0.3.0 - Second STU ballot

This page is part of a downloaded copy of this specification. This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v0.3.0: STU 1 Ballot 2) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

## StructureDefinition: ServiceRequestR4 - Detailed Descriptions

Definitions for the profile-servicerequest-r4 Profile.

1. ServiceRequest
Definition | A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.
Control | 0..*
Alternate Names | diagnostic request, referral, referral request, transfer of care request
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.div.exists()) prr-1: orderDetail SHALL only be present if code is present (: orderDetail.empty() or code.exists())
2. ServiceRequest.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | id
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
3. ServiceRequest.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Control | 0..1
Type | Meta
4. ServiceRequest.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Control | 0..1
Type | uri
Is Modifier | true
Comments | 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
5. ServiceRequest.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | A human language. The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages
Type | code
Comments | 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).
6. ServiceRequest.text
Definition | A human-readable narrative that contains a summary of the resource and can 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.
Control | 0..1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
7. ServiceRequest.contained
Definition | 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.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
Comments | 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
8. ServiceRequest.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | 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.
9. ServiceRequest.modifierExtension
Definition | 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Comments | 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.
10. ServiceRequest.identifier
Definition | Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Must Support | true
Comments | The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.
11. ServiceRequest.instantiatesCanonical
Definition | The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Control | 1..1
Type | canonical(ActivityDefinition | PlanDefinition)
Must Support | true
Comments | Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
12. ServiceRequest.instantiatesUri
Definition | The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Control | 0..*
Type | uri
Comments | This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
13. ServiceRequest.basedOn
Definition | Plan/proposal/order fulfilled by this request.
Control | 1..1
Type | Reference(ServiceRequestR4 | MedicationRequestR4)
Must Support | true
Alternate Names | fulfills
14. ServiceRequest.replaces
Definition | The request takes the place of the referenced completed or terminated request(s).
Control | 0..*
Type | Reference(ServiceRequest)
Alternate Names | supersedes, prior, renewed order
Comments | potentially relevant for CRD in some situations.
15. ServiceRequest.requisition
Definition | A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.
Control | 0..1
Type | Identifier
Requirements | Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.
Alternate Names | grouperId, groupIdentifier
Comments | Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
16. ServiceRequest.status
Definition | The status of the order.
Control | 1..1
Binding | The status of a service order. The codes SHALL be taken from RequestStatus
Type | code
Is Modifier | true
Must Support | true
Comments | The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.
Fixed Value | draft
17. ServiceRequest.intent
Definition | Whether the request is a proposal, plan, an original order or a reflex order.
Control | 1..1
Binding | The kind of service request. The codes SHALL be taken from RequestIntent
Type | code
Is Modifier | true
Comments | potentially relevant for CRD in some situations.
18. ServiceRequest.category
Definition | A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").
Control | 0..*
Binding | Classification of the requested service. For example codes, see ServiceRequestCategoryCodes
Type | CodeableConcept
Requirements | Used for filtering what service request are retrieved and displayed.
Comments | There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.
19. ServiceRequest.priority
Definition | Indicates how quickly the ServiceRequest should be addressed with respect to other requests.
Control | 0..1
Binding | Identifies the level of importance to be assigned to actioning the request. The codes SHALL be taken from RequestPriority
Type | code
Meaning if Missing | If missing, this task should be performed with normal priority
20. ServiceRequest.doNotPerform
Definition | Set this to true if the record is saying that the service/procedure should NOT be performed.
Control | 0..0
Type | boolean
Is Modifier | true
Requirements | Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.
Comments | In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.
Meaning if Missing | If missing, the request is a positive request e.g. "do perform"
21. ServiceRequest.code
Definition | A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.
Control | 1..1
Binding | Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available [here](valueset-diagnostic-requests.html). For example codes, see ProcedureCodes(SNOMEDCT)
Type | CodeableConcept
Must Support | true
Alternate Names | service requested
Comments | Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.
22. ServiceRequest.orderDetail
Definition | Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.
