Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for a specific patient encounter
• Query for recent patient encounters
• Record or update an encounter

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 Views below provides the formal summary, definitions, and terminology requirements.

Each Encounter Must Have:

1. A status
2. An classification such as inpatient, outpatient or emergency
3. An encounter type
4. A patient

Each Encounter Must Support:

1. An encounter identifier
2. Providers involved in the encounter
3. When the encounter occurred
4. Reason for the visit
5. The discharge disposition
6. Where the encounter occurred

Profile Specific Implementation Guidance:

• To search for an encounter diagnosis, query for Condition resources that reference the Encounter of interest and have a category of encounter-diagnosis. An example search is shown in the Condition Quick Start section.
• The Encounter resource can represent a reason using either a code with Encounter.reasonCode, or a reference with Encounter.reasonReference to Condition or other resource.
  • Although both are marked as Must Support, servers are not required to support both a code and a reference, but they SHALL support at least one of these elements.
  • The client application SHALL support both elements.
  • If Encounter.reasonReference references an Observation, it SHOULD conform to a US Core Observation if applicable. For example, a laboratory result SHOULD conform to the US Core Laboratory Result Observation Profile.
• This profile supports where the encounter occurred. The location address can be represented by the Location referenced by Encounter.location.location or indirectly through the Organization referenced by Encounter.serviceProvider.
  • Although both are marked as Must Support, servers are not required to support both Encounter.location.location and Encounter.serviceProvider, but they SHALL support at least one of these elements.
  • The client application SHALL support both elements.
  • If using Encounter.location.location it SHOULD conform to US Core Location. However, as a result of implementation feedback, it MAY reference the base FHIR Location resource. See this guidance on Referencing US Core Profiles.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
identifier	S	0..*	Identifier	(USCDI) Identifier(s) by which this encounter is known
system	S	1..1	uri	(USCDI) The namespace for the identifier value
value	S	1..1	string	(USCDI) The value that is unique
status	S	1..1	code	(USCDI) planned | arrived | triaged | in-progress | onleave | finished | cancelled +
class	S	1..1	Coding	(USCDI) Classification of patient encounter
type	S	1..*	CodeableConcept	(USCDI) Specific type of encounter Binding: US Core Encounter Type (extensible): Valueset to describe the Encounter Type
subject	S	1..1	Reference(US Core Patient Profile)	(USCDI) The patient or group present at the encounter
participant	S	0..*	BackboneElement	(USCDI) List of participants involved in the encounter
type	S	0..*	CodeableConcept	(USCDI) Role of participant in encounter
period	S	0..1	Period	(USCDI) Period of time during the encounter that the participant participated
individual	S	0..1	Reference(US Core Practitioner Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile)	(USCDI) Persons involved in the encounter other than the patient
period	S	0..1	Period	(USCDI) The start and end time of the encounter
reasonCode	S	0..*	CodeableConcept	(USCDI) Coded reason the encounter takes place
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile S | US Core Condition Encounter Diagnosis Profile S | US Core Procedure Profile | Observation | ImmunizationRecommendation)	(USCDI) Reason the encounter takes place (reference)
hospitalization	S	0..1	BackboneElement	(USCDI) Details about the admission to a healthcare service
dischargeDisposition	S	0..1	CodeableConcept	(USCDI) Category or kind of location after discharge Binding: US Core Discharge Disposition (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location	S	0..*	BackboneElement	(USCDI) List of locations where the patient has been
location	S	1..1	Reference(Location)	(USCDI) Location the encounter takes place
serviceProvider	S	0..1	Reference(US Core Organization Profile)	(USCDI) The organization (facility) responsible for this encounter
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Encounter.type	extensible	USCoreEncounterType
Encounter.hospitalization.dischargeDisposition	preferred	USCoreDischargeDisposition (a valid code from http://www.nubc.org/patient-discharge)

