eLTSS ServiceRequest Profile - Electronic Long-Term Services and Supports (eLTSS) Release 1

Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm
2.0.0-ballot - ballot United States of America flag

This page is part of the electronic Long-Term Services and Supports Implementation Guide (v2.0.0-ballot: STU2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: eLTSS ServiceRequest Profile

Official URL: http://hl7.org/fhir/us/eltss/StructureDefinition/ServiceRequest-eltss				Version: 2.0.0-ballot
Standards status: Trial-use			Maturity Level: 2	Computable Name: ServiceRequest_eltss

ServiceRequest resource mapping for eLTSS

Implementer mapping guidance

The following aids in finding the location of eLTSS data elements. See R4 FHIR Mapping page for complete guidance, here we are providing a subset of fields for convenience.

eLTSS Grouping	eLTSS Data Element Name	Data Element Definition (includes examples, expected list of values and usage note where applicable)	FHIR R4 Resource Element(s)	FHIR R4 Resource Element Cardinality (with US Core Constraints)	Additional Mapping Details	Important change
Service Information	Service Name	Identifies the paid and/or non-paid service provided to a person. Include the code and display name plus any modifiers when a coding system (e.g., Healthcare Common Procedure Coding System (HCPCS), Home Health Revenue Codes) is used.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → code → text ServiceRequest → code → coding → code ServiceRequest → code → coding → system	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........code 0..1 ............text 0..1 ............coding 0..1 ...............code 0..1 ...............system 0..1	1) activity is part of CarePlan, so no references are required to link the two. 2) coding → code is the "code plus any modifiers" described in the eLTSS Dataset data element definition. system identifies the code system from which the code is from. For HCPCS, the system value can be set to "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/". 3) text is the "display name" described in the eLTSS Dataset data element definition. 4) Note that modifiers for CPT & HCPCS are appended to the code using a dash. So the entire code plus the modifier is a single string.
Service Information	Self-Directed Service Indicator	Indicates whether the individual chose to self-direct the service.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → extension → url ServiceRequest → extension → valueCodeableConcept → text	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........extension 0..* ............url 0..1 ............valueCodeableConcept 0..1 ...............text 0..1	1) activity is part of CarePlan, so no references are required to link the two. 2) The procedure-directedBy extension is indicated by populating the url data attribute with the value "http://hl7.org/fhir/StructureDefinition/procedure-directedBy". 3) The text data element can be populated with the value "self" to indicate that this service is self-directed. Other values could be provided to indicate that someone else is directing the service. This is in addition to populating the proper element in the Resource indicated in CarePlan.activity.reference such as Task, Observation etc to indicate who is responsible or carried out the task.
Service Information	Service Start Date	The start date of the service being provided.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → occurrenceTiming → boundsPeriod → start	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........occurrenceTiming 0..1 ............boundsPeriod 0..1 ...............start 0..1	1) activity is part of CarePlan, so no references are required to link the two. 2) start is in dateTime format which can be date, date-time or partial date (e.g. just year or year + month).
Service Information	Service End Date	The end date of the service being provided.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → occurrenceTiming → boundsPeriod → end	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........occurrenceTiming 0..1 ............boundsPeriod 0..1 ...............end 0..1	1) activity is part of CarePlan, so no references are required to link the two. 2) end is in dateTime format which can be date, date-time or partial date (e.g. just year or year + month).
