Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: PASCommunicationRequest - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 3

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.identifier
ShortUnique Identifier used in linking the Communication Request to the response (X12's Attachment Control Number).
NoteThis is a business identifier, not a resource identifier (see discussion)
Must Supporttrue
4. CommunicationRequest.status
Fixed Valueactive
6. CommunicationRequest.category
BindingThe codes SHALL be taken from https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755
(required to https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755)

Codes indicating the title or contents of a document, report or supporting item. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

Must Supporttrue
8. CommunicationRequest.medium
BindingUnless not suitable, these codes SHALL be taken from PAS Communication Medium Value Set
(extensible to http://hl7.org/fhir/us/davinci-pas/ValueSet/PASCommunicationRequestMedium)
Must Supporttrue
10. CommunicationRequest.payload
Must Supporttrue
12. CommunicationRequest.payload.extension
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
  • 14. CommunicationRequest.payload.extension:serviceLineNumber
    Slice NameserviceLineNumber
    Control0..1
    TypeExtension(ServiceLineNumber) (Extension Type: positiveInt)
    Must Supporttrue
    16. CommunicationRequest.payload.extension:communicatedDiagnosis
    Slice NamecommunicatedDiagnosis
    Control0..*
    TypeExtension(CommunicatedDiagnosis) (Extension Type: CodeableConcept)
    Must Supporttrue
    18. CommunicationRequest.payload.extension:contentModifier
    Slice NamecontentModifier
    Control0..*
    TypeExtension(ContentModifier) (Extension Type: CodeableConcept)
    Must Supporttrue
    20. CommunicationRequest.payload.content[x]
    Typestring, Reference(Resource), Attachment
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    22. CommunicationRequest.requester
    TypeReference(PAS Insurer Organization)
    Must Supporttrue
    24. CommunicationRequest.recipient
    TypeReference(PAS Practitioner, PAS Organization Base Profile)
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    26. CommunicationRequest.sender
    TypeReference(PAS Requestor Organization)
    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.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())
    6. 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 used in linking the Communication Request to the response (X12's Attachment Control Number).Unique 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()))
    8. CommunicationRequest.status
    Definition

    The status of the proposal or order.

    Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
    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
    Summarytrue
    Fixed Valueactive
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. 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..*
    BindingThe codes SHALL be taken from For example codes, see https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755http://hl7.org/fhir/ValueSet/communication-category
    (required to https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755)

    Codes indicating the title or contents of a document, report or supporting item. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


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

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. 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..1
    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()))
    14. CommunicationRequest.medium
    Definition

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

    ShortA channel of communication
    Control0..*
    BindingUnless not suitable, these codes SHALL be taken from For example codes, see PAS Communication Medium Value Sethttp://terminology.hl7.org/ValueSet/v3-ParticipationMode
    (extensible to http://hl7.org/fhir/us/davinci-pas/ValueSet/PASCommunicationRequestMedium)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. CommunicationRequest.payload
    Definition

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

    ShortMessage payload
    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. 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.

    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.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 20. CommunicationRequest.payload.extension:serviceLineNumber
      Slice NameserviceLineNumber
      Definition

      A number that links the content being requested with the claim item number.

      ShortExtension
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(ServiceLineNumber) (Extension Type: positiveInt)
      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())
      22. CommunicationRequest.payload.extension:communicatedDiagnosis
      Slice NamecommunicatedDiagnosis
      Definition

      A code representing the diagnosis that is the subject of the communication

      ShortExtension
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(CommunicatedDiagnosis) (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())
      24. CommunicationRequest.payload.extension:contentModifier
      Slice NamecontentModifier
      Definition

      A code representing a modifier of the content being requested

      ShortExtension
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(ContentModifier) (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())
      26. 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())
      28. CommunicationRequest.payload.content[x]
      Definition

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

      ShortMessage part content
      Control1..1
      Typestring, Reference(Resource), Attachment
      [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
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. CommunicationRequest.requester
      Definition

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

      ShortWho/what is requesting service
      Control0..1
      TypeReference(PAS Insurer Organization, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate Namesauthor
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. 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(PAS Practitioner, PAS Organization Base Profile, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, Group, CareTeam, HealthcareService)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. 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(PAS Requestor Organization, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, HealthcareService)
      Is Modifierfalse
      Must Supporttrue
      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

      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.

      ShortAdditional 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())
      16. 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())
      18. 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 used in linking the Communication Request to the response (X12's Attachment Control Number).
      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()))
      20. CommunicationRequest.basedOn
      Definition

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

      ShortFulfills plan or proposal
      Control0..*
      TypeReference(Resource)
      Is Modifierfalse
      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()))
      22. CommunicationRequest.replaces
      Definition

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

      ShortRequest(s) replaced by this request
      Comments

      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(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()))
      24. 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()))
      26. CommunicationRequest.status
      Definition

      The status of the proposal or order.

      Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
      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
      Summarytrue
      Fixed Valueactive
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. 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()))
      30. 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..*
      BindingThe codes SHALL be taken from https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755
      (required to https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755)

      Codes indicating the title or contents of a document, report or supporting item. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. 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()))
      34. 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..1
      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()))
      36. CommunicationRequest.medium
      Definition

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

      ShortA channel of communication
      Control0..*
      BindingUnless not suitable, these codes SHALL be taken from PAS Communication Medium Value Set
      (extensible to http://hl7.org/fhir/us/davinci-pas/ValueSet/PASCommunicationRequestMedium)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. CommunicationRequest.subject
      Definition

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

      ShortFocus of message
      Control0..1
      TypeReference(Patient, Group)
      Is Modifierfalse
      Summaryfalse
      Alternate Namespatient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. 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()))
      42. 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

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

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

      ShortMessage payload
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. 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
      48. CommunicationRequest.payload.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.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 50. CommunicationRequest.payload.extension:serviceLineNumber
        Slice NameserviceLineNumber
        Definition

        A number that links the content being requested with the claim item number.

        ShortExtension
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(ServiceLineNumber) (Extension Type: positiveInt)
        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())
        52. CommunicationRequest.payload.extension:communicatedDiagnosis
        Slice NamecommunicatedDiagnosis
        Definition

        A code representing the diagnosis that is the subject of the communication

        ShortExtension
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(CommunicatedDiagnosis) (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:contentModifier
        Slice NamecontentModifier
        Definition

        A code representing a modifier of the content being requested

        ShortExtension
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(ContentModifier) (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())
        56. 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())
        58. CommunicationRequest.payload.content[x]
        Definition

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

        ShortMessage part content
        Control1..1
        Typestring
        [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
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. 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
        Summarytrue
        Alternate Namestiming
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. 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
        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Alternate NamescreatedOn
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        64. CommunicationRequest.requester
        Definition

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

        ShortWho/what is requesting service
        Control0..1
        TypeReference(PAS Insurer Organization)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Alternate Namesauthor
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        66. 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(PAS Practitioner, PAS Organization Base Profile)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        68. 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(PAS Requestor Organization)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. 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
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. CommunicationRequest.reasonReference
        Definition

        Indicates another resource whose existence justifies this request.

        ShortWhy is communication needed?
        Control0..*
        TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. 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()))