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	(USCDI) Identifier(s) by which this encounter is known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique Example General: 123456
status	?!SΣ	1..1	code	(USCDI) planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
class	SΣ	1..1	Coding	(USCDI) Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
type	SΣ	1..*	CodeableConcept	(USCDI) Specific type of encounter Binding: US Core Encounter Type (extensible): Valueset to describe the Encounter Type
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) The patient or group present at the encounter
participant	SΣ	0..*	BackboneElement	(USCDI) List of participants involved in the encounter
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	(USCDI) Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period	S	0..1	Period	(USCDI) Period of time during the encounter that the participant participated
individual	SΣ	0..1	Reference(US Core Practitioner Profile)	(USCDI) Persons involved in the encounter other than the patient
period	S	0..1	Period	(USCDI) The start and end time of the encounter
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile | US Core Condition Encounter Diagnosis Profile)	(USCDI) Reason the encounter takes place (reference)
hospitalization	S	0..1	BackboneElement	(USCDI) Details about the admission to a healthcare service
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
dischargeDisposition	S	0..1	CodeableConcept	(USCDI) Category or kind of location after discharge Binding: US Core Discharge Disposition (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location	S	0..*	BackboneElement	(USCDI) List of locations where the patient has been
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location	S	1..1	Reference(Location)	(USCDI) Location the encounter takes place
serviceProvider	S	0..1	Reference(US Core Organization Profile)	(USCDI) The organization (facility) responsible for this encounter
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.identifier.use	required	IdentifierUse
Encounter.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.type	extensible	USCoreEncounterType
Encounter.participant.type	extensible	ParticipantType
Encounter.reasonCode	preferred	EncounterReasonCodes
Encounter.hospitalization.dischargeDisposition	preferred	USCoreDischargeDisposition (a valid code from http://www.nubc.org/patient-discharge)

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	(USCDI) Identifier(s) by which this encounter is known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	(USCDI) planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory		0..*	BackboneElement	List of past encounter statuses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period		1..1	Period	The time that the episode was in the specified status
class	SΣ	1..1	Coding	(USCDI) Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
classHistory		0..*	BackboneElement	List of past encounter classes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
class		1..1	Coding	inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period		1..1	Period	The time that the episode was in the specified class
type	SΣ	1..*	CodeableConcept	(USCDI) Specific type of encounter Binding: US Core Encounter Type (extensible): Valueset to describe the Encounter Type
serviceType	Σ	0..1	CodeableConcept	Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
priority		0..1	CodeableConcept	Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) The patient or group present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	SΣ	0..*	BackboneElement	(USCDI) List of participants involved in the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	(USCDI) Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period	S	0..1	Period	(USCDI) Period of time during the encounter that the participant participated
individual	SΣ	0..1	Reference(US Core Practitioner Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile)	(USCDI) Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period	S	0..1	Period	(USCDI) The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile S | US Core Condition Encounter Diagnosis Profile S | US Core Procedure Profile | Observation | ImmunizationRecommendation)	(USCDI) Reason the encounter takes place (reference)
diagnosis	Σ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition | Procedure)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank		0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization	S	0..1	BackboneElement	(USCDI) Details about the admission to a healthcare service
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location | Organization)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
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 Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination		0..1	Reference(Location | Organization)	Location/organization to which the patient is discharged
dischargeDisposition	S	0..1	CodeableConcept	(USCDI) Category or kind of location after discharge Binding: US Core Discharge Disposition (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location	S	0..*	BackboneElement	(USCDI) List of locations where the patient has been
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location	S	1..1	Reference(Location)	(USCDI) Location the encounter takes place
status		0..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider	S	0..1	Reference(US Core Organization Profile)	(USCDI) The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Encounter.identifier.use	required	IdentifierUse
Encounter.identifier.type	extensible	Identifier Type Codes
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	extensible	USCoreEncounterType
Encounter.serviceType	example	ServiceType
Encounter.priority	example	ActPriority
Encounter.participant.type	extensible	ParticipantType
Encounter.reasonCode	preferred	EncounterReasonCodes
Encounter.diagnosis.use	preferred	DiagnosisRole
Encounter.hospitalization.admitSource	preferred	AdmitSource
Encounter.hospitalization.reAdmission	example	Hl7VSReAdmissionIndicator
Encounter.hospitalization.dietPreference	example	Diet
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	preferred	USCoreDischargeDisposition (a valid code from http://www.nubc.org/patient-discharge)
Encounter.location.status	required	EncounterLocationStatus
Encounter.location.physicalType	example	LocationType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
identifier	S	0..*	Identifier	(USCDI) Identifier(s) by which this encounter is known
system	S	1..1	uri	(USCDI) The namespace for the identifier value
value	S	1..1	string	(USCDI) The value that is unique
status	S	1..1	code	(USCDI) planned | arrived | triaged | in-progress | onleave | finished | cancelled +
class	S	1..1	Coding	(USCDI) Classification of patient encounter
type	S	1..*	CodeableConcept	(USCDI) Specific type of encounter Binding: US Core Encounter Type (extensible): Valueset to describe the Encounter Type
subject	S	1..1	Reference(US Core Patient Profile)	(USCDI) The patient or group present at the encounter
participant	S	0..*	BackboneElement	(USCDI) List of participants involved in the encounter
type	S	0..*	CodeableConcept	(USCDI) Role of participant in encounter
period	S	0..1	Period	(USCDI) Period of time during the encounter that the participant participated
individual	S	0..1	Reference(US Core Practitioner Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile)	(USCDI) Persons involved in the encounter other than the patient
period	S	0..1	Period	(USCDI) The start and end time of the encounter
reasonCode	S	0..*	CodeableConcept	(USCDI) Coded reason the encounter takes place
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile S | US Core Condition Encounter Diagnosis Profile S | US Core Procedure Profile | Observation | ImmunizationRecommendation)	(USCDI) Reason the encounter takes place (reference)
hospitalization	S	0..1	BackboneElement	(USCDI) Details about the admission to a healthcare service
dischargeDisposition	S	0..1	CodeableConcept	(USCDI) Category or kind of location after discharge Binding: US Core Discharge Disposition (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location	S	0..*	BackboneElement	(USCDI) List of locations where the patient has been
location	S	1..1	Reference(Location)	(USCDI) Location the encounter takes place
serviceProvider	S	0..1	Reference(US Core Organization Profile)	(USCDI) The organization (facility) responsible for this encounter
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Encounter.type	extensible	USCoreEncounterType
Encounter.hospitalization.dischargeDisposition	preferred	USCoreDischargeDisposition (a valid code from http://www.nubc.org/patient-discharge)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	(USCDI) Identifier(s) by which this encounter is known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique Example General: 123456
status	?!SΣ	1..1	code	(USCDI) planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
class	SΣ	1..1	Coding	(USCDI) Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
type	SΣ	1..*	CodeableConcept	(USCDI) Specific type of encounter Binding: US Core Encounter Type (extensible): Valueset to describe the Encounter Type
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) The patient or group present at the encounter
participant	SΣ	0..*	BackboneElement	(USCDI) List of participants involved in the encounter
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	(USCDI) Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period	S	0..1	Period	(USCDI) Period of time during the encounter that the participant participated
individual	SΣ	0..1	Reference(US Core Practitioner Profile)	(USCDI) Persons involved in the encounter other than the patient
period	S	0..1	Period	(USCDI) The start and end time of the encounter
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile | US Core Condition Encounter Diagnosis Profile)	(USCDI) Reason the encounter takes place (reference)
hospitalization	S	0..1	BackboneElement	(USCDI) Details about the admission to a healthcare service
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
dischargeDisposition	S	0..1	CodeableConcept	(USCDI) Category or kind of location after discharge Binding: US Core Discharge Disposition (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location	S	0..*	BackboneElement	(USCDI) List of locations where the patient has been
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location	S	1..1	Reference(Location)	(USCDI) Location the encounter takes place
serviceProvider	S	0..1	Reference(US Core Organization Profile)	(USCDI) The organization (facility) responsible for this encounter
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.identifier.use	required	IdentifierUse
Encounter.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.type	extensible	USCoreEncounterType
Encounter.participant.type	extensible	ParticipantType
Encounter.reasonCode	preferred	EncounterReasonCodes
Encounter.hospitalization.dischargeDisposition	preferred	USCoreDischargeDisposition (a valid code from http://www.nubc.org/patient-discharge)

