US Core Implementation Guide
5.0.0 - STU5 Release US

This page is part of the US Core (v5.0.0: STU5) based on FHIR R4. The current version which supercedes this version is 5.0.1. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core ServiceRequest Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest Version: 5.0.0
Active as of 2022-04-20 Computable Name: USCoreServiceRequestProfile

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This profile sets minimum expectations for recording, searching, and fetching using the ServiceRequest resource to promote interoperability and adoption through common implementation. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile. It provides the floor for standards development for specific uses cases.

Example Usage Scenarios:

The following are example usage scenarios for the this profile:

  • Query for a specific procedure or test request such as an electrocardiogram (ECG) order or a referral to a support program.
  • Query for a specific service offered to a patient such as a referral to a support program.
  • Query for category of service request (e.g. all cardiology requests)

Mandatory and Must Support Data Elements

The following data-elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Service Request must have:

  1. a status
  2. an intent code indicating whether the request is a proposal, plan, or order.
  3. a code defining what is being requested
  4. a patient

Each Service Request must support:

  1. a category
  2. when requested service should happen
  3. when request was made
  4. the requester

Profile specific implementation guidance:

  • See the SDOH guidance page for more information when exchanging Social Determinants of Health (SDOH) Service Requests.
  • The ServiceRequest.category binding must support at a minimum the US Core ServiceRequest Category Codes. However, this valueset can be treated as extensible and other category codes can be used instead.
  • The ServiceRequest.code valueset is broad to accommodate a wide variety of use cases and should be constrained to a subset for a particular use case or domain. (for example, LOINC for laboratory orders.)

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from ServiceRequest

This structure is derived from ServiceRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..*ServiceRequestA request for a service to be performed
... status S1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
... intent S1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
... Slices for category S1..*CodeableConceptClassification of service
Slice: Unordered, Open by pattern:$this
.... category:us-core S0..*CodeableConceptClassification of service
Binding: US Core ServiceRequest Category Codes (required)
... code S1..1CodeableConceptWhat is being requested/ordered
Binding: US Core Procedure Codes (extensible)
... subject S1..1Reference(US Core Patient Profile)Individual or Entity the service is ordered for
... occurrence[x] S0..1When service should occur
.... occurrencePeriodPeriod S
.... occurrenceDateTimedateTime
.... occurrenceTimingTiming
... authoredOn S0..1dateTimeDate request signed
... requester S0..1Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device)Who/what is requesting service

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest I0..*ServiceRequestA request for a service to be performed
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierIdentifiers assigned to this order
... instantiatesCanonical Σ0..*canonical(ActivityDefinition | PlanDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | MedicationRequest)What request fulfills
... replaces Σ0..*Reference(ServiceRequest)What request replaces
... requisition Σ0..1IdentifierComposite Request ID
... status ?!SΣ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.

... intent ?!SΣ1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.

... Slices for category SΣ1..*CodeableConceptClassification of service
Slice: Unordered, Open by pattern:$this
Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


.... category:us-core SΣ0..*CodeableConceptClassification of service
Binding: US Core ServiceRequest Category Codes (required)
... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ0..1booleanTrue if service/procedure should not be performed
... code SΣ1..1CodeableConceptWhat is being requested/ordered
Binding: US Core Procedure Codes (extensible)
... orderDetail ΣI0..*CodeableConceptAdditional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] Σ0..1Service amount
.... quantityQuantityQuantity
.... quantityRatioRatio
.... quantityRangeRange
... subject SΣ1..1Reference(US Core Patient Profile)Individual or Entity the service is ordered for
... encounter Σ0..1Reference(Encounter)Encounter in which the request was created
... occurrence[x] SΣ0..1When service should occur
.... occurrencePeriodPeriod S
.... occurrenceDateTimedateTime
.... occurrenceTimingTiming
... asNeeded[x] Σ0..1Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBooleanboolean
.... asNeededCodeableConceptCodeableConcept
... authoredOn SΣ0..1dateTimeDate request signed
... requester SΣ0..1Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device)Who/what is requesting service
... performerType Σ0..1CodeableConceptPerformer role
Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)Requested performer
... locationCode Σ0..*CodeableConceptRequested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ0..*Reference(Location)Requested location
... reasonCode Σ0..*CodeableConceptExplanation/Justification for procedure or service
Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Explanation/Justification for service or service
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... supportingInfo 0..*Reference(Resource)Additional clinical information
... specimen Σ0..*Reference(Specimen)Procedure Samples
... bodySite Σ0..*CodeableConceptLocation on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..*AnnotationComments
... patientInstruction Σ0..1stringPatient or consumer-oriented instructions
... relevantHistory 0..*Reference(Provenance)Request provenance