Control | 0..* This element is affected by the following invariants: prr-1
Binding | Codified order entry details which are based on order context. For example codes, see ServiceRequestOrderDetailsCodes
Type | CodeableConcept
Alternate Names | detailed instructions
Comments | For information from the medical record intended to support the delivery of the requested services, use the `supportingInformation` element.
23. ServiceRequest.quantity[x]
Definition | An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).
Control | 0..1
Type | Choice of: Quantity, Ratio, Range
[x] Note | See Choice of Data Types for further information about how to use [x]
Requirements | When ordering a service the number of service items may need to be specified separately from the the service item.
24. ServiceRequest.subject
Definition | On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).
Control | 1..1
Type | Reference(PatientR4)
Must Support | true
25. ServiceRequest.encounter
Definition | An encounter that provides additional information about the healthcare context in which this request is made.
Control | 0..1
Type | Reference(EncounterR4)
Alternate Names | context
Comments | potentially relevant for CRD in some situations.
26. ServiceRequest.occurrence[x]
Definition | The date/time at which the requested service should occur.
Control | 0..1
Type | Choice of: dateTime, Period, Timing
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Alternate Names | schedule
27. ServiceRequest.asNeeded[x]
Definition | If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.
Control | 0..1
Binding | A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc. For example codes, see SNOMEDCTMedicationAsNeededReasonCodes
Type | Choice of: boolean, CodeableConcept
[x] Note | See Choice of Data Types for further information about how to use [x]
28. ServiceRequest.authoredOn
Definition | When the request transitioned to being actionable.
Control | 1..1
Type | dateTime
Must Support | true
Alternate Names | orderedOn
29. ServiceRequest.requester
Definition | The individual who initiated the request and has responsibility for its activation.
Control | 1..1
Type | Reference(PractitionerR4 | US Core PractitionerRole Profile)
Must Support | true
Alternate Names | author, orderer
Comments | This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.
30. ServiceRequest.performerType
Definition | Desired type of performer for doing the requested service.
Control | 0..1
Binding | Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc. For example codes, see ParticipantRoles
Type | CodeableConcept
Alternate Names | specialty
Comments | potentially relevant for CRD in some situations.
31. ServiceRequest.performer
Definition | The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.
Control | 0..*
Type | Reference(PractitionerR4 | US Core PractitionerRole Profile)
Must Support | true
Alternate Names | request recipient
Comments | If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).
32. ServiceRequest.locationCode
Definition | The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.
Control | 0..*
Binding | A location type where services are delivered. For example codes, see V3 Value SetServiceDeliveryLocationRoleType
Type | CodeableConcept
33. ServiceRequest.locationReference
Definition | A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.
Control | 1..1
Type | Reference(LocationR4)
Must Support | true
34. ServiceRequest.reasonCode
Definition | An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in `supportingInfo`.
Control | 0..*
Binding | Diagnosis or problem codes justifying the reason for requesting the service investigation. For example codes, see ProcedureReasonCodes
Type | CodeableConcept
Must Support | true
Comments | This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use `CodeableConcept.text` element if the data is free (uncoded) text as shown in the CT Scan example.
35. ServiceRequest.reasonReference
Definition | Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo`.
Control | 0..*
Type | Reference(US Core Condition Profile | US Core Result Observation)
Must Support | true
Comments | potentially relevant for CRD in some situations.
36. ServiceRequest.insurance
Definition | Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.
Control | 0..*
Type | Reference(CoverageR4)
Must Support | true
37. ServiceRequest.supportingInfo
Definition | Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.
Control | 0..*
Type | Reference(Resource)
Alternate Names | Ask at order entry question, AOE
Comments | potentially relevant for CRD in some situations.
38. ServiceRequest.specimen
Definition | One or more specimens that the laboratory procedure will use.
Control | 0..*
Type | Reference(Specimen)
Comments | Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.
39. ServiceRequest.bodySite
Definition | Anatomic location where the procedure should be performed. This is the target site.
Control | 0..*
Binding | Codes describing anatomical locations. May include laterality. For example codes, see SNOMEDCTBodyStructures
Type | CodeableConcept
Requirements | Knowing where the procedure is performed is important for tracking if multiple sites are possible.
Alternate Names | location
Comments | Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure.
40. ServiceRequest.note
Definition | Any other notes and comments made about the service request. For example, internal billing notes.
Control | 0..*
Type | Annotation
Comments | potentially relevant for CRD in some situations.
41. ServiceRequest.patientInstruction
Definition | Instructions in terms that are understood by the patient or consumer.
Control | 0..1
Type | string
42. ServiceRequest.relevantHistory
Definition | Key events in the history of the request.
Control | 0..*
Type | Reference(Provenance)
Comments | potentially relevant for CRD in some situations.