R6 Ballot (2nd Draft)

Publish-box (todo)

Patient Administration icon Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Device, Patient, Practitioner, RelatedPerson

Detailed Descriptions for the elements in the Appointment resource.

Appointment
Element Id Appointment
Definition

A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s).

Short Display A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s)
Cardinality 0..*
Type DomainResource
Summary false
Invariants
Defined on this element
app-2Rule Either start and end are specified, or neitherstart.exists() = end.exists()
app-3Rule Only proposed or cancelled appointments can be missing start/end dates(start.exists() and end.exists()) or (status in ('proposed' | 'cancelled' | 'waitlist'))
app-4Rule Cancellation reason is only used for appointments that have been cancelled, or noshowcancellationReason.exists() implies (status='noshow' or status='cancelled')
app-5Rule The start must be less than or equal to the endstart.exists() implies start <= end
app-6Guideline An appointment may have an originatingAppointment or recurrenceTemplate, but not bothoriginatingAppointment.exists().not() or recurrenceTemplate.exists().not()
This is (only) a best practice guideline because:

For a recurring series of appointments, the originating appointment should have the recurrenceTemplate defining the details of the overall recurrence. Each occurence should refer back to the originatingAppointment as the single source of truth for the details of the recurrence.

app-7Rule Cancellation date is only used for appointments that have been cancelled, or noshowcancellationDate.exists() implies (status='noshow' or status='cancelled')
Appointment.identifier
Element Id Appointment.identifier
Definition

This records identifiers associated with this appointment concern that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

Short Display External Ids for this item
Note This is a business identifier, not a resource identifier (see discussion)
Cardinality 0..*
Type Identifier
Summary true
Appointment.status
Element Id Appointment.status
Definition

The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status.

Short Display proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist
Cardinality 1..1
Terminology Binding Appointment Status (Required)
Type code
Is Modifier true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Summary true
Comments

If the Appointment's status is "cancelled" then all participants are expected to have their calendars released for the appointment period, and as such any Slots that were marked as BUSY can be re-set to FREE.

This element is labeled as a modifier because the status contains the code entered-in-error that mark the Appointment as not currently valid.

Invariants
Affect this element
app-4Rule Cancellation reason is only used for appointments that have been cancelled, or noshowcancellationReason.exists() implies (status='noshow' or status='cancelled')
app-3Rule Only proposed or cancelled appointments can be missing start/end dates(start.exists() and end.exists()) or (status in ('proposed' | 'cancelled' | 'waitlist'))
app-7Rule Cancellation date is only used for appointments that have been cancelled, or noshowcancellationDate.exists() implies (status='noshow' or status='cancelled')
Appointment.cancellationReason
Element Id Appointment.cancellationReason
Definition

The coded reason for the appointment being cancelled. This is often used in reporting/billing/further processing to determine if further actions are required, or specific fees apply.

Short Display The coded reason for the appointment being cancelled
Cardinality 0..1
Terminology Binding Appointment Cancellation Reason (Example)
Type CodeableConcept
Summary true
Invariants
Affect this element
app-4Rule Cancellation reason is only used for appointments that have been cancelled, or noshowcancellationReason.exists() implies (status='noshow' or status='cancelled')
Appointment.class
Element Id Appointment.class
Definition

Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.

Short Display Classification when becoming an encounter
Cardinality 0..*
Terminology Binding EncounterClass icon:
Type CodeableConcept
Summary true
Appointment.serviceCategory
Element Id Appointment.serviceCategory
Definition

A broad categorization of the service that is to be performed during this appointment.

Short Display A broad categorization of the service that is to be performed during this appointment
Cardinality 0..*
Terminology Binding Service Category (Example)
Type CodeableConcept
Summary true
Appointment.serviceType
Element Id Appointment.serviceType
Definition

The specific service that is to be performed during this appointment.

Short Display The specific service that is to be performed during this appointment
Cardinality 0..*
Terminology Binding Service Type (Example)
Type CodeableReference(HealthcareService)
Summary true
Comments

For a provider to provider appointment the code "FOLLOWUP" may be appropriate, as this is expected to be discussing some patient that was seen in the past.

Appointment.specialty
Element Id Appointment.specialty
Definition

The specialty of a practitioner that would be required to perform the service requested in this appointment.