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest I0..*ServiceRequestA request for a service to be performed
... status ?!Σ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.

... intent ?!Σ1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.

... Slices for category Σ1..*CodeableConceptClassification of service
Slice: Unordered, Open by pattern:$this
Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


.... category:us-core Σ0..*CodeableConceptClassification of service
Binding: US Core ServiceRequest Category Codes (required)
... code Σ1..1CodeableConceptWhat is being requested/ordered
Binding: US Core Procedure Codes (extensible)
... subject Σ1..1Reference(US Core Patient Profile)Individual or Entity the service is ordered for
... occurrence[x] Σ0..1When service should occur
.... occurrencePeriodPeriod
... authoredOn Σ0..1dateTimeDate request signed
... requester Σ0..1Reference(US Core Practitioner Profile)Who/what is requesting service

doco Documentation for this format

This structure is derived from ServiceRequest

Differential View

This structure is derived from ServiceRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..*ServiceRequestA request for a service to be performed
... status S1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
... intent S1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
... Slices for category S1..*CodeableConceptClassification of service
Slice: Unordered, Open by pattern:$this
.... category:us-core S0..*CodeableConceptClassification of service
Binding: US Core ServiceRequest Category Codes (required)
... code S1..1CodeableConceptWhat is being requested/ordered
Binding: US Core Procedure Codes (extensible)
... subject S1..1Reference(US Core Patient Profile)Individual or Entity the service is ordered for
... occurrence[x] S0..1When service should occur
.... occurrencePeriodPeriod S
.... occurrenceDateTimedateTime
.... occurrenceTimingTiming
... authoredOn S0..1dateTimeDate request signed
... requester S0..1Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device)Who/what is requesting service

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest I0..*ServiceRequestA request for a service to be performed
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierIdentifiers assigned to this order
... instantiatesCanonical Σ0..*canonical(ActivityDefinition | PlanDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | MedicationRequest)What request fulfills
... replaces Σ0..*Reference(ServiceRequest)What request replaces
... requisition Σ0..1IdentifierComposite Request ID
... status ?!SΣ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.

... intent ?!SΣ1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.

... Slices for category SΣ1..*CodeableConceptClassification of service
Slice: Unordered, Open by pattern:$this
Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


.... category:us-core SΣ0..*CodeableConceptClassification of service
Binding: US Core ServiceRequest Category Codes (required)
... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ0..1booleanTrue if service/procedure should not be performed
... code SΣ1..1CodeableConceptWhat is being requested/ordered
Binding: US Core Procedure Codes (extensible)
... orderDetail ΣI0..*CodeableConceptAdditional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] Σ0..1Service amount
.... quantityQuantityQuantity
.... quantityRatioRatio
.... quantityRangeRange
... subject SΣ1..1Reference(US Core Patient Profile)Individual or Entity the service is ordered for
... encounter Σ0..1Reference(Encounter)Encounter in which the request was created
... occurrence[x] SΣ0..1When service should occur
.... occurrencePeriodPeriod S
.... occurrenceDateTimedateTime
.... occurrenceTimingTiming
... asNeeded[x] Σ0..1Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBooleanboolean
.... asNeededCodeableConceptCodeableConcept
... authoredOn SΣ0..1dateTimeDate request signed
... requester SΣ0..1Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile | Device)Who/what is requesting service
... performerType Σ0..1CodeableConceptPerformer role
Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)Requested performer
... locationCode Σ0..*CodeableConceptRequested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ0..*Reference(Location)Requested location
... reasonCode Σ0..*CodeableConceptExplanation/Justification for procedure or service
Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Explanation/Justification for service or service
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... supportingInfo 0..*Reference(Resource)Additional clinical information
... specimen Σ0..*Reference(Specimen)Procedure Samples
... bodySite Σ0..*CodeableConceptLocation on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..*AnnotationComments
... patientInstruction Σ0..1stringPatient or consumer-oriented instructions
... relevantHistory 0..*Reference(Provenance)Request provenance