Service Information	Service Delivery Address	The address where service delivery will take place if service will not be provided at the person's address.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → locationReference(Location) Location → address → line Location → address → city Location → address → district Location → address → state Location → address → postalCode Location → address → text Location → description	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........locationReference(Location) 0..* ............address 0..* ...............line 0..* ...............city 0..1 ...............district 0..1 ...............state 0..1 ...............postalCode 0..1 ...............text 0..1 ............description 0..1	1) activity is part of CarePlan, so no references are required to link the two. 2) text is the full (not broken out) address. 3 line includes street name, number and suffix (e.g. 123 Main St.). 4) Information such as apt #, floor & room #, etc. also go into line, generally as a separate data element. 5) district covers county. 6) description can be used when the location is not a specific address, such as when support is being provided at a general location, such as someone providing assistance wherever the recipient grocery shops.
Service Information	Service Comment	Additional information related to the service being provided. This field could capture additional information of the frequency of the service, how the person wants the service delivered and only used when the comment provides additional detail of the service not already handled by another element.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → note → text	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........note 0..* ............text 1	1) activity is part of CarePlan, so no references are required to link the two. 2) text is required by FHIR if note is provided, and is a string.
Service Information	Service Funding Source	The source of payment for the service.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → insurance(Coverage) Coverage → payor(Organization \| Patient \| RelatedPerson) Organization \| Patient \| RelatedPerson → name	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........insurance(Coverage) 0..* ............payor(Organization \| Patient \| RelatedPerson) 1..* ...............name 0..1	1) Will use CarePlan → activity → reference to reference a ServiceRequest, and insurance to reference a Coverage resource, which must include a payor that is a person or an organization. 2) Coverage resource may be used to register "SelfPay" where an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care cost.
Service Information	Service Unit Quantity	The numerical amount of the service unit being provided for a frequency. This element is slated to be used in conjunction with Service Quantity Interval and Unit of Service Type elements to form a full description of how often a service is provided. For example, a service being provided 7 units per week, the Service Unit Quantity = "7". For a service being provided 8 hours a day, the Service Unit Value = "8".	CarePlan → activity → reference(ServiceRequest) ServiceRequest → quantityQuantity → value ServiceRequest → quantityQuantity → unit or ServiceRequest → quantityRatio → numerator → value ServiceRequest → quantityRatio → numerator → unit ServiceRequest → quantityRatio → denominator → value ServiceRequest → quantityRatio → denominator → unit	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........quantityQuantity 0..1 ............value 0..1 ............unit 0..1 .........quantityRatio 0..1 ............numerator 0..1 ...............value 0..1 ...............unit 0..1 ............denominator 0..1 ...............value 0..1 ...............unit 0..1	1) Will use CarePlan → activity → reference to reference a ServiceRequest. 2) quantityQuantity can be used to represent simple quantities such as "1 installation" or "5 trips". quantityRatio can be used to represent quantities with intervals such as "8 hours a day" or "7 units per week". Either quantityQuantity or quantityRatio can be used, but not both for the same ServiceRequest. 3) value is a decimal, and unit is a string. 4) numerator and denominator are used to represent a quantity with an interval. For example, to represent 8 hours a day, numerator → value would be "8" and numerator → unit would be "hour", while denominator → value would be "1" and denominator → unit would be "day". 5) See the "qty-unit-interval examples" worksheet in this spreadsheet for additional details. 6) Please also consider occurrencePeriod for use when the quantity is meant to be performed within a defined, simple start and end date. E.g. For May 31,2023 to June 10, 2023 give ServicePlan.quantity of 5 [USD]/day. AND, use occurrenceTiming for timing information that fluctuates or is sufficiently complex. The recipient may need to calculate end-date, or one can use occurrenceTiming.boundsPeriod to ascribe a start and end date. E.g. Give ServicePlan.quantity 5 with unit=[USD]/day with the occurrenceTiming.boundsPeriod of May 31, 2023 to June 23, 2023 on occurrenceTiming.dayOfWeek = Mon and Wed at occurrenceTiming.timeOfDay = 3 pm.	Added guidance on ServiceRequest.occurrenceTiming and ServiceRequest.occurrencePeriod
