A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s).

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.

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.

An Extension

R5: Appointment.class (new:CodeableConcept)

Element Appointment.class has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.class has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Procedure), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation))

Element Appointment.reason is mapped to FHIR R4 element Appointment.reasonCode as SourceIsBroaderThanTarget. Element Appointment.reason is mapped to FHIR R4 element Appointment.reasonReference as SourceIsBroaderThanTarget. The mappings for Appointment.reason do not cover the following types: CodeableReference.

R5: Appointment.replaces (new:Reference(Appointment))

Element Appointment.replaces has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.replaces has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.virtualService (new:VirtualServiceDetail)

Element Appointment.virtualService has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.virtualService has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). There are two types of virtual meetings that often exist:

• a persistent, virtual meeting room that can only be used for a single purpose at a time,
• and a dynamic virtual meeting room that is generated on demand for a specific purpose.

Implementers may consider using Location.virtualService for persistent meeting rooms.

If each participant would have a different meeting link, an extension using the VirtualServiceContactDetail can be applied to the Appointment.participant BackboneElement.

R5: Appointment.previousAppointment (new:Reference(Appointment))

Element Appointment.previousAppointment has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.previousAppointment has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This property is intended for use when representing a series of related appointments. For example, in a nuclear medicine procedure, where there is an appointment for the injection of the isotopes, and then a subsequent appointment for the scan, the scan appointment would refer to the injection appointment via Appointment.previousAppointment. For representing recurring appointments, see the guidance on recurring vs. series appointments.

R5: Appointment.originatingAppointment (new:Reference(Appointment))

Element Appointment.originatingAppointment has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.originatingAppointment has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This property is intended for use when representing a recurring set of related appointments.

For example, a patient undergoing physical therapy may have a recurring appointment every Tuesday and Thursday. Each occurrence of the set will refer to the originating appointment, which contains the recurring template information. For representing appointment series, see the guidance on recurring vs. series appointments.

R5: Appointment.account (new:Reference(Account))

Element Appointment.account has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.account has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The specified account(s) could be those identified during pre-registration workflows in preparation for an upcoming Encounter.

R5: Appointment.cancellationDate (new:dateTime)

Element Appointment.cancellationDate has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.cancellationDate has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). If the appointment was cancelled multiple times, this would reflect the most recent cancellation.

R5: Appointment.subject (new:Reference(Patient,Group))

Element Appointment.subject has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.subject has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.recurrenceId (new:positiveInt)

Element Appointment.recurrenceId has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.recurrenceId has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.occurrenceChanged (new:boolean)

Element Appointment.occurrenceChanged has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.occurrenceChanged has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). For example, if a patient has physical therapy appointments every Tuesday and Thursday, but due to a national holiday, a single occurrence was rescheduled to a different day, while the rest of the recurring series remained on Tuesday / Thursday.

R5: Appointment.recurrenceTemplate (new:BackboneElement)

Element Appointment.recurrenceTemplate has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.recurrenceTemplate has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

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).

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.

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.

The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status.

If the Appointment's status is "cancelled" then all participants are expected to have their calendars released for the appointment period, and as such any Slots that were marked as BUSY can be re-set to FREE.

This element is labeled as a modifier because the status contains the code entered-in-error that mark the Appointment as not currently valid.

The free/busy status of an appointment.

List of participants involved in the appointment.

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).

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.

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.

Participation status of the actor.

The Participation status of an appointment.

R5: Appointment.class (new:CodeableConcept)

Element Appointment.class has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.class has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Procedure), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation))

Element Appointment.reason is mapped to FHIR R4 element Appointment.reasonCode as SourceIsBroaderThanTarget. Element Appointment.reason is mapped to FHIR R4 element Appointment.reasonReference as SourceIsBroaderThanTarget. The mappings for Appointment.reason do not cover the following types: CodeableReference.

R5: Appointment.replaces (new:Reference(Appointment))

Element Appointment.replaces has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.replaces has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.virtualService (new:VirtualServiceDetail)

Element Appointment.virtualService has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.virtualService has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). There are two types of virtual meetings that often exist:

• a persistent, virtual meeting room that can only be used for a single purpose at a time,
• and a dynamic virtual meeting room that is generated on demand for a specific purpose.

Implementers may consider using Location.virtualService for persistent meeting rooms.

If each participant would have a different meeting link, an extension using the VirtualServiceContactDetail can be applied to the Appointment.participant BackboneElement.

R5: Appointment.previousAppointment (new:Reference(Appointment))

Element Appointment.previousAppointment has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.previousAppointment has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This property is intended for use when representing a series of related appointments. For example, in a nuclear medicine procedure, where there is an appointment for the injection of the isotopes, and then a subsequent appointment for the scan, the scan appointment would refer to the injection appointment via Appointment.previousAppointment. For representing recurring appointments, see the guidance on recurring vs. series appointments.

