesy (Preferred)
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. SpecialArrangements (Preferred)
destination		0..1	Reference(Location)	Location to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge DischargeDisposition (Example)
dischargeDiagnosis		0..*	Reference(Condition)	The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
location		0..*	BackboneElement	List of locations where the patient has been
location		1..1	Reference(Location)	Location the encounter takes place
status		0..1	code	planned \| active \| reserved \| completed EncounterLocationStatus (Required)
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization)	The custodian organization of this Encounter record
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

UML Diagram (Legend)

XML Template

<Encounter xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known --></identifier>
 <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error -->
 <statusHistory>  <!-- 0..* List of past encounter statuses -->
  <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error -->
  <period><!-- 1..1 Period The time that the episode was in the specified status --></period>
 </statusHistory>
 <class><!-- 0..1 Coding inpatient | outpatient | ambulatory | emergency + --></class>
 <type><!-- 0..* CodeableConcept Specific type of encounter --></type>
 <priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter --></priority>
 <patient><!-- 0..1 Reference(Patient) The patient present at the encounter --></patient>
 <episodeOfCare><!-- 0..* Reference(EpisodeOfCare) Episode(s) of care that this encounter should be recorded against --></episodeOfCare>
 <incomingReferral><!-- 0..* Reference(ReferralRequest) The ReferralRequest that initiated this encounter --></incomingReferral>
 <participant>  <!-- 0..* List of participants involved in the encounter -->
  <type><!-- 0..* CodeableConcept Role of participant in encounter --></type>
  <period><!-- 0..1 Period Period of time during the encounter that the participant participated --></period>
  <individual><!-- 0..1 Reference(Practitioner|RelatedPerson) Persons involved in the encounter other than the patient --></individual>
 </participant>
 <appointment><!-- 0..1 Reference(Appointment) The appointment that scheduled this encounter --></appointment>
 <period><!-- 0..1 Period The start and end time of the encounter --></period>
 <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length>
 <reason><!-- 0..* CodeableConcept Reason the encounter takes place (code) --></reason>
 <indication><!-- 0..* Reference(Condition|Procedure) Reason the encounter takes place (resource) --></indication>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account>
 <hospitalization>  <!-- 0..1 Details about the admission to a healthcare service -->
  <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier>
  <origin><!-- 0..1 Reference(Location) The location from which the patient came before admission --></origin>
  <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource>
  <admittingDiagnosis><!-- 0..* Reference(Condition) The admitting diagnosis as reported by admitting practitioner --></admittingDiagnosis>
  <reAdmission><!-- 0..1 CodeableConcept The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission --></reAdmission>
  <dietPreference><!-- 0..* CodeableConcept Diet preferences reported by the patient --></dietPreference>
  <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy>
  <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc. --></specialArrangement>
  <destination><!-- 0..1 Reference(Location) Location to which the patient is discharged --></destination>
  <dischargeDisposition><!-- 0..1 CodeableConcept Category or kind of location after discharge --></dischargeDisposition>
  <dischargeDiagnosis><!-- 0..* Reference(Condition) The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete --></dischargeDiagnosis>
 </hospitalization>
 <location>  <!-- 0..* List of locations where the patient has been -->
  <location><!-- 1..1 Reference(Location) Location the encounter takes place --></location>
  <status value="[code]"/><!-- 0..1 planned | active | reserved | completed -->
  <period><!-- 0..1 Period Time period during which the patient was present at the location --></period>
 </location>
 <serviceProvider><!-- 0..1 Reference(Organization) The custodian organization of this Encounter record --></serviceProvider>
 <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf>
</Encounter>