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
ServiceRequest.languagepreferredCommonLanguages
Max Binding: AllLanguages
ServiceRequest.statusrequiredRequestStatus
ServiceRequest.intentrequiredRequestIntent
ServiceRequest.categoryexampleServiceRequestCategoryCodes
ServiceRequest.category:us-corerequiredUSCoreServiceRequestCategoryCodes
ServiceRequest.priorityrequiredRequestPriority
ServiceRequest.codeextensibleUSCoreProcedureCodes
ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
ServiceRequest.performerTypeexampleParticipantRoles
ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
ServiceRequest.reasonCodeexampleProcedureReasonCodes
ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures

Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

  • The syntax used to describe the interactions is described here.
  • See the General Requirements section for additional rules and expectations when a server requires status parameters.
  • See the General Guidance section for additional guidance on searching for multiple patients.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

  1. SHALL support searching for all servicerequests for a patient using the patient search parameter:

    GET [base]/ServiceRequest?patient={Type/}[id]

    Example:

    1. GET [base]/ServiceRequest?patient=1137192

    Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient (how to search by reference)

  2. SHALL support fetching a ServiceRequest using the _id search parameter:

    GET [base]/ServiceRequest[id]

    Example:

    1. GET [base]/ServiceRequest/1032702
    2. GET [base]/ServiceRequest?_id=1032702

    Implementation Notes: (how to search by the logical id of the resource)

  3. SHALL support searching using the combination of the patient and category search parameters:

    GET [base]/ServiceRequest?patient={Type/}[id]&category={system|}[code]

    Example:

    1. GET [base]/ServiceRequest?patient=f201&category=http://loinc.org|sdoh

    Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and a category code (how to search by reference and how to search by token)

  4. SHALL support searching using the combination of the patient and code search parameters:
    • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

    GET [base]/ServiceRequest?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/ServiceRequest?patient=1032702&code=http://snomed.info/sct|35637008

    Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and report code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token)

  5. SHALL support searching using the combination of the patient and category and authored search parameters:
    • including support for these authored comparators: gt,lt,ge,le
    • including optional support for AND search on authored (e.g.authored=[date]&authored=[date]]&...)

    GET [base]/ServiceRequest?patient={Type/}[id]&category={system|}[code]&authored={gt|lt|ge|le}[date]{&authored={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/ServiceRequest?patient=f201&category=http://loinc.org|sdoh&date=ge2010-01-14T00:00:00Z

    Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and date and a category code (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

  1. SHOULD support searching using the combination of the patient and status search parameters:
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

    GET [base]/ServiceRequest?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/ServiceRequest?patient=1137192&status=completed

    Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and status (how to search by reference and how to search by token)

  2. SHOULD support searching using the combination of the patient and code and authored search parameters:
    • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
    • including support for these authored comparators: gt,lt,ge,le
    • including optional support for AND search on authored (e.g.authored=[date]&authored=[date]]&...)

    GET [base]/ServiceRequest?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&authored={gt|lt|ge|le}[date]{&authored={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/ServiceRequest?patient=f201&code=http://snomed.info/sct|35637008&date=ge2019-01-14T00:00:00Z

    Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and date and service code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token and how to search by date)