R5: Appointment.originatingAppointment (new:Reference(Appointment))

Element Appointment.originatingAppointment has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.originatingAppointment has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This property is intended for use when representing a recurring set of related appointments.

For example, a patient undergoing physical therapy may have a recurring appointment every Tuesday and Thursday. Each occurrence of the set will refer to the originating appointment, which contains the recurring template information. For representing appointment series, see the guidance on recurring vs. series appointments.

R5: Appointment.account (new:Reference(Account))

Element Appointment.account has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.account has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The specified account(s) could be those identified during pre-registration workflows in preparation for an upcoming Encounter.

R5: Appointment.cancellationDate (new:dateTime)

Element Appointment.cancellationDate has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.cancellationDate has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). If the appointment was cancelled multiple times, this would reflect the most recent cancellation.

R5: Appointment.subject (new:Reference(Patient,Group))

Element Appointment.subject has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.subject has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.recurrenceId (new:positiveInt)

Element Appointment.recurrenceId has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.recurrenceId has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.occurrenceChanged (new:boolean)

Element Appointment.occurrenceChanged has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.occurrenceChanged has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). For example, if a patient has physical therapy appointments every Tuesday and Thursday, but due to a national holiday, a single occurrence was rescheduled to a different day, while the rest of the recurring series remained on Tuesday / Thursday.

R5: Appointment.recurrenceTemplate (new:BackboneElement)

Element Appointment.recurrenceTemplate has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.recurrenceTemplate has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.serviceType additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/HealthcareService)) additional types from child elements (reference)

Element Appointment.serviceType is mapped to FHIR R4 element Appointment.serviceType as SourceIsBroaderThanTarget. The mappings for Appointment.serviceType do not cover the following types: CodeableReference. The mappings for Appointment.serviceType do not cover the following types based on type expansion: reference. For a provider to provider appointment the code "FOLLOWUP" may be appropriate, as this is expected to be discussing some patient that was seen in the past.

R5: Appointment.priority additional types (CodeableConcept) additional types from child elements (coding, text)

Element Appointment.priority is mapped to FHIR R4 element Appointment.priority as SourceIsBroaderThanTarget. The mappings for Appointment.priority do not cover the following types: CodeableConcept. The mappings for Appointment.priority do not cover the following types based on type expansion: coding, text. Seeking implementer feedback on this property and how interoperable it is.

Using an extension to record a CodeableConcept for named values may be tested at a future connectathon.

R5: Appointment.note additional types (Annotation) additional types from child elements (time)

Element Appointment.note is mapped to FHIR R4 element Appointment.comment as SourceIsBroaderThanTarget. The mappings for Appointment.note do not cover the following types: Annotation. The mappings for Appointment.note do not cover the following types based on type expansion: time. Additional text to aid in facilitating the appointment. For instance, a note might be, "patient should proceed immediately to infusion room upon arrival"

Where this is a planned appointment and the start/end dates are not set then this field can be used to provide additional guidance on the details of the appointment request, including any restrictions on when to book it.

Typically only the concept.text will be used, however occasionally a reference to some generic documentation (or specific) and also supports coded instructions if/when they are required.

R5: Appointment.patientInstruction additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/DocumentReference), CodeableReference(http://hl7.org/fhir/StructureDefinition/Binary), CodeableReference(http://hl7.org/fhir/StructureDefinition/Communication))

Element Appointment.patientInstruction is mapped to FHIR R4 element Appointment.patientInstruction as SourceIsBroaderThanTarget. The mappings for Appointment.patientInstruction do not cover the following types: CodeableReference.

R5: Appointment.basedOn

Element Appointment.basedOn is mapped to FHIR R4 element Appointment.basedOn as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Appointment.basedOn with unmapped reference targets: CarePlan, DeviceRequest, MedicationRequest.

R5: Appointment.participant.actor

Element Appointment.participant.actor is mapped to FHIR R4 element Appointment.participant.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Appointment.participant.actor with unmapped reference targets: CareTeam, Group. Where a CareTeam is provided, this does not imply that the entire team is included, just a single member from the group with the appropriate role. Where multiple members are required, please include the CareTeam the required number of times.

R5: Appointment.participant.required additional types (boolean) additional types from child elements (value)

Element Appointment.participant.required is mapped to FHIR R4 element Appointment.participant.required as SourceIsBroaderThanTarget. The mappings for Appointment.participant.required do not cover the following types: boolean. The mappings for Appointment.participant.required do not cover the following types based on type expansion: value. For the use-case where two doctors need to meet to discuss the results for a specific patient, and the patient is not required to be present include the patient in the subject field, but do not include them as a participant - this was formerly done prior to R5 with required='information-only'.

A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s).

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

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

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.

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.

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.

The base language in which the resource is written.

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).

The codes SHOULD be taken from CommonLanguages
(preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

A human language.

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.

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.

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.

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.