JSON Template

{
  "resourceType" : "Encounter",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
  "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
  "statusHistory" : [{ // List of past encounter statuses
    "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
    "period" : { Period } // R!  The time that the episode was in the specified status
  }],
  "class" : { Coding }, // inpatient | outpatient | ambulatory | emergency +
  "type" : [{ CodeableConcept }], // Specific type of encounter
  "priority" : { CodeableConcept }, // Indicates the urgency of the encounter
  "patient" : { Reference(Patient) }, // The patient present at the encounter
  "episodeOfCare" : [{ Reference(EpisodeOfCare) }], // Episode(s) of care that this encounter should be recorded against
  "incomingReferral" : [{ Reference(ReferralRequest) }], // The ReferralRequest that initiated this encounter
  "participant" : [{ // List of participants involved in the encounter
    "type" : [{ CodeableConcept }], // Role of participant in encounter
    "period" : { Period }, // Period of time during the encounter that the participant participated
    "individual" : { Reference(Practitioner|RelatedPerson) } // Persons involved in the encounter other than the patient
  }],
  "appointment" : { Reference(Appointment) }, // The appointment that scheduled this encounter
  "period" : { Period }, // The start and end time of the encounter
  "length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
  "reason" : [{ CodeableConcept }], // Reason the encounter takes place (code)
  "indication" : [{ Reference(Condition|Procedure) }], // Reason the encounter takes place (resource)
  "account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
  "hospitalization" : { // Details about the admission to a healthcare service
    "preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
    "origin" : { Reference(Location) }, // The location from which the patient came before admission
    "admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
    "admittingDiagnosis" : [{ Reference(Condition) }], // The admitting diagnosis as reported by admitting practitioner
    "reAdmission" : { CodeableConcept }, // The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
    "dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
    "specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
    "specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc.
    "destination" : { Reference(Location) }, // Location to which the patient is discharged
    "dischargeDisposition" : { CodeableConcept }, // Category or kind of location after discharge
    "dischargeDiagnosis" : [{ Reference(Condition) }] // The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
  },
  "location" : [{ // List of locations where the patient has been
    "location" : { Reference(Location) }, // R!  Location the encounter takes place
    "status" : "<code>", // planned | active | reserved | completed
    "period" : { Period } // Time period during which the patient was present at the location
  }],
  "serviceProvider" : { Reference(Organization) }, // The custodian organization of this Encounter record
  "partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Encounter;
  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:Encounter.identifier [ Identifier ], ... ; # 0..* Identifier(s) by which this encounter is known
  fhir:Encounter.status [ code ]; # 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
  fhir:Encounter.statusHistory [ # 0..* List of past encounter statuses
    fhir:Encounter.statusHistory.status [ code ]; # 1..1 planned | arrived | in-progress | onleave | finished | cancelled | entered-in-error
    fhir:Encounter.statusHistory.period [ Period ]; # 1..1 The time that the episode was in the specified status
  ], ...;
  fhir:Encounter.class [ Coding ]; # 0..1 inpatient | outpatient | ambulatory | emergency +
  fhir:Encounter.type [ CodeableConcept ], ... ; # 0..* Specific type of encounter
  fhir:Encounter.priority [ CodeableConcept ]; # 0..1 Indicates the urgency of the encounter
  fhir:Encounter.patient [ Reference(Patient) ]; # 0..1 The patient present at the encounter
  fhir:Encounter.episodeOfCare [ Reference(EpisodeOfCare) ], ... ; # 0..* Episode(s) of care that this encounter should be recorded against
  fhir:Encounter.incomingReferral [ Reference(ReferralRequest) ], ... ; # 0..* The ReferralRequest that initiated this encounter
  fhir:Encounter.participant [ # 0..* List of participants involved in the encounter
    fhir:Encounter.participant.type [ CodeableConcept ], ... ; # 0..* Role of participant in encounter
    fhir:Encounter.participant.period [ Period ]; # 0..1 Period of time during the encounter that the participant participated
    fhir:Encounter.participant.individual [ Reference(Practitioner|RelatedPerson) ]; # 0..1 Persons involved in the encounter other than the patient
  ], ...;
  fhir:Encounter.appointment [ Reference(Appointment) ]; # 0..1 The appointment that scheduled this encounter
  fhir:Encounter.period [ Period ]; # 0..1 The start and end time of the encounter
  fhir:Encounter.length [ Duration ]; # 0..1 Quantity of time the encounter lasted (less time absent)
  fhir:Encounter.reason [ CodeableConcept ], ... ; # 0..* Reason the encounter takes place (code)
  fhir:Encounter.indication [ Reference(Condition|Procedure) ], ... ; # 0..* Reason the encounter takes place (resource)
  fhir:Encounter.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this Encounter
  fhir:Encounter.hospitalization [ # 0..1 Details about the admission to a healthcare service
    fhir:Encounter.hospitalization.preAdmissionIdentifier [ Identifier ]; # 0..1 Pre-admission identifier
    fhir:Encounter.hospitalization.origin [ Reference(Location) ]; # 0..1 The location from which the patient came before admission
    fhir:Encounter.hospitalization.admitSource [ CodeableConcept ]; # 0..1 From where patient was admitted (physician referral, transfer)
    fhir:Encounter.hospitalization.admittingDiagnosis [ Reference(Condition) ], ... ; # 0..* The admitting diagnosis as reported by admitting practitioner
    fhir:Encounter.hospitalization.reAdmission [ CodeableConcept ]; # 0..1 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
    fhir:Encounter.hospitalization.dietPreference [ CodeableConcept ], ... ; # 0..* Diet preferences reported by the patient
    fhir:Encounter.hospitalization.specialCourtesy [ CodeableConcept ], ... ; # 0..* Special courtesies (VIP, board member)
    fhir:Encounter.hospitalization.specialArrangement [ CodeableConcept ], ... ; # 0..* Wheelchair, translator, stretcher, etc.
    fhir:Encounter.hospitalization.destination [ Reference(Location) ]; # 0..1 Location to which the patient is discharged
    fhir:Encounter.hospitalization.dischargeDisposition [ CodeableConcept ]; # 0..1 Category or kind of location after discharge
    fhir:Encounter.hospitalization.dischargeDiagnosis [ Reference(Condition) ], ... ; # 0..* The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
  ];
  fhir:Encounter.location [ # 0..* List of locations where the patient has been
    fhir:Encounter.location.location [ Reference(Location) ]; # 1..1 Location the encounter takes place
    fhir:Encounter.location.status [ code ]; # 0..1 planned | active | reserved | completed
    fhir:Encounter.location.period [ Period ]; # 0..1 Time period during which the patient was present at the location
  ], ...;
  fhir:Encounter.serviceProvider [ Reference(Organization) ]; # 0..1 The custodian organization of this Encounter record
  fhir:Encounter.partOf [ Reference(Encounter) ]; # 0..1 Another Encounter this encounter is part of
]