Short Display The specialty of a practitioner that would be required to perform the service requested in this appointment
Cardinality 0..*
Terminology Binding Practice Setting Code Value Set (Preferred)
Type CodeableConcept
Summary true
Appointment.appointmentType
Element Id Appointment.appointmentType
Definition

The style of appointment or patient that has been booked in the slot (not service type).

Short Display The style of appointment or patient that has been booked in the slot (not service type)
Cardinality 0..1
Terminology Binding hl7VS-appointmentReasonCodes icon (Preferred)
Type CodeableConcept
Summary true
Appointment.reason
Element Id Appointment.reason
Definition

The reason that this appointment is being scheduled. This is more clinical than administrative. This can be coded, or as specified using information from another resource. When the patient arrives and the encounter begins it may be used as the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.

Short Display Reason this appointment is scheduled
Cardinality 0..*
Terminology Binding Encounter Reason Codes (Preferred)
Type CodeableReference(Condition | Procedure | Observation | ImmunizationRecommendation)
Summary true
Appointment.priority
Element Id Appointment.priority
Definition

The priority of the appointment. Can be used to make informed decisions if needing to re-prioritize appointments. (The iCal Standard specifies 0 as undefined, 1 as highest, 9 as lowest priority).

Short Display Used to make informed decisions if needing to re-prioritize
Cardinality 0..1
Terminology Binding ActPriority icon (Example)
Type CodeableConcept
Summary false
Comments

Seeking implementer feedback on this property and how interoperable it is.

Using an extension to record a CodeableConcept for named values may be tested at a future connectathon.

Appointment.description
Element Id Appointment.description
Definition

The brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Detailed or expanded information should be put in the note field.

Short Display Shown on a subject line in a meeting request, or appointment list
Cardinality 0..1
Type string
Summary false
Appointment.replaces
Element Id Appointment.replaces
Definition

Appointment replaced by this Appointment in cases where there is a cancellation, the details of the cancellation can be found in the cancellationReason property (on the referenced resource).

Short Display Appointment replaced by this Appointment
Cardinality 0..*
Type Reference(Appointment)
Summary false
Appointment.virtualService
Element Id Appointment.virtualService
Definition

Connection details of a virtual service (e.g. conference call).

Short Display Connection details of a virtual service (e.g. conference call)
Cardinality 0..*
Type VirtualServiceDetail
Summary false
Comments

There are two types of virtual meetings that often exist:

  • a persistent, virtual meeting room that can only be used for a single purpose at a time,
  • and a dynamic virtual meeting room that is generated on demand for a specific purpose.

Implementers may consider using Location.virtualService for persistent meeting rooms.

If each participant would have a different meeting link, an extension using the VirtualServiceContactDetail can be applied to the Appointment.participant BackboneElement.

Appointment.supportingInformation
Element Id Appointment.supportingInformation
Definition

Additional information to support the appointment provided when making the appointment.

Short Display Additional information to support the appointment
Cardinality 0..*
Type Reference(Any)
Summary false
Appointment.previousAppointment
Element Id Appointment.previousAppointment
Definition

The previous appointment in a series of related appointments.

Short Display The previous appointment in a series
Cardinality 0..1
Type Reference(Appointment)
Summary false
Comments

This property is intended for use when representing a series of related appointments. For example, in a nuclear medicine procedure, where there is an appointment for the injection of the isotopes, and then a subsequent appointment for the scan, the scan appointment would refer to the injection appointment via Appointment.previousAppointment. For representing recurring appointments, see the guidance on recurring vs. series appointments.

Appointment.originatingAppointment
Element Id Appointment.originatingAppointment
Definition

The originating appointment in a recurring set of related appointments.

Short Display The originating appointment in a recurring set of appointments
Cardinality 0..1
Type Reference(Appointment)
Summary false
Comments

This property is intended for use when representing a recurring set of related appointments.

For example, a patient undergoing physical therapy may have a recurring appointment every Tuesday and Thursday. Each occurrence of the set will refer to the originating appointment, which contains the recurring template information. For representing appointment series, see the guidance on recurring vs. series appointments.