Service Information	Unit of Service Type	A named quantity in terms of which services are measured or specified, used as a standard measurement of like services. Values include: minute(s), 8 hour(s), quarter hour(s), hour(s), half day(s), full day(s), day(s), week(s), month(s), dollar(s), meal(s), mile(s), visit(s)/session(s), installation(s), none, other (free text). This element is slated to be used in conjunction with Service Unit Quantity interval and Service Unit Quantity elements to form a full description of how often a service is provided. For example, a service being provided 7 units per week, the Unit of Service Type = "units". For a service being provided 8 hours a day, the Unit of Service Type = "hours".	see above	see above	see above
Service Information	Service Unit Quantity Interval	A period of time corresponding to the quantity of service(s) indicated. Values include: per day, per week, per month, per year, one time only, other (free text). This element is slated to be used in conjunction with Unit of Service Type and Service Unit Quantity elements to form a full description of how often a service is provided. For example, a service being provided 7 units per week, the Service Unit Quantity Interval = "per week". For a service being provided 8 hours a day, the Service Unit Quantity Interval = "per day".	see above	see above	see above
Service Information	Service Rate per Unit	The rate of one unit for a service.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → supportingInfo(Claim) Claim → item → unitPrice	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........supportingInfo(Claim) 0..* ............item 0..* ...............unitPrice 0..1	1) Will use CarePlan → activity → reference to reference a ServiceRequest, and supportingInfo to reference a Claim. 2) item maps to a service. 3) unitPrice contains the charge or cost per point, which maps to the cost per one unit of the service. 4) unitPrice is of type Money, which is a descendant of the Quantity complex type and inherits value, unit, system, code, and comparator. 5) Workgroup in charge of ServiceRequest wants to work with the Claim workgroup to determine best approach. One potential approach is to update the scope of ClaimResponse since that reflects what has been approved rather than what is being asked for.
Service Information	Total Cost of Service	The total cost of a service for the plan.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → supportingInfo(Claim) Claim → item → net	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........supportingInfo(Claim) 0..* ............item 0..* ...............net 0..1	1) Will use CarePlan → activity → reference to reference a ServiceRequest, and supportingInfo to reference a Claim. 2) item maps to a service. 3) net is the total cost of an item, which in this case is the total cost for the service. 4) net is of type Money, which is a descendant of the Quantity complex type and inherits value, unit, system, code, and comparator. 5) See above.
Service Provider Information	Support Planner Name	The name of the person (e.g., Case Manager, Care Coordinator, Plan Coordinator) who helped develop the plan.	CarePlan → author(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Organization \| CareTeam) Practitioner \| Patient \| RelatedPerson → name → family Practitioner \| Patient \| RelatedPerson → name → given Practitioner \| Patient \| RelatedPerson → name → text Organization \| CareTeam → name	CarePlan ...author(Patient \| Practitioner \| RelatedPerson ) 0..1 ......name 0..* .........family 0..1 .........given 0..* .........text 0..1 CarePlan …author(Organization \| CareTeam ) 0..1 ......name 0..1	1) Will use CarePlan → author to reference a Practitioner, PractitionerRole, RelatedPerson, Organization, CareTeam or Patient (in self-directed plans) who is the primary author of the care plan being developed. 2) Practitioner, Organization, CareTeam, RelatedPerson and Patient all include name. 3) PractitionerRole should be used when the Organization for whom the Practitioner works for is also needed. 4) given is used for both first name & MI, so need more than one. 5) family is a string with the person's surname. 6) text is a string that contains the full name of the person. 7) The values for Support Planner Name and Support Planner Printed Name would include the same information.
Service Provider Information	Support Planner Phone Number	The primary phone number (and extension when applicable) of the support planner.	CarePlan → author(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Organization \| CareTeam ) Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Organization \| CareTeam → telecom → system Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Organization \| CareTeam → telecom → value	CarePlan ...author(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Organization \| CareTeam ) 0..1 ......telecom 0..* .........system 0..1 .........value 0..1	1) Will use CarePlan → author to reference a Practitioner, PractitionerRole, RelatedPerson, Organization, CareTeam or Patient (in self-directed plan) who is the primary author of the care plan being developed. 2) Practitioner, PractitionerRole, RelatedPerson, Organization, CareTeam and Patient all include telecom. 3) PractitionerRole should be used when the Organization for whom the Practitioner works for is also needed. 4) telecom is of type ContactPoint which contains elements to populate for the phone number. 5) system is required if value is provided, and can be: phone, fax, email, pager, url, sms, other. 6) Per FHIR, phone # should be formatted according to ITU-T E.123, so "(555) 675 5745" or "+22 555 675 5745".