Changes since DSTU2

Encounter

Encounter.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-state to http://hl7.org/fhir/ValueSet/encounter-status

Encounter.statusHistory.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-state to http://hl7.org/fhir/ValueSet/encounter-status

Encounter.class

Encounter.length

Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Duration} to Duration

Encounter.account

added Element

See the Full Difference for further information

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle), JSON-LD (for RDF as JSON-LD),

8.15.3.1 Terminology Bindings

Path	Definition	Type	Reference
Encounter.status Encounter.statusHistory.status	Current state of the encounter	Required	EncounterStatus
Encounter.class	Classification of the encounter	Extensible	ActEncounterCode
Encounter.type	The type of encounter	Example	EncounterType
Encounter.priority	Indicates the urgency of the encounter.	Example	v3 Code System ActPriority
Encounter.participant.type	Role of participant in encounter	Extensible	ParticipantType
Encounter.reason	Reason why the encounter takes place.	Example	Encounter Reason Codes
Encounter.hospitalization.admitSource	From where the patient was admitted.	Preferred	AdmitSource
Encounter.hospitalization.reAdmission	The reason for re-admission of this hospitalization encounter.	Example	v2 Re-Admission Indicator
Encounter.hospitalization.dietPreference	Medical, cultural or ethical food preferences to help with catering requirements.	Example	Diet
Encounter.hospitalization.specialCourtesy	Special courtesies	Preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	Special arrangements	Preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	Discharge Disposition	Example	DischargeDisposition
Encounter.location.status	The status of the location.	Required	EncounterLocationStatus

Path

Definition

Type

Reference

Encounter.status
Encounter.statusHistory.status

Current state of the encounter

Required

EncounterStatus

Encounter.class

Classification of the encounter

Extensible

ActEncounterCode

Encounter.type

The type of encounter

Example

EncounterType

Encounter.priority

Indicates the urgency of the encounter.

Example

v3 Code System ActPriority

Encounter.participant.type

Role of participant in encounter

Extensible

ParticipantType

Encounter.reason

Reason why the encounter takes place.

Example

Encounter Reason Codes

Encounter.hospitalization.admitSource

From where the patient was admitted.