Invariants
Affect this element
app-6Guideline An appointment may have an originatingAppointment or recurrenceTemplate, but not bothoriginatingAppointment.exists().not() or recurrenceTemplate.exists().not()
This is (only) a best practice guideline because:

For a recurring series of appointments, the originating appointment should have the recurrenceTemplate defining the details of the overall recurrence. Each occurence should refer back to the originatingAppointment as the single source of truth for the details of the recurrence.

Appointment.start
Element Id Appointment.start
Definition

Date/Time that the appointment is to take place.

Short Display When appointment is to take place
Cardinality 0..1
Type instant
Summary true
Comments

If actual start/end times are not known then the requested period start/end can be used.

Invariants
Affect this element
app-5Rule The start must be less than or equal to the endstart.exists() implies start <= end
app-3Rule Only proposed or cancelled appointments can be missing start/end dates(start.exists() and end.exists()) or (status in ('proposed' | 'cancelled' | 'waitlist'))
app-2Rule Either start and end are specified, or neitherstart.exists() = end.exists()
Appointment.end
Element Id Appointment.end
Definition

Date/Time that the appointment is to conclude.

Short Display When appointment is to conclude
Cardinality 0..1
Type instant
Summary true
Comments

If actual start/end times are not known then the requested period start/end can be used.

Invariants
Affect this element
app-5Rule The start must be less than or equal to the endstart.exists() implies start <= end
app-3Rule Only proposed or cancelled appointments can be missing start/end dates(start.exists() and end.exists()) or (status in ('proposed' | 'cancelled' | 'waitlist'))
app-2Rule Either start and end are specified, or neitherstart.exists() = end.exists()
Appointment.minutesDuration
Element Id Appointment.minutesDuration
Definition

Number of minutes that the appointment is to take. This can be less than the duration between the start and end times. For example, where the actual time of appointment is only an estimate or if a 30 minute appointment is being requested, but any time would work. Also, if there is, for example, a planned 15 minute break in the middle of a long appointment, the duration may be 15 minutes less than the difference between the start and end.

Short Display Can be less than start/end (e.g. estimate)
Cardinality 0..1
Type positiveInt
Summary false
Appointment.requestedPeriod
Element Id Appointment.requestedPeriod
Definition

A set of date ranges (potentially including times) that the appointment is preferred to be scheduled within.

The duration (usually in minutes) could also be provided to indicate the length of the appointment to fill and populate the start/end times for the actual allocated time. However, in other situations the duration may be calculated by the scheduling system.

Short Display Potential date/time interval(s) requested to allocate the appointment within
Cardinality 0..*
Type Period
Summary false
Comments

This does not introduce a capacity for recurring appointments.

Appointment.slot
Element Id Appointment.slot
Definition

The slots from the participants' schedules that will be filled by the appointment.

Short Display The slots that this appointment is filling
Cardinality 0..*
Type Reference(Slot)
Summary false
Appointment.account
Element Id Appointment.account
Definition

The set of accounts that is expected to be used for billing the activities that result from this Appointment.

Short Display The set of accounts that may be used for billing for this Appointment
Cardinality 0..*
Type Reference(Account)
Summary false
Comments

The specified account(s) could be those identified during pre-registration workflows in preparation for an upcoming Encounter.

Appointment.created
Element Id Appointment.created
Definition

The date that this appointment was initially created. This could be different to the meta.lastModified value on the initial entry, as this could have been before the resource was created on the FHIR server, and should remain unchanged over the lifespan of the appointment.

Short Display The date that this appointment was initially created
Cardinality 0..1
Type dateTime
Summary false
Comments

This property is required for many use cases where the age of an appointment is considered in processing workflows for scheduling and billing of appointments.

Appointment.cancellationDate
Element Id Appointment.cancellationDate
Definition

The date/time describing when the appointment was cancelled.

Short Display When the appointment was cancelled
Cardinality 0..1
Type dateTime
Summary false
Comments

If the appointment was cancelled multiple times, this would reflect the most recent cancellation.

Invariants
Affect this element
app-7Rule Cancellation date is only used for appointments that have been cancelled, or noshowcancellationDate.exists() implies (status='noshow' or status='cancelled')
Appointment.note
Element Id Appointment.note
Definition

Additional notes/comments about the appointment.

