Da Vinci - Coverage Requirements Discovery
2.1.0 - STU 2.1 United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.1.0: STU 2.1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CRDCommunicationRequest - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the profile-communicationrequest resource profile.

Guidance on how to interpret the contents of this table can be found here

0. CommunicationRequest
2. CommunicationRequest.extension
SlicingThis element introduces a set of slices on CommunicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. CommunicationRequest.extension:Coverage-Information
    Slice NameCoverage-Information
    Control0..*
    TypeExtension(Coverage Information) (Complex Extension)
    Must Supporttrue
    6. CommunicationRequest.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Must Supporttrue
    8. CommunicationRequest.basedOn
    Control1..1
    Must Supporttrue
    10. CommunicationRequest.replaces
    Comments

    potentially relevant for CRD in some situations.

    TypeReference(CRD Communication Request)
    12. CommunicationRequest.status
    Comments

    This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order, for order-dispatch or when referenced by an appointment.

    Must Supporttrue
    Example<br/><b>General</b>:draft
    14. CommunicationRequest.doNotPerform
    Control0..0
    16. CommunicationRequest.subject
    Control1..?
    TypeReference(CRD Patient)
    Must Supporttrue
    18. CommunicationRequest.encounter
    Comments

    potentially relevant for CRD in some situations.

    TypeReference(CRD Encounter)
    20. CommunicationRequest.payload
    Control1..?
    Must Supporttrue
    22. CommunicationRequest.payload.extension
    Control1..?
    SlicingThis element introduces a set of slices on CommunicationRequest.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 24. CommunicationRequest.payload.extension:codeableConcept
      Slice NamecodeableConcept
      Comments

      If the actual communication request being authored is conveying resources or an attachment, the CRD client SHALL either determine a coded way to indicate what information sharing is being requested or shall omit sharing the CommunicationRequest - i.e. don't bother calling the hook service.

      Control1..1
      TypeExtension(Extension Definition for CommunicationRequest.payload.content[x] for Version 5.0) (Extension Type: CodeableConcept)
      Must Supporttrue
      26. CommunicationRequest.payload.extension:codeableConcept.value[x]
      TypeCodeableConcept
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      28. CommunicationRequest.occurrence[x]
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Must Supporttrue
      30. CommunicationRequest.authoredOn
      Control1..?
      Must Supporttrue
      32. CommunicationRequest.requester
      Control1..?
      TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
      Must Supporttrue
      Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
      34. CommunicationRequest.recipient
      TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
      Must Supporttrue
      Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
      36. CommunicationRequest.sender
      TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
      Must Supporttrue
      Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
      38. CommunicationRequest.reasonCode
      Must Supporttrue
      40. CommunicationRequest.reasonReference
      Comments

      potentially relevant for CRD in some situations.

      Must Supporttrue

      Guidance on how to interpret the contents of this table can be found here

      0. CommunicationRequest
      Definition

      A request to convey information; e.g. the CDS system proposes that an alert be sent to a responsible provider, the CDS system proposes that the public health agency be notified about a reportable condition.

      ShortA request for information to be sent to a receiver
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Invariantsdom-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())
      2. CommunicationRequest.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.

      ShortA set of rules under which this content was created
      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.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      4. CommunicationRequest.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional content defined by implementations
      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.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on CommunicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 6. CommunicationRequest.extension:Coverage-Information
        Slice NameCoverage-Information
        Definition

        Indicates coverage information.

        ShortCoverageInfo
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Coverage Information) (Complex Extension)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        crd-ci-q1: Questionnaire is only allowed when doc-needed exists (extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists())
        crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' must not exist. (extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not())
        crd-ci-q3: 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. (extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists())
        crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'withpa'. (extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa'))
        crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. (extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists())
        crd-ci-q6: If 'info-needed' is Other, then reason must be specified (extension.where(url = 'info-needed' and value = 'Other').exists() implies extension.where(url = 'reason').exists())
        crd-ci-q7: If reason.coding is present and is not from the extensible value set, then reason.text must be present (extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons'))
        8. CommunicationRequest.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).

        ShortExtensions that cannot be ignored
        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        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 Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        10. CommunicationRequest.identifier
        Definition

        Business identifiers assigned to this communication request by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

        ShortUnique identifier
        Comments

        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.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows identification of the communication request as it is known by various participating systems and in a way that remains consistent across servers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. CommunicationRequest.basedOn
        Definition

        A plan or proposal that is fulfilled in whole or in part by this request.