Service Provider Information	Service Provider Name	The name of the entity or individual providing the service. For paid services use the organization/agency name, for non-paid services use the first and last name of the individual providing the service.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → performer(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson \| HealthcareService \| CareTeam) Practitioner \| PractitionerRole \| CareTeam \| Organization \| Patient \| Device \| RelatedPerson \| HealthcareService → name	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........performer(Practitioner \| PractitionerRole \| Patient \| Device \| RelatedPerson \| HealthcareService \| CareTeam) 0..* ............name 0..1 ---------------------------------- .........performer(Organization) 0..* ............name 1	1) Will use CarePlan → activity → reference to reference a ServiceRequest, and performer to reference a RelatedPerson, Organization or HealthcareService. Other options listed are available in FHIR, but may not be appropriate here. 2) Per eLTSS Dataset element definition, performer would reference an Organization or HealthcareService for paid services, and RelatedPerson for a non-paid service. 3) Organization → name and HealthcareService → name are strings with the organization's name. 4) RelatedPerson → name is a complex data element that includes strings for the person's surname and first name. 6) name is required by US Core for Organization. 7) The values for Service Provider Name and Service Provider Printed Name would include the same information.
Service Provider Information	Service Provider Phone Number	The primary phone number (and extension when applicable) of the service provider.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → performer(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson \| HealthcareService \| CareTeam) Practitioner \| PractitionerRole \| CareTeam \| Organization \| Patient \| Device \| RelatedPerson \| HealthcareService → telecom → system Practitioner \| PractitionerRole \| CareTeam \| Organization \| Patient \| Device \| RelatedPerson \| HealthcareService → telecom → value	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........performer(Practitioner \| PractitionerRole \| Patient \| Device \| RelatedPerson \| HealthcareService \| CareTeam) 0..* ............telecom 0..* .............system 0..1 .............value 0..1 ---------------------------------- .........performer(Organization) 0..* ............telecom 1..* .............system 0..1 .............value 1	1) Will use CarePlan → activity → reference to reference a ServiceRequest, and performer to reference a RelatedPerson, Organization or HealthcareService. Other options listed are available in FHIR, but may not be appropriate here. 2) Per eLTSS Dataset element definition, performer would reference an Organization or HealthcareService for paid services, and RelatedPerson for a non-paid service. 3) telecom is of type ContactPoint (https://www.hl7.org/fhir/datatypes.html#contactpoint) which contains elements to populate for the phone number. 4) system is required if value is provided, and can be: phone, fax, email, pager, url, sms, other. 5) Per FHIR, phone # should be formatted according to ITU-T E.123, so "(555) 675 5745" or "+22 555 675 5745". 6) US Core requires at least one contact be provided in telecom for an Organization.
Service Provider Information	Non-Paid Service Provider Relationship	The relationship (e.g., spouse, neighbor, guardian, daughter) of the individual providing a non-paid service or support to the person.	CarePlan → activity → reference(ServiceRequest) ServiceRequest → performer(RelatedPerson) RelatedPerson → relationship	CarePlan ...activity 0..* ......reference(ServiceRequest) 0..1 .........performer(RelatedPerson) 0..* ...........relationship 0.*	1) Will use CarePlan → activity → reference to reference a ServiceRequest, and performer to reference a RelatedPerson. 2) Per eLTSS Dataset element definition, performer would reference a RelatedPerson for a non-paid service. 3) relationship is a CodeableConcept, and FHIR provides a preferred value set whose values can be found in the PatientRelationshipType here: https://www.hl7.org/fhir/relatedperson.html. The list is very long and detailed, for example including not only sister, but stepsister, half-sister, twin sister, natural sister, and identical twin sister.