Short Display Additional comments
Cardinality 0..*
Type Annotation
Summary false
Comments

Additional text to aid in facilitating the appointment. For instance, a note might be, "patient should proceed immediately to infusion room upon arrival"

Where this is a planned appointment and the start/end dates are not set then this field can be used to provide additional guidance on the details of the appointment request, including any restrictions on when to book it.

Typically only the concept.text will be used, however occasionally a reference to some generic documentation (or specific) and also supports coded instructions if/when they are required.

Appointment.patientInstruction
Element Id Appointment.patientInstruction
Definition

While Appointment.note contains information for internal use, Appointment.patientInstructions is used to capture patient facing information about the Appointment (e.g. please bring your referral or fast from 8pm night before).

Short Display Detailed information and instructions for the patient
Cardinality 0..*
Type CodeableReference(DocumentReference | Binary | Communication)
Summary false
Appointment.basedOn
Element Id Appointment.basedOn
Definition

The request this appointment is allocated to assess (e.g. incoming referral or procedure request).

Short Display The request this appointment is allocated to assess
Cardinality 0..*
Type Reference(CarePlan | DeviceRequest | MedicationRequest | ServiceRequest | RequestOrchestration | NutritionOrder | VisionPrescription | ImmunizationRecommendation)
Alternate Names incomingReferral
Summary false
Appointment.subject
Element Id Appointment.subject
Definition

The patient or group associated with the appointment, if they are to be present (usually) then they should also be included in the participant backbone element.

Short Display The patient or group associated with the appointment
Cardinality 0..1
Type Reference(Patient | Group)
Summary true
Appointment.participant
Element Id Appointment.participant
Definition

List of participants involved in the appointment.

Short Display Participants involved in appointment
Cardinality 1..*
Summary false
Invariants
Defined on this element
app-1Rule Either the type or actor on the participant SHALL be specifiedtype.exists() or actor.exists()
Appointment.participant.type
Element Id Appointment.participant.type
Definition

Role of participant in the appointment.

Short Display Role of participant in the appointment
Cardinality 0..*
Terminology Binding Participant Type (Extensible)
Type CodeableConcept
Summary true
Comments

The role of the participant can be used to declare what the actor will be doing in the scope of this appointment.

If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning.

This value SHALL be the same when creating an AppointmentResponse so that they can be matched, and subsequently update the Appointment.

Invariants
Affect this element
app-1Rule Either the type or actor on the participant SHALL be specifiedtype.exists() or actor.exists()
Appointment.participant.period
Element Id Appointment.participant.period
Definition

Participation period of the actor.

Short Display Participation period of the actor
Cardinality 0..1
Type Period
Summary false
Appointment.participant.actor
Element Id Appointment.participant.actor
Definition

The individual, device, location, or service participating in the appointment.

Short Display The individual, device, location, or service participating in the appointment
Cardinality 0..1
Type Reference(Patient | Group | Practitioner | PractitionerRole | CareTeam | RelatedPerson | Device | HealthcareService | Location)
Summary true
Comments

Where a CareTeam is provided, this does not imply that the entire team is included, just a single member from the group with the appropriate role. Where multiple members are required, please include the CareTeam the required number of times.

Invariants
Affect this element
app-1Rule Either the type or actor on the participant SHALL be specifiedtype.exists() or actor.exists()
Appointment.participant.required
Element Id Appointment.participant.required
Definition

Whether this participant is required to be present at the meeting. If false, the participant is optional.

Short Display The participant is required to attend (optional when false)
Cardinality 0..1
Type boolean
Summary true
Comments

For the use-case where two doctors need to meet to discuss the results for a specific patient, and the patient is not required to be present include the patient in the subject field, but do not include them as a participant - this was formerly done prior to R5 with required='information-only'.

Appointment.participant.status
Element Id Appointment.participant.status
Definition

Participation status of the actor.

Short Display accepted | declined | tentative | needs-action
Cardinality 1..1
Terminology Binding Participation Status (Required)
Type code
Summary true
Appointment.recurrenceId
Element Id Appointment.recurrenceId
Definition

The sequence number that identifies a specific appointment in a recurring pattern.

Short Display The sequence number in the recurrence
Cardinality 0..1
Type positiveInt
Summary false
Appointment.occurrenceChanged
Element Id Appointment.occurrenceChanged
Definition

This appointment varies from the recurring pattern.