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	(USCDI) Identifier(s) by which this encounter is known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	(USCDI) planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory		0..*	BackboneElement	List of past encounter statuses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period		1..1	Period	The time that the episode was in the specified status
class	SΣ	1..1	Coding	(USCDI) Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
classHistory		0..*	BackboneElement	List of past encounter classes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
class		1..1	Coding	inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period		1..1	Period	The time that the episode was in the specified class
type	SΣ	1..*	CodeableConcept	(USCDI) Specific type of encounter Binding: US Core Encounter Type (extensible): Valueset to describe the Encounter Type
serviceType	Σ	0..1	CodeableConcept	Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
priority		0..1	CodeableConcept	Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) The patient or group present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	SΣ	0..*	BackboneElement	(USCDI) List of participants involved in the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	(USCDI) Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period	S	0..1	Period	(USCDI) Period of time during the encounter that the participant participated
individual	SΣ	0..1	Reference(US Core Practitioner Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile)	(USCDI) Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period	S	0..1	Period	(USCDI) The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile S | US Core Condition Encounter Diagnosis Profile S | US Core Procedure Profile | Observation | ImmunizationRecommendation)	(USCDI) Reason the encounter takes place (reference)
diagnosis	Σ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition | Procedure)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank		0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization	S	0..1	BackboneElement	(USCDI) Details about the admission to a healthcare service
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location | Organization)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
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 Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination		0..1	Reference(Location | Organization)	Location/organization to which the patient is discharged
dischargeDisposition	S	0..1	CodeableConcept	(USCDI) Category or kind of location after discharge Binding: US Core Discharge Disposition (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location	S	0..*	BackboneElement	(USCDI) List of locations where the patient has been
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location	S	1..1	Reference(Location)	(USCDI) Location the encounter takes place
status		0..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider	S	0..1	Reference(US Core Organization Profile)	(USCDI) The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Encounter.identifier.use	required	IdentifierUse
Encounter.identifier.type	extensible	Identifier Type Codes
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	extensible	USCoreEncounterType
Encounter.serviceType	example	ServiceType
Encounter.priority	example	ActPriority
Encounter.participant.type	extensible	ParticipantType
Encounter.reasonCode	preferred	EncounterReasonCodes
Encounter.diagnosis.use	preferred	DiagnosisRole
Encounter.hospitalization.admitSource	preferred	AdmitSource
Encounter.hospitalization.reAdmission	example	Hl7VSReAdmissionIndicator
Encounter.hospitalization.dietPreference	example	Diet
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	preferred	USCoreDischargeDisposition (a valid code from http://www.nubc.org/patient-discharge)
Encounter.location.status	required	EncounterLocationStatus
Encounter.location.physicalType	example	LocationType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Encounter