        ShortFulfills plan or proposal
        Control10..1*
        TypeReference(Resource)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows tracing of authorization for the request and tracking whether proposals/recommendations were acted upon.

        Alternate Namesfulfills
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. CommunicationRequest.replaces
        Definition

        Completed or terminated request(s) whose function is taken by this new request.

        ShortRequest(s) replaced by this request
        Comments

        potentially relevant for CRD in some situations.


        The replacement could be because the initial request was immediately rejected (due to an issue) or because the previous request was completed, but the need for the action described by the request remains ongoing.

        Control0..*
        TypeReference(CRD Communication Request, CommunicationRequest)
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows tracing the continuation of a therapy or administrative process instantiated through multiple requests.

        Alternate Namessupersedes, prior
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. CommunicationRequest.status
        Definition

        The status of the proposal or order.

        Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
        Comments

        This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order, for order-dispatch or when referenced by an appointment.

        Control1..1
        BindingThe codes SHALL be taken from RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

        The status of the communication request.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Example<br/><b>General</b>:draft
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. CommunicationRequest.doNotPerform
        Definition

        If true indicates that the CommunicationRequest is asking for the specified action to not occur.

        ShortTrue if request is prohibiting action
        Comments

        The attributes provided with the request qualify what is not to be done.

        Control0..01
        Typeboolean
        Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a communication, it is a request for the communication to not occur.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Alternate Namesprohibited
        Meaning if MissingIf do not perform is not specified, the request is a positive request e.g. "do perform"
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. CommunicationRequest.subject
        Definition

        The patient or group that is the focus of this communication request.

        ShortFocus of message
        Control10..1
        TypeReference(CRD Patient, Patient, Group)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Alternate Namespatient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. CommunicationRequest.encounter
        Definition

        The Encounter during which this CommunicationRequest was created or to which the creation of this record is tightly associated.

        ShortEncounter created as part of
        Comments

        potentially relevant for CRD in some situations.


        This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

        Control0..1
        TypeReference(CRD Encounter, Encounter)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. CommunicationRequest.payload
        Definition

        Text, attachment(s), or resource(s) to be communicated to the recipient.

        ShortMessage payload
        Control10..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. CommunicationRequest.payload.extension
        Definition

        An Extension


        May be used to represent additional information that is not part of the basic definition of the element. 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.

        ShortExtensionAdditional content defined by implementations
        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.

        Control10..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on CommunicationRequest.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 28. CommunicationRequest.payload.extension:codeableConcept
          Slice NamecodeableConcept
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Comments

          If the actual communication request being authored is conveying resources or an attachment, the CRD client SHALL either determine a coded way to indicate what information sharing is being requested or shall omit sharing the CommunicationRequest - i.e. don't bother calling the hook service.

          Control1..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Extension Definition for CommunicationRequest.payload.content[x] for Version 5.0) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          30. CommunicationRequest.payload.extension:codeableConcept.extension
          Definition

          An Extension


          May be used to represent additional information that is not part of the basic definition of the element. 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.

          ShortExtensionAdditional content defined by implementations
          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.

          Control0..0*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on CommunicationRequest.payload.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 32. CommunicationRequest.payload.extension:codeableConcept.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-CommunicationRequest.payload.content[x]
            34. CommunicationRequest.payload.extension:codeableConcept.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control10..1
            TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. CommunicationRequest.payload.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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).

            ShortExtensions that cannot be ignored even if unrecognized
            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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            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 Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            38. CommunicationRequest.payload.content[x]
            Definition

            The communicated content (or for multi-part communications, one portion of the communication).

            ShortMessage part content
            Control1..1
            TypeChoice of: string, Attachment, Reference(Resource)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. CommunicationRequest.occurrence[x]
            Definition

            The time when this communication is to occur.

            ShortWhen scheduled
            Control0..1
            TypeChoice of: dateTime, Period
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summarytrue
            Alternate Namestiming
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. CommunicationRequest.authoredOn
            Definition

            For draft requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation.

            ShortWhen request transitioned to being actionable
            Control10..1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate NamescreatedOn
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. CommunicationRequest.requester
            Definition

            The device, individual, or organization who initiated the request and has responsibility for its activation.