Data Requirements Not Specific to eLTSS Dataset Data Elements This section documents data elements that are mandatory per FHIR XML schemas or US Core requirements, but that do not align with individual eLTSS Dataset data elements.
FHIR Data Element Name Requirement Source	Data Element Definition	FHIR R4 Resource Element(s)	FHIR R4 Resource Element Cardinality (with US Core Constraints)	Additional Mapping Details
ServiceRequest Intent FHIR	Whether the request is a proposal, plan, an original order or a reflex order.	ServiceRequest → intent	ServiceRequest ...intent 1	1) intent is required by FHIR, and must use the RequestIntent value set. Possible values are: proposal, plan, order, original-order, reflex-order, filler-order, instance-order and option.
ServiceRequest Status FHIR	The status of the request.	ServiceRequest → status	ServiceRequest ...status 0..1	1) status is required by FHIR, and must use the RequestStatus value set which has values: draft, active, suspended, completed, entered-in-error, and cancelled.
ServiceRequest Subject FHIR	On whom or what the service is to be performed.	ServiceRequest → subject(Patient)	ServiceRequest ...subject 0..1	1) subject is required by FHIR, and is a reference to a Patient.

Usage:

Refer to this Resource Profile: CarePlan_eltss, Claim_eltss, EpisodeOfCare_eltss, Goal_eltss and ServiceRequest_eltss
Examples for this Resource Profile: ServiceRequest/service1, ServiceRequest/service2, ServiceRequest/service3 and ServiceRequest/service4

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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
directedBy		0..*	CodeableConcept	Self-Directed Service Indicator URL: http://hl7.org/fhir/us/eltss/StructureDefinition/eltss-directedBy
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
basedOn		0..*	Reference(CarePlan_eltss \| ServiceRequest_eltss \| MedicationRequest)	What request fulfills
replaces		0..*	Reference(ServiceRequest_eltss)	What request replaces
code	S	0..1	CodeableConcept	Service Name Binding: HealthCareCommonProcedureCodingSystem (preferred): Use HCPCS (https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/) code + modifiers or free text.
coding	S	0..*	Coding	Code defined by a terminology system
system	S	0..1	uri	Identity of the terminology system
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
Slices for quantity[x]	S	0..1	Quantity, Ratio, Range	Service Unit Quantity + Unit Type + Time Interval Slice: Unordered, Open by type:$this
quantity[x]:quantityQuantity	S	0..1	Quantity	Service amount
value	S	0..1	decimal	Numerical value (with implicit precision)
unit	S	0..1	string	UCUM codes are very useful here. But, if the concept maps to the unity unit in UCUM, then it is likely appropriate to choose a specific concept from another system. Use quanitityRatio when appropriate (such as in sessions per week) instead of quantityQuantity.
system	S	0..1	uri	System that defines coded unit form
code	S	0..1	code	Coded form of the unit
quantity[x]:quantityRatio	S	0..1	Ratio	Service amount
numerator	S	0..1	Quantity	Numerator value
value	S	0..1	decimal	Numerical value (with implicit precision)
unit	S	0..1	string	UCUM codes are very useful here, but also coded numerators could be used for something like: sessions per week. See the Implementation guidance section
system	S	0..1	uri	System that defines coded unit form
code	S	0..1	code	Coded form of the unit
denominator	S	0..1	Quantity	Denominator value
value	S	0..1	decimal	Numerical value (with implicit precision)
unit	S	0..1	string	UCUM codes are very useful here
system	S	0..1	uri	System that defines coded unit form
code	S	0..1	code	Coded form of the unit
subject	S	1..1	Reference(Patient_eltss S \| Group \| US Core Implantable Device Profile \| Device \| Location_eltss)	Individual or Entity the service is ordered for
encounter		0..1	Reference(US Core Encounter Profile)	Encounter in which the request was created
Slices for occurrence[x]	S	0..1	dateTime, Period, Timing	Service Start + End Date Slice: Unordered, Open by type:$this
occurrence[x]:occurrencePeriod	S	0..1	Period	Use this when the quantity is meant to be performed within a defined, simple start and end date. E.g. For May 31,2023 to June 10, 2023 give ServicePlan.quantity of 5 [USD]/day.
occurrence[x]:occurrenceTiming	S	0..1	Timing	Please consider using this for timing information that fluctuates or is sufficiently complex. You will need to calculate end-date, or use occurrenceTiming.boundsPeriod to ascribe a start and end date. E.g. Give ServicePlan.quantity 5 with unit=[USD]/day with the occurrenceTiming.boundsPeriod of May 31, 2023 to June 23, 2023 on occurrenceTiming.dayOfWeek = Mon and Wed at occurrenceTiming.timeOfDay = 3 pm.
repeat	S	0..1	Element	When the event is to occur
Slices for bounds[x]	S	0..1	Duration, Range, Period	Length/Range of lengths, or (Start and/or end) limits Slice: Unordered, Open by type:$this
bounds[x]:boundsPeriod	S	0..1	Period	Length/Range of lengths, or (Start and/or end) limits
start	S	0..1	dateTime	Starting time with inclusive boundary
end	S	0..1	dateTime	End time with inclusive boundary, if not ongoing
authoredOn	S	0..1	dateTime	Date request signed
requester	S	0..1	Reference(Practitioner_eltss S \| eLTSS PractitionerRole Profile \| Patient_eltss \| US Core Organization Profile \| eLTSS RelatedPerson Profile \| US Core Implantable Device Profile \| Device)	Who/what is requesting service
performer	S	0..*	Reference(Practitioner_eltss S \| eLTSS PractitionerRole Profile S \| Patient_eltss S \| US Core Organization Profile S \| eLTSS RelatedPerson Profile S \| US Core Implantable Device Profile \| Device \| US Core CareTeam Profile \| HealthcareService)	Service Provider Name + Phone + Relationship
locationReference	S	0..*	Reference(Location_eltss)	Service Delivery Address
reasonReference		0..*	Reference(Condition_eltss \| Observation_eltss \| US Core DiagnosticReport Profile for Report and Note exchange \| US Core DocumentReference Profile)	Explanation/Justification for service or service
insurance	S	0..*	Reference(Coverage S \| ClaimResponse)	Service Funding Source
supportingInfo	S	0..*	Reference(Resource)	Additional clinical information
note	S	0..*	Annotation	Service Comment
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
ServiceRequest.code	preferred	HealthCareCommonProcedureCodingSystem