Short Display Indicates that this appointment varies from a recurrence pattern
Cardinality 0..1
Type boolean
Summary false
Comments

For example, if a patient has physical therapy appointments every Tuesday and Thursday, but due to a national holiday, a single occurrence was rescheduled to a different day, while the rest of the recurring series remained on Tuesday / Thursday.

Appointment.recurrenceTemplate
Element Id Appointment.recurrenceTemplate
Definition

The details of the recurrence pattern or template that is used to generate recurring appointments.

Short Display Details of the recurrence pattern/template used to generate occurrences
Cardinality 0..*
Summary false
Invariants
Affect this element
app-6Guideline An appointment may have an originatingAppointment or recurrenceTemplate, but not bothoriginatingAppointment.exists().not() or recurrenceTemplate.exists().not()
This is (only) a best practice guideline because:

For a recurring series of appointments, the originating appointment should have the recurrenceTemplate defining the details of the overall recurrence. Each occurence should refer back to the originatingAppointment as the single source of truth for the details of the recurrence.

Appointment.recurrenceTemplate.timezone
Element Id Appointment.recurrenceTemplate.timezone
Definition

The timezone of the recurring appointment occurrences.

Short Display The timezone of the occurrences
Cardinality 0..1
Terminology Binding IANA Timezones (Required)
Type CodeableConcept
Summary false
Appointment.recurrenceTemplate.recurrenceType
Element Id Appointment.recurrenceTemplate.recurrenceType
Definition

How often the appointment series should recur.

Short Display The frequency of the recurrence
Cardinality 1..1
Terminology Binding Appointment Recurrence Type (Preferred)
Type CodeableConcept
Summary false
Appointment.recurrenceTemplate.lastOccurrenceDate
Element Id Appointment.recurrenceTemplate.lastOccurrenceDate
Definition

Recurring appointments will not occur after this date.

Short Display The date when the recurrence should end
Cardinality 0..1
Type date
Summary false
Appointment.recurrenceTemplate.occurrenceCount
Element Id Appointment.recurrenceTemplate.occurrenceCount
Definition

How many appointments are planned in the recurrence.

Short Display The number of planned occurrences
Cardinality 0..1
Type positiveInt
Summary false
Appointment.recurrenceTemplate.occurrenceDate
Element Id Appointment.recurrenceTemplate.occurrenceDate
Definition

The list of specific dates that will have appointments generated.

Short Display Specific dates for a recurring set of appointments (no template)
Cardinality 0..*
Type date
Summary false
Appointment.recurrenceTemplate.weeklyTemplate
Element Id Appointment.recurrenceTemplate.weeklyTemplate
Definition

Information about weekly recurring appointments.

Short Display Information about weekly recurring appointments
Cardinality 0..1
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.monday
Element Id Appointment.recurrenceTemplate.weeklyTemplate.monday
Definition

Indicates that recurring appointments should occur on Mondays.

Short Display Recurs on Mondays
Cardinality 0..1
Type boolean
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.tuesday
Element Id Appointment.recurrenceTemplate.weeklyTemplate.tuesday
Definition

Indicates that recurring appointments should occur on Tuesdays.

Short Display Recurs on Tuesday
Cardinality 0..1
Type boolean
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.wednesday
Element Id Appointment.recurrenceTemplate.weeklyTemplate.wednesday
Definition

Indicates that recurring appointments should occur on Wednesdays.

Short Display Recurs on Wednesday
Cardinality 0..1
Type boolean
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.thursday
Element Id Appointment.recurrenceTemplate.weeklyTemplate.thursday
Definition

Indicates that recurring appointments should occur on Thursdays.

Short Display Recurs on Thursday
Cardinality 0..1
Type boolean
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.friday
Element Id Appointment.recurrenceTemplate.weeklyTemplate.friday
Definition

Indicates that recurring appointments should occur on Fridays.

Short Display Recurs on Friday
Cardinality 0..1
Type boolean
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.saturday
Element Id Appointment.recurrenceTemplate.weeklyTemplate.saturday
Definition

Indicates that recurring appointments should occur on Saturdays.