            ShortWho/what is requesting service
            Control10..1
            TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
            Summarytrue
            Alternate Namesauthor
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. CommunicationRequest.recipient
            Definition

            The entity (e.g. person, organization, clinical information system, device, group, or care team) which is the intended target of the communication.

            ShortMessage recipient
            Control0..*
            TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, Group, CareTeam, HealthcareService)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. CommunicationRequest.sender
            Definition

            The entity (e.g. person, organization, clinical information system, or device) which is to be the source of the communication.

            ShortMessage sender
            Control0..1
            TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, HealthcareService)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. CommunicationRequest.reasonCode
            Definition

            Describes why the request is being made in coded or textual form.

            ShortWhy is communication needed?
            Comments

            Textual reasons can be captured using reasonCode.text.

            Control0..*
            BindingFor example codes, see v3 Code System ActReasonhttp://terminology.hl7.org/ValueSet/v3-ActReason
            (example to http://terminology.hl7.org/ValueSet/v3-ActReason)

            Codes for describing reasons for the occurrence of a communication.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. CommunicationRequest.reasonReference
            Definition

            Indicates another resource whose existence justifies this request.

            ShortWhy is communication needed?
            Comments

            potentially relevant for CRD in some situations.

            Control0..*
            TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

            Guidance on how to interpret the contents of this table can be found here

            0. CommunicationRequest
            Definition

            A request to convey information; e.g. the CDS system proposes that an alert be sent to a responsible provider, the CDS system proposes that the public health agency be notified about a reportable condition.

            ShortA request for information to be sent to a receiver
            Control0..*
            Is Modifierfalse
            Summaryfalse
            Invariantsdom-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())
            2. CommunicationRequest.id
            Definition

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

            ShortLogical id of this artifact
            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.

            Control0..1
            Typeid
            Is Modifierfalse
            Summarytrue
            4. CommunicationRequest.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.

            ShortMetadata about the resource
            Control0..1
            TypeMeta
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            6. CommunicationRequest.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.

            ShortA set of rules under which this content was created
            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.

            Control0..1
            Typeuri
            Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            8. CommunicationRequest.language
            Definition

            The base language in which the resource is written.

            ShortLanguage of the resource content
            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).

            Control0..1
            BindingThe codes SHOULD be taken from CommonLanguages
            (preferred to http://hl7.org/fhir/ValueSet/languages)

            A human language.

            Additional BindingsPurpose
            AllLanguagesMax Binding
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            10. CommunicationRequest.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.

            ShortText summary of the resource, for human interpretation
            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.

            Control0..1
            TypeNarrative
            Is Modifierfalse
            Summaryfalse
            Alternate Namesnarrative, html, xhtml, display
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            12. CommunicationRequest.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.

            ShortContained, inline 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.

            Control0..*
            TypeResource
            Is Modifierfalse
            Summaryfalse
            Alternate Namesinline resources, anonymous resources, contained resources
            14. CommunicationRequest.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on CommunicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 16. CommunicationRequest.extension:Coverage-Information
              Slice NameCoverage-Information
              Definition

              Indicates coverage information.

              ShortCoverageInfo
              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(Coverage Information) (Complex Extension)
              Is Modifierfalse
              Must Supporttrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              crd-ci-q1: Questionnaire is only allowed when doc-needed exists (extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists())
              crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' must not exist. (extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not())
              crd-ci-q3: 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. (extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists())
              crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'withpa'. (extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa'))
              crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. (extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists())
              crd-ci-q6: If 'info-needed' is Other, then reason must be specified (extension.where(url = 'info-needed' and value = 'Other').exists() implies extension.where(url = 'reason').exists())
              crd-ci-q7: If reason.coding is present and is not from the extensible value set, then reason.text must be present (extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons'))
              18. CommunicationRequest.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).

              ShortExtensions that cannot be ignored
              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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
              Summaryfalse
              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 Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              20. CommunicationRequest.identifier
              Definition

              Business identifiers assigned to this communication request by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

              ShortUnique identifier
              Comments

              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.

              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Allows identification of the communication request as it is known by various participating systems and in a way that remains consistent across servers.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. CommunicationRequest.basedOn
              Definition

              A plan or proposal that is fulfilled in whole or in part by this request.

