This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

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Resource Profile: PCT GFE ServiceRequest

The PCT ServiceRequest including details about a service for which a GFE is being requested.

Usage:

• Use this Resource Profile: PCT GFE Information Bundle and PCT GFE Missing Bundle
• Examples for this Resource Profile: ServiceRequest/PCT-ServiceRequest-1

Formal Views of Profile Content

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

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

This structure is derived from ServiceRequest

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest			ServiceRequest
status		1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Required Pattern: active
intent		1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: proposal
doNotPerform		0..0
code	S	1..1	CodeableConcept	What is being requested/ordered Binding: Claim Medical Product or Service Value Set (extensible)
quantity[x]	S	0..1	Quantity, Ratio, Range	Service amount
subject		1..1	Reference(HRex Patient Demographics)	Individual or Entity the service is ordered for
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ServiceRequest.code	extensible	USClaimMedicalProductOrServiceCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes from this IG

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	ServiceRequest	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order. Required Pattern: active
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: proposal
code	SΣ	1..1	CodeableConcept	What is being requested/ordered Binding: Claim Medical Product or Service Value Set (extensible)
quantity[x]	SΣ	0..1		Service amount
quantityQuantity			Quantity
quantityRatio			Ratio
quantityRange			Range
subject	Σ	1..1	Reference(HRex Patient Demographics)	Individual or Entity the service is ordered for
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: proposal http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.code	extensible	USClaimMedicalProductOrServiceCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes from this IG

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	ServiceRequest	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Identifiers assigned to this order
instantiatesCanonical	Σ	0..*	canonical(ActivityDefinition | PlanDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills
replaces	Σ	0..*	Reference(ServiceRequest)	What request replaces
requisition	Σ	0..1	Identifier	Composite Request ID
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order. Required Pattern: active
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: proposal
category	Σ	0..*	CodeableConcept	Classification of service Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
priority	Σ	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
code	SΣ	1..1	CodeableConcept	What is being requested/ordered Binding: Claim Medical Product or Service Value Set (extensible)
orderDetail	ΣC	0..*	CodeableConcept	Additional order information Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.
quantity[x]	SΣ	0..1		Service amount
quantityQuantity			Quantity
quantityRatio			Ratio
quantityRange			Range
subject	Σ	1..1	Reference(HRex Patient Demographics)	Individual or Entity the service is ordered for
encounter	Σ	0..1	Reference(Encounter)	Encounter in which the request was created
occurrence[x]	Σ	0..1		When service should occur
occurrenceDateTime			dateTime
occurrencePeriod			Period
occurrenceTiming			Timing
asNeeded[x]	Σ	0..1		Preconditions for service Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
authoredOn	Σ	0..1	dateTime	Date request signed
requester	Σ	0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	Who/what is requesting service
performerType	Σ	0..1	CodeableConcept	Performer role Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
performer	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer
locationCode	Σ	0..*	CodeableConcept	Requested location Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.
locationReference	Σ	0..*	Reference(Location)	Requested location
reasonCode	Σ	0..*	CodeableConcept	Explanation/Justification for procedure or service Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.
reasonReference	Σ	0..*	Reference(Condition | Observation | DiagnosticReport | DocumentReference)	Explanation/Justification for service or service
insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
supportingInfo		0..*	Reference(Resource)	Additional clinical information
specimen	Σ	0..*	Reference(Specimen)	Procedure Samples
bodySite	Σ	0..*	CodeableConcept	Location on Body Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
note		0..*	Annotation	Comments
patientInstruction	Σ	0..1	string	Patient or consumer-oriented instructions
relevantHistory		0..*	Reference(Provenance)	Request provenance
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ServiceRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: proposal http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.category	example	ServiceRequestCategoryCodes http://hl7.org/fhir/ValueSet/servicerequest-category from the FHIR Standard
ServiceRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
ServiceRequest.code	extensible	USClaimMedicalProductOrServiceCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes from this IG
ServiceRequest.orderDetail	example	ServiceRequestOrderDetailsCodes http://hl7.org/fhir/ValueSet/servicerequest-orderdetail from the FHIR Standard
ServiceRequest.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
ServiceRequest.performerType	example	ParticipantRoles http://hl7.org/fhir/ValueSet/participant-role from the FHIR Standard
ServiceRequest.locationCode	example	ServiceDeliveryLocationRoleType http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCode	example	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
ServiceRequest.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard

This structure is derived from ServiceRequest

Summary

Mandatory: 1 element
Must-Support: 2 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• HRex Patient Demographics (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics)

Maturity: 2

Differential View

This structure is derived from ServiceRequest

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest			ServiceRequest
status		1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Required Pattern: active
intent		1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: proposal
doNotPerform		0..0
code	S	1..1	CodeableConcept	What is being requested/ordered Binding: Claim Medical Product or Service Value Set (extensible)
quantity[x]	S	0..1	Quantity, Ratio, Range	Service amount
subject		1..1	Reference(HRex Patient Demographics)	Individual or Entity the service is ordered for
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ServiceRequest.code	extensible	USClaimMedicalProductOrServiceCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	ServiceRequest	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order. Required Pattern: active
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: proposal
code	SΣ	1..1	CodeableConcept	What is being requested/ordered Binding: Claim Medical Product or Service Value Set (extensible)
quantity[x]	SΣ	0..1		Service amount
quantityQuantity			Quantity
quantityRatio			Ratio
quantityRange			Range
subject	Σ	1..1	Reference(HRex Patient Demographics)	Individual or Entity the service is ordered for
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: proposal http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.code	extensible	USClaimMedicalProductOrServiceCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	ServiceRequest	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Identifiers assigned to this order
instantiatesCanonical	Σ	0..*	canonical(ActivityDefinition | PlanDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills
replaces	Σ	0..*	Reference(ServiceRequest)	What request replaces
requisition	Σ	0..1	Identifier	Composite Request ID
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order. Required Pattern: active
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: proposal
category	Σ	0..*	CodeableConcept	Classification of service Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
priority	Σ	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
code	SΣ	1..1	CodeableConcept	What is being requested/ordered Binding: Claim Medical Product or Service Value Set (extensible)
orderDetail	ΣC	0..*	CodeableConcept	Additional order information Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.
quantity[x]	SΣ	0..1		Service amount
quantityQuantity			Quantity
quantityRatio			Ratio
quantityRange			Range
subject	Σ	1..1	Reference(HRex Patient Demographics)	Individual or Entity the service is ordered for
encounter	Σ	0..1	Reference(Encounter)	Encounter in which the request was created
occurrence[x]	Σ	0..1		When service should occur
occurrenceDateTime			dateTime
occurrencePeriod			Period
occurrenceTiming			Timing
asNeeded[x]	Σ	0..1		Preconditions for service Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
authoredOn	Σ	0..1	dateTime	Date request signed
requester	Σ	0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	Who/what is requesting service
performerType	Σ	0..1	CodeableConcept	Performer role Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
performer	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer
locationCode	Σ	0..*	CodeableConcept	Requested location Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.
locationReference	Σ	0..*	Reference(Location)	Requested location
reasonCode	Σ	0..*	CodeableConcept	Explanation/Justification for procedure or service Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.
reasonReference	Σ	0..*	Reference(Condition | Observation | DiagnosticReport | DocumentReference)	Explanation/Justification for service or service
insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
supportingInfo		0..*	Reference(Resource)	Additional clinical information
specimen	Σ	0..*	Reference(Specimen)	Procedure Samples
bodySite	Σ	0..*	CodeableConcept	Location on Body Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
note		0..*	Annotation	Comments
patientInstruction	Σ	0..1	string	Patient or consumer-oriented instructions
relevantHistory		0..*	Reference(Provenance)	Request provenance
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ServiceRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: proposal http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.category	example	ServiceRequestCategoryCodes http://hl7.org/fhir/ValueSet/servicerequest-category from the FHIR Standard
ServiceRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
ServiceRequest.code	extensible	USClaimMedicalProductOrServiceCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes from this IG
ServiceRequest.orderDetail	example	ServiceRequestOrderDetailsCodes http://hl7.org/fhir/ValueSet/servicerequest-orderdetail from the FHIR Standard
ServiceRequest.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
ServiceRequest.performerType	example	ParticipantRoles http://hl7.org/fhir/ValueSet/participant-role from the FHIR Standard
ServiceRequest.locationCode	example	ServiceDeliveryLocationRoleType http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCode	example	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
ServiceRequest.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard

This structure is derived from ServiceRequest

Summary

Mandatory: 1 element
Must-Support: 2 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• HRex Patient Demographics (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics)

Maturity: 2

Other representations of profile: CSV, Excel, Schematron