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	ServiceRequest	A request for a service to be performed
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
directedBy		0..*	CodeableConcept	Self-Directed Service Indicator URL: http://hl7.org/fhir/us/eltss/StructureDefinition/eltss-directedBy
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	0..*	Reference(CarePlan_eltss \| ServiceRequest_eltss \| MedicationRequest)	What request fulfills
replaces	Σ	0..*	Reference(ServiceRequest_eltss)	What request replaces
status	?!Σ	1..1	code	draft \| active \| on-hold \| revoked \| completed \| entered-in-error \| unknown Binding: RequestStatus (required): The status of a service order.
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.
doNotPerform	?!Σ	0..1	boolean	True if service/procedure should not be performed
code	SΣ	0..1	CodeableConcept	Service Name Binding: HealthCareCommonProcedureCodingSystem (preferred): Use HCPCS (https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/) code + modifiers or free text.
coding	SΣ	0..*	Coding	Code defined by a terminology system
system	SΣ	0..1	uri	Identity of the terminology system
code	SΣ	0..1	code	Symbol in syntax defined by the system
text	SΣ	0..1	string	Plain text representation of the concept
Slices for quantity[x]	SΣ	0..1		Service Unit Quantity + Unit Type + Time Interval Slice: Unordered, Open by type:$this
quantityQuantity			Quantity
quantityRatio			Ratio
quantityRange			Range
quantity[x]:quantityQuantity	SΣ	0..1	Quantity	Service amount
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	0..1	string	UCUM codes are very useful here. But, if the concept maps to the unity unit in UCUM, then it is likely appropriate to choose a specific concept from another system. Use quanitityRatio when appropriate (such as in sessions per week) instead of quantityQuantity.
system	SΣC	0..1	uri	System that defines coded unit form
code	SΣ	0..1	code	Coded form of the unit
quantity[x]:quantityRatio	SΣ	0..1	Ratio	Service amount
numerator	SΣ	0..1	Quantity	Numerator value
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	0..1	string	UCUM codes are very useful here, but also coded numerators could be used for something like: sessions per week. See the Implementation guidance section
system	SΣC	0..1	uri	System that defines coded unit form
code	SΣ	0..1	code	Coded form of the unit
denominator	SΣ	0..1	Quantity	Denominator value
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	0..1	string	UCUM codes are very useful here
system	SΣC	0..1	uri	System that defines coded unit form
code	SΣ	0..1	code	Coded form of the unit
subject	SΣ	1..1	Reference(Patient_eltss)	Individual or Entity the service is ordered for
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Encounter in which the request was created
Slices for occurrence[x]	SΣ	0..1		Service Start + End Date Slice: Unordered, Open by type:$this
occurrenceDateTime			dateTime
occurrencePeriod			Period
occurrenceTiming			Timing
occurrence[x]:occurrencePeriod	SΣ	0..1	Period	Use this when the quantity is meant to be performed within a defined, simple start and end date. E.g. For May 31,2023 to June 10, 2023 give ServicePlan.quantity of 5 [USD]/day.
occurrence[x]:occurrenceTiming	SΣ	0..1	Timing	Please consider using this for timing information that fluctuates or is sufficiently complex. You will need to calculate end-date, or use occurrenceTiming.boundsPeriod to ascribe a start and end date. E.g. Give ServicePlan.quantity 5 with unit=[USD]/day with the occurrenceTiming.boundsPeriod of May 31, 2023 to June 23, 2023 on occurrenceTiming.dayOfWeek = Mon and Wed at occurrenceTiming.timeOfDay = 3 pm.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