              ShortFulfills plan or proposal
              Control1..1
              TypeReference(Resource)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Allows tracing of authorization for the request and tracking whether proposals/recommendations were acted upon.

              Alternate Namesfulfills
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              24. CommunicationRequest.replaces
              Definition

              Completed or terminated request(s) whose function is taken by this new request.

              ShortRequest(s) replaced by this request
              Comments

              potentially relevant for CRD in some situations.

              Control0..*
              TypeReference(CRD Communication Request)
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows tracing the continuation of a therapy or administrative process instantiated through multiple requests.

              Alternate Namessupersedes, prior
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. CommunicationRequest.groupIdentifier
              Definition

              A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition, prescription or similar form.

              ShortComposite request this is part of
              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.

              Control0..1
              TypeIdentifier
              Is Modifierfalse
              Summarytrue
              Alternate NamesgrouperId
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              28. CommunicationRequest.status
              Definition

              The status of the proposal or order.

              Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
              Comments

              This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order, for order-dispatch or when referenced by an appointment.

              Control1..1
              BindingThe codes SHALL be taken from RequestStatus
              (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

              The status of the communication request.

              Typecode
              Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid.
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Example<br/><b>General</b>:draft
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. CommunicationRequest.statusReason
              Definition

              Captures the reason for the current state of the CommunicationRequest.

              ShortReason for current status
              Comments

              This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the CommunicationRequest was created at all is captured in reasonCode, not here. [distinct reason codes for different statuses can be enforced using invariants if they are universal bindings].

              Control0..1
              Binding

              Codes identifying the reason for the current state of a request.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Alternate NamesSuspended Reason, Cancelled Reason
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              32. CommunicationRequest.category
              Definition

              The type of message to be sent such as alert, notification, reminder, instruction, etc.

              ShortMessage category
              Comments

              There may be multiple axes of categorization and one communication request may serve multiple purposes.

              Control0..*
              BindingFor example codes, see CommunicationCategory
              (example to http://hl7.org/fhir/ValueSet/communication-category)

              Codes for general categories of communications such as alerts, instruction, etc.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. CommunicationRequest.priority
              Definition

              Characterizes how quickly the proposed act must be initiated. Includes concepts such as stat, urgent, routine.

              Shortroutine | urgent | asap | stat
              Control0..1
              BindingThe codes SHALL be taken from RequestPriority
              (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

              Codes indicating the relative importance of a communication request.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Meaning if MissingIf missing, this task should be performed with normal priority
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. CommunicationRequest.doNotPerform
              Definition

              If true indicates that the CommunicationRequest is asking for the specified action to not occur.

              ShortTrue if request is prohibiting action
              Comments

              The attributes provided with the request qualify what is not to be done.

              Control0..0
              Typeboolean
              Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a communication, it is a request for the communication to not occur.
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Alternate Namesprohibited
              Meaning if MissingIf do not perform is not specified, the request is a positive request e.g. "do perform"
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. CommunicationRequest.medium
              Definition

              A channel that was used for this communication (e.g. email, fax).

              ShortA channel of communication
              Control0..*
              BindingFor example codes, see ParticipationMode
              (example to http://terminology.hl7.org/ValueSet/v3-ParticipationMode)

              Codes for communication mediums such as phone, fax, email, in person, etc.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              40. CommunicationRequest.subject
              Definition

              The patient or group that is the focus of this communication request.

              ShortFocus of message
              Control1..1
              TypeReference(CRD Patient)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Alternate Namespatient
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. CommunicationRequest.about
              Definition

              Other resources that pertain to this communication request and to which this communication request should be associated.

              ShortResources that pertain to this communication request
              Comments

              Don't use CommunicationRequest.about element when a more specific element exists, such as basedOn, reasonReference, or replaces.

              Control0..*
              TypeReference(Resource)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. CommunicationRequest.encounter
              Definition

              The Encounter during which this CommunicationRequest was created or to which the creation of this record is tightly associated.

              ShortEncounter created as part of
              Comments

              potentially relevant for CRD in some situations.

              Control0..1
              TypeReference(CRD Encounter)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              46. CommunicationRequest.payload
              Definition

              Text, attachment(s), or resource(s) to be communicated to the recipient.

