Used to record and send details about a request for referral service or transfer of a patient to the care of another provider or provider organisation.

The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource

Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

An Extension

• unordered
• Open
• discriminators: url

The reason the referral request was refused. Only applicable when status = refused.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The workflow status of the referral or transfer of care request.

Business Id that uniquely identifies the referral/care transfer request instance.

An indication of the type of referral (or where applicable the type of transfer of care) request.

Examples of referral type: - consultation; second opinion; third opinion - Assume management - Request for procedure(s)

HL7 v2.8 Example - Table 0336: S = second opinion p = patient preference o = provider ordered w = work load.

Indication of the clinical domain or discipline to which the referral or transfer of care request is sent.

Examples: Cardiology Gastroenterology Diabetology.

An indication of the urgency of referral (or where applicable the type of transfer of care) request.

The patient who is the subject of a referral or transfer of care request.

Referral of family, group or community is to be catered for by profiles.

The healthcare provider or provider organization who/which initaited the referral/transfer of care request. Can also be Patient (a self referral).

The healthcare provider(s) or provider organization(s) who/which is to receive the referral/transfer of care request.

There will be a primary receiver. But the request can be received by any number of "copied to" providers or organisations.

The encounter at which the request for referral or transfer of care is initiated.

Date/DateTime the request for referral or transfer of care is sent by the author.

Description of clinical condition indicating why referral/transfer of care is requested.

Examples: "2nd degree AV block"

Oral Health example ReferralReasonCode: 01 = Pathological Anomalies 02 = Disabled (physical or mental) 03 = Complexity of Treatment 04 = Seizure Disorders 05 = Extensive Surgery 06 = Surgical Complexity 07 = Rampant decay 08 = Medical History (to provide details upon request) 09 = Temporal Mandibular Joint Anomalies 10 = Accidental Injury 11 = Anaesthesia complications (local or general) 12 = Developmental Anomalies 13 = Behavioral Management.

The reason gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summary.

This would be a good candidate for a 'markdown' data type.

The service(s) that is/are requested to be provided to the patient.

Examples: "cardiac pacemaker insertion"

HL7 v3 Concept domain - ReferralReasonCode examples: - Specialized medical assistance - Other care requirement.

Any additional (administrative, financial or clinical) information required to support request for referral or transfer of care.

Examples include: Presenting problems/chief complaints Medical History Family History Alerts Allergy/Intolerance and Adverse Reactions Medications Observations/Assessments (may include cognitive and fundtional assessments) Diagnostic Reports Care Plan.

The period of time within which the services identified in the referral/transfer of care is specified or required to occur.

Use cases: (1) to indicate that the requested service is not to happen before a specified date (2) to indicate that the requested service must happen before a specified date (3) to indicate that the requested service must happen during the specified dates ("low" and "high" values).