Short Display Recurs on Saturday
Cardinality 0..1
Type boolean
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.sunday
Element Id Appointment.recurrenceTemplate.weeklyTemplate.sunday
Definition

Indicates that recurring appointments should occur on Sundays.

Short Display Recurs on Sunday
Cardinality 0..1
Type boolean
Summary false
Appointment.recurrenceTemplate.weeklyTemplate.weekInterval
Element Id Appointment.recurrenceTemplate.weeklyTemplate.weekInterval
Definition

The interval defines if the recurrence is every nth week. The default is every week, so it is expected that this value will be 2 or more.

e.g. For recurring every second week this interval would be 2, or every third week the interval would be 3.

Short Display Recurs every nth week
Cardinality 0..1
Type positiveInt
Summary false
Appointment.recurrenceTemplate.monthlyTemplate
Element Id Appointment.recurrenceTemplate.monthlyTemplate
Definition

Information about monthly recurring appointments.

Short Display Information about monthly recurring appointments
Cardinality 0..1
Summary false
Appointment.recurrenceTemplate.monthlyTemplate.dayOfMonth
Element Id Appointment.recurrenceTemplate.monthlyTemplate.dayOfMonth
Definition

Indicates that appointments in the series of recurring appointments should occur on a specific day of the month.

Short Display Recurs on a specific day of the month
Cardinality 0..1
Type positiveInt
Summary false
Appointment.recurrenceTemplate.monthlyTemplate.nthWeekOfMonth
Element Id Appointment.recurrenceTemplate.monthlyTemplate.nthWeekOfMonth
Definition

Indicates which week within a month the appointments in the series of recurring appointments should occur on.

Short Display Indicates which week of the month the appointment should occur
Cardinality 0..1
Terminology Binding Week Of Month (Required)
Type Coding
Summary false
Appointment.recurrenceTemplate.monthlyTemplate.dayOfWeek
Element Id Appointment.recurrenceTemplate.monthlyTemplate.dayOfWeek
Definition

Indicates which day of the week the recurring appointments should occur each nth week.

Short Display Indicates which day of the week the appointment should occur
Cardinality 0..1
Terminology Binding Days Of Week (Required)
Type Coding
Summary false
Comments

This property is intended to be used with Appointment.recurrenceTemplate.monthly.nthWeek.

Appointment.recurrenceTemplate.monthlyTemplate.monthInterval
Element Id Appointment.recurrenceTemplate.monthlyTemplate.monthInterval
Definition

Indicates that recurring appointments should occur every nth month.

Short Display Recurs every nth month
Cardinality 1..1
Type positiveInt
Summary false
Appointment.recurrenceTemplate.yearlyTemplate
Element Id Appointment.recurrenceTemplate.yearlyTemplate
Definition

Information about yearly recurring appointments.

Short Display Information about yearly recurring appointments
Cardinality 0..1
Summary false
Appointment.recurrenceTemplate.yearlyTemplate.yearInterval
Element Id Appointment.recurrenceTemplate.yearlyTemplate.yearInterval
Definition

Appointment recurs every nth year.

Short Display Recurs every nth year
Cardinality 1..1
Type positiveInt
Summary false
Appointment.recurrenceTemplate.excludingDate
Element Id Appointment.recurrenceTemplate.excludingDate
Definition

Any dates, such as holidays, that should be excluded from the recurrence.

Short Display Any dates that should be excluded from the series
Cardinality 0..*
Type date
Summary false
Comments

excludingDate is an alternative to excludingRecurrenceId. You may say either that 12/25/XXXX should be excluded using excludingDate, or you may indicate the recurrenceId of the appointment that would fall on the excluded date in the excludingRecurrenceId property.

Appointment.recurrenceTemplate.excludingRecurrenceId
Element Id Appointment.recurrenceTemplate.excludingRecurrenceId
Definition

Any dates, such as holidays, that should be excluded from the recurrence.

Short Display Any recurrence IDs that should be excluded from the recurrence
Cardinality 0..*
Type positiveInt
Summary false
Comments

excludingRecurrenceId is an alternative to excludingDate. You may say either that 12/25/XXXX should be excluded using excludingDate, or you may indicate the recurrenceId of the appointment that would fall on the excluded date in the excludingRecurrenceId property.