              ShortMessage payload
              Control1..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. CommunicationRequest.payload.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              50. CommunicationRequest.payload.extension
              Definition

              An Extension

              ShortExtension
              Control1..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on CommunicationRequest.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 52. CommunicationRequest.payload.extension:codeableConcept
                Slice NamecodeableConcept
                Definition

                Optional Extension Element - found in all resources.

                ShortOptional Extensions Element
                Comments

                If the actual communication request being authored is conveying resources or an attachment, the CRD client SHALL either determine a coded way to indicate what information sharing is being requested or shall omit sharing the CommunicationRequest - i.e. don't bother calling the hook service.

                Control1..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Extension Definition for CommunicationRequest.payload.content[x] for Version 5.0) (Extension Type: CodeableConcept)
                Is Modifierfalse
                Must Supporttrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                54. CommunicationRequest.payload.extension:codeableConcept.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                56. CommunicationRequest.payload.extension:codeableConcept.extension
                Definition

                An Extension

                ShortExtension
                Control0..0
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on CommunicationRequest.payload.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 58. CommunicationRequest.payload.extension:codeableConcept.url
                  Definition

                  Source of the definition for the extension code - a logical name or a URL.

                  Shortidentifies the meaning of the extension
                  Comments

                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                  Control1..1
                  Typeuri
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-CommunicationRequest.payload.content[x]
                  60. CommunicationRequest.payload.extension:codeableConcept.value[x]
                  Definition

                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                  ShortValue of extension
                  Control1..1
                  TypeCodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  62. CommunicationRequest.payload.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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).

                  ShortExtensions that cannot be ignored even if unrecognized
                  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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  64. CommunicationRequest.payload.content[x]
                  Definition

                  The communicated content (or for multi-part communications, one portion of the communication).

                  ShortMessage part content
                  Control1..1
                  TypeChoice of: string, Attachment, Reference(Resource)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  66. CommunicationRequest.occurrence[x]
                  Definition

                  The time when this communication is to occur.

                  ShortWhen scheduled
                  Control0..1
                  TypeChoice of: dateTime, Period
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Must Support TypesNo must-support rules about the choice of types/profiles
                  Summarytrue
                  Alternate Namestiming
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  68. CommunicationRequest.authoredOn
                  Definition

                  For draft requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation.

                  ShortWhen request transitioned to being actionable
                  Control1..1
                  TypedateTime
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Alternate NamescreatedOn
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  70. CommunicationRequest.requester
                  Definition

                  The device, individual, or organization who initiated the request and has responsibility for its activation.

                  ShortWho/what is requesting service
                  Control1..1
                  TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
                  Is Modifierfalse
                  Must Supporttrue
                  Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
                  Summarytrue
                  Alternate Namesauthor
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  72. CommunicationRequest.recipient
                  Definition

                  The entity (e.g. person, organization, clinical information system, device, group, or care team) which is the intended target of the communication.

                  ShortMessage recipient
                  Control0..*
                  TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
                  Is Modifierfalse
                  Must Supporttrue
                  Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  74. CommunicationRequest.sender
                  Definition

                  The entity (e.g. person, organization, clinical information system, or device) which is to be the source of the communication.

                  ShortMessage sender
                  Control0..1
                  TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
                  Is Modifierfalse
                  Must Supporttrue
                  Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization)
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  76. CommunicationRequest.reasonCode
                  Definition

                  Describes why the request is being made in coded or textual form.

                  ShortWhy is communication needed?
                  Comments

                  Textual reasons can be captured using reasonCode.text.

                  Control0..*
                  BindingFor example codes, see v3 Code System ActReason
                  (example to http://terminology.hl7.org/ValueSet/v3-ActReason)

                  Codes for describing reasons for the occurrence of a communication.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  78. CommunicationRequest.reasonReference
                  Definition

                  Indicates another resource whose existence justifies this request.

                  ShortWhy is communication needed?
                  Comments

                  potentially relevant for CRD in some situations.

                  Control0..*
                  TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
                  Is Modifierfalse
                  Must Supporttrue
                  Must Support TypesNo must-support rules about the choice of types/profiles
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  80. CommunicationRequest.note
                  Definition

                  Comments made about the request by the requester, sender, recipient, subject or other participants.

                  ShortComments made about communication request
                  Control0..*
                  TypeAnnotation
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))