Summary

Mandatory: 2 elements (2 nested mandatory elements)
Must-Support: 19 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
• US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)
• US Core Condition Problems and Health Concerns Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns)
• US Core Condition Encounter Diagnosis Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis)
• US Core Procedure Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)

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.

• Servers providing access to encounter data can use US Core SMART Scopes for:
  • resource level scopes (for example, patient/Encounter.rs).
• 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 both read Encounter by id AND Encounter search using the _id search parameter:

   GET [base]/Encounter/[id] or GET [base]/Encounter?_id=[id]

   Example:

   1. GET [base]/Encounter/12354
   2. GET [base]/Encounter?_id=12354

   Implementation Notes: Fetches a single Encounter (how to search by the logical id of the resource)

2. SHALL support searching for all encounters for a patient using the patient search parameter:

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

   Example:

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

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

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

   • including support for these date comparators: gt,lt,ge,le
   • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

   GET [base]/Encounter?date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}&patient={Type/}[id]

   Example:

   1. GET [base]/Encounter?patient=example1&date=ge2019-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all Encounter resources matching the specified date and patient (how to search by date and how to search by reference)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching for an encounter by an identifier using the identifier search parameter:

   GET [base]/Encounter?identifier={system|}[code]

   Example:

   1. GET [base]/Encounter?identifier=http://hospital.smarthealthit.org|1032702

   Implementation Notes: Fetches a bundle containing any Encounter resources matching the identifier (how to search by token)

2. SHOULD support searching using the combination of the class and patient search parameters:

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

   Example:

   1. GET [base]/Encounter?patient=example1&class= http://terminology.hl7.org/CodeSystem/v3-ActCode code|AMB

   Implementation Notes: Fetches a bundle of all Encounter resources matching the specified class and patient (how to search by reference and how to search by token)

3. SHOULD support searching using the combination of the patient and type search parameters:

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

   Example:

   1. GET [base]/Encounter?patient=1137192&type=http://www.ama-assn.org/go/cpt code|99201

   Implementation Notes: Fetches a bundle of all Encounter resources matching the specified patient and type (how to search by reference and how to search by token)

4. SHOULD support searching using the combination of the patient and location search parameters:

   GET [base]/Encounter?patient={Type/}[id]&location={Type/}[id]

   Example:

   1. GET [base]/Encounter?patient=1137192&location=Location/hospital

   Implementation Notes: Fetches a bundle of all Encounter resources matching the specified patient and location (how to search by reference)

5. SHOULD support searching using the combination of the patient and status search parameters:

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

   Example:

   1. GET [base]/Encounter?patient=example1&status=finished

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

6. SHOULD support searching using the combination of the patient and discharge-disposition search parameters:

   GET [base]/Encounter?patient={Type/}[id]&discharge-disposition={system|}[code]

   Example:

   1. GET [base]/Encounter?patient=example1&discharge-disposition=01

   Implementation Notes: Fetches a bundle of all Encounter resources matching the specified patient and discharge-disposition (how to search by reference and how to search by token)