repeat	SΣC	0..1	Element	When the event is to occur
Slices for bounds[x]	SΣ	0..1		Length/Range of lengths, or (Start and/or end) limits Slice: Unordered, Open by type:$this
boundsDuration			Duration
boundsRange			Range
boundsPeriod			Period
bounds[x]:boundsPeriod	SΣ	0..1	Period	Length/Range of lengths, or (Start and/or end) limits
start	SΣC	0..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
authoredOn	SΣ	0..1	dateTime	Date request signed
requester	SΣ	0..1	Reference(Practitioner_eltss)	Who/what is requesting service
performer	SΣ	0..*	Reference(Practitioner_eltss \| eLTSS PractitionerRole Profile \| Patient_eltss \| US Core Organization Profile \| eLTSS RelatedPerson Profile)	Service Provider Name + Phone + Relationship
locationReference	SΣ	0..*	Reference(Location_eltss)	Service Delivery Address
reasonReference	Σ	0..*	Reference(Condition_eltss \| Observation_eltss \| US Core DiagnosticReport Profile for Report and Note exchange \| US Core DocumentReference Profile)	Explanation/Justification for service or service
insurance	S	0..*	Reference(Coverage)	Service Funding Source
supportingInfo	S	0..*	Reference(Resource)	Additional clinical information
note	S	0..*	Annotation	Service Comment
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
ServiceRequest.status	required	RequestStatus
ServiceRequest.intent	required	RequestIntent
ServiceRequest.code	preferred	HealthCareCommonProcedureCodingSystem
ServiceRequest.quantity[x]:quantityQuantity.comparator	required	QuantityComparator
ServiceRequest.quantity[x]:quantityRatio.numerator.comparator	required	QuantityComparator
ServiceRequest.quantity[x]:quantityRatio.denominator.comparator	required	QuantityComparator

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	ServiceRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ServiceRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ServiceRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ServiceRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ServiceRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
prr-1	error	ServiceRequest	orderDetail SHALL only be present if code is present : orderDetail.empty() or code.exists()
tim-1	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	if there's a duration, there needs to be duration units : duration.empty() or durationUnit.exists()
tim-2	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	if there's a period, there needs to be period units : period.empty() or periodUnit.exists()
tim-4	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	duration SHALL be a non-negative value : duration.exists() implies duration >= 0
tim-5	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	period SHALL be a non-negative value : period.exists() implies period >= 0
tim-6	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	If there's a periodMax, there must be a period : periodMax.empty() or period.exists()
tim-7	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	If there's a durationMax, there must be a duration : durationMax.empty() or duration.exists()
tim-8	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	If there's a countMax, there must be a count : countMax.empty() or count.exists()
tim-9	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	If there's an offset, there must be a when (and not C, CM, CD, CV) : offset.empty() or (when.exists() and ((when in ('C' \| 'CM' \| 'CD' \| 'CV')).not()))
tim-10	error	ServiceRequest.occurrence[x]:occurrenceTiming.repeat	If there's a timeOfDay, there cannot be a when, or vice versa : timeOfDay.empty() or when.empty()