Preferred

AdmitSource

Encounter.hospitalization.reAdmission

The reason for re-admission of this hospitalization encounter.

Example

v2 Re-Admission Indicator

Encounter.hospitalization.dietPreference

Medical, cultural or ethical food preferences to help with catering requirements.

Example

Diet

Encounter.hospitalization.specialCourtesy

Special courtesies

Preferred

SpecialCourtesy

Encounter.hospitalization.specialArrangement

Special arrangements

Preferred

SpecialArrangements

Encounter.hospitalization.dischargeDisposition

Discharge Disposition

Example

DischargeDisposition

Encounter.location.status

The status of the location.

Required

EncounterLocationStatus

8.15.4 Notes

The class element describes the setting (in/outpatient etc.) in which the Encounter took place. Since this is important for interpreting the context of the encounter, choosing the appropriate business rules to enforce and for the management of the process, this element is required.
In future versions of FHIR, some kind of charge posting vehicle (e.g. Account) will be added.

8.15.5 Example usage

As stated, Encounter allows a flexible nesting of Encounters using the partOf element. For example:

A patient is admitted for two weeks - This could be modeled using a single Encounter instance, in which the start and length are given for the duration of the whole stay. The admitting doctor and the responsible doctor during the stay are specified using the Participant component.
During the encounter, the patient moves from the admitting department to the Intensive Care unit and back - Three more detailed additional Encounters can be created, one for each location in which the patient stayed. Each of these Encounters has a single location (twice the admitting department and once the Intensive Care unit) and one or more participants at that location. These Encounters may use the partOf relationship to indicate these movements occurred during the longer overarching Encounter.
During the last part of the stay, the patient is visited by the members of the multi-disciplinary team that treated him for final evaluation - If relevant, for each of these short visits, an Encounter may be created with a single participant. Since these took place during the last part of the stay, the partOf element can be used to associate these short visits with either the third patient movement or the bigger overall encounter.

Exactly how the Encounter is used depends on information available in the source system, the relevance of exchange of each level of Encounter and demands specific to the communicating partners. The expectation is that for each domain of exchange, profiles are used to limit the flexibility of Encounter to meet the demands of the use case.

8.15.6 Search Parameters

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	In Common
appointment	reference	The appointment that scheduled this encounter	Encounter.appointment (Appointment)
class	token	inpatient \| outpatient \| ambulatory \| emergency +	Encounter.class
condition	reference	Reason the encounter takes place (resource)	Encounter.indication (Condition)
date	date	A date within the period the Encounter lasted	Encounter.period	18 Resources
episodeofcare	reference	Episode(s) of care that this encounter should be recorded against	Encounter.episodeOfCare (EpisodeOfCare)
identifier	token	Identifier(s) by which this encounter is known	Encounter.identifier	26 Resources
incomingreferral	reference	The ReferralRequest that initiated this encounter	Encounter.incomingReferral (ReferralRequest)
indication	reference	Reason the encounter takes place (resource)	Encounter.indication (Condition, Procedure)
length	number	Length of encounter in days	Encounter.length
location	reference	Location the encounter takes place	Encounter.location.location (Location)
location-period	date	Time period during which the patient was present at the location	Encounter.location.period
part-of	reference	Another Encounter this encounter is part of	Encounter.partOf (Encounter)
participant	reference	Persons involved in the encounter other than the patient	Encounter.participant.individual (Practitioner, RelatedPerson)
participant-type	token	Role of participant in encounter	Encounter.participant.type
patient	reference	The patient present at the encounter	Encounter.patient (Patient)	31 Resources
practitioner	reference	Persons involved in the encounter other than the patient	Encounter.participant.individual (Practitioner)
procedure	reference	Reason the encounter takes place (resource)	Encounter.indication (Procedure)
reason	token	Reason the encounter takes place (code)	Encounter.reason
service-provider	reference	The custodian organization of this Encounter record	Encounter.serviceProvider (Organization)
special-arrangement	token	Wheelchair, translator, stretcher, etc.	Encounter.hospitalization.specialArrangement
status	token	planned \| arrived \| in-progress \| onleave \| finished \| cancelled \| entered-in-error	Encounter.status
type	token	Specific type of encounter	Encounter.type	6 Resources