An Extension

R5: Appointment.class (new:CodeableConcept)

Element Appointment.class has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.class has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Procedure), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation))

Element Appointment.reason is mapped to FHIR R4 element Appointment.reasonCode as SourceIsBroaderThanTarget. Element Appointment.reason is mapped to FHIR R4 element Appointment.reasonReference as SourceIsBroaderThanTarget. The mappings for Appointment.reason do not cover the following types: CodeableReference.

R5: Appointment.replaces (new:Reference(Appointment))

Element Appointment.replaces has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.replaces has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.virtualService (new:VirtualServiceDetail)

Element Appointment.virtualService has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.virtualService has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). There are two types of virtual meetings that often exist:

• a persistent, virtual meeting room that can only be used for a single purpose at a time,
• and a dynamic virtual meeting room that is generated on demand for a specific purpose.

Implementers may consider using Location.virtualService for persistent meeting rooms.

If each participant would have a different meeting link, an extension using the VirtualServiceContactDetail can be applied to the Appointment.participant BackboneElement.

R5: Appointment.previousAppointment (new:Reference(Appointment))

Element Appointment.previousAppointment has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.previousAppointment has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This property is intended for use when representing a series of related appointments. For example, in a nuclear medicine procedure, where there is an appointment for the injection of the isotopes, and then a subsequent appointment for the scan, the scan appointment would refer to the injection appointment via Appointment.previousAppointment. For representing recurring appointments, see the guidance on recurring vs. series appointments.

R5: Appointment.originatingAppointment (new:Reference(Appointment))

Element Appointment.originatingAppointment has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.originatingAppointment has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This property is intended for use when representing a recurring set of related appointments.

For example, a patient undergoing physical therapy may have a recurring appointment every Tuesday and Thursday. Each occurrence of the set will refer to the originating appointment, which contains the recurring template information. For representing appointment series, see the guidance on recurring vs. series appointments.

R5: Appointment.account (new:Reference(Account))

Element Appointment.account has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.account has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The specified account(s) could be those identified during pre-registration workflows in preparation for an upcoming Encounter.

R5: Appointment.cancellationDate (new:dateTime)

Element Appointment.cancellationDate has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.cancellationDate has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). If the appointment was cancelled multiple times, this would reflect the most recent cancellation.

R5: Appointment.subject (new:Reference(Patient,Group))

Element Appointment.subject has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.subject has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.recurrenceId (new:positiveInt)

Element Appointment.recurrenceId has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.recurrenceId has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

R5: Appointment.occurrenceChanged (new:boolean)

Element Appointment.occurrenceChanged has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.occurrenceChanged has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). For example, if a patient has physical therapy appointments every Tuesday and Thursday, but due to a national holiday, a single occurrence was rescheduled to a different day, while the rest of the recurring series remained on Tuesday / Thursday.

R5: Appointment.recurrenceTemplate (new:BackboneElement)

Element Appointment.recurrenceTemplate has a context of Appointment based on following the parent source element upwards and mapping to Appointment. Element Appointment.recurrenceTemplate has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

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).

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.

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.

This records identifiers associated with this appointment concern that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status.

If the Appointment's status is "cancelled" then all participants are expected to have their calendars released for the appointment period, and as such any Slots that were marked as BUSY can be re-set to FREE.

This element is labeled as a modifier because the status contains the code entered-in-error that mark the Appointment as not currently valid.

The free/busy status of an appointment.

The coded reason for the appointment being cancelled. This is often used in reporting/billing/futher processing to determine if further actions are required, or specific fees apply.

A broad categorization of the service that is to be performed during this appointment.

The specific service that is to be performed during this appointment.

For a provider to provider appointment the code "FOLLOWUP" may be appropriate, as this is expected to be discussing some patient that was seen in the past.

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

An Extension

R5: Appointment.serviceType additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/HealthcareService)) additional types from child elements (reference)

Element Appointment.serviceType is mapped to FHIR R4 element Appointment.serviceType as SourceIsBroaderThanTarget. The mappings for Appointment.serviceType do not cover the following types: CodeableReference. The mappings for Appointment.serviceType do not cover the following types based on type expansion: reference. For a provider to provider appointment the code "FOLLOWUP" may be appropriate, as this is expected to be discussing some patient that was seen in the past.

A reference to a code defined by a terminology system.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Very often the text is the same as a displayName of one of the codings.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

The specialty of a practitioner that would be required to perform the service requested in this appointment.

The style of appointment or patient that has been booked in the slot (not service type).

The coded reason that this appointment is being scheduled. This is more clinical than administrative.

The Reason for the appointment to take place.

Reason the appointment has been scheduled to take place, as specified using information from another resource. When the patient arrives and the encounter begins it may be used as the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.

The priority of the appointment. Can be used to make informed decisions if needing to re-prioritize appointments. (The iCal Standard specifies 0 as undefined, 1 as highest, 9 as lowest priority).

Seeking implementer feedback on this property and how interoperable it is.

Using an extension to record a CodeableConcept for named values may be tested at a future connectathon.

unique id for the element within a resource (for internal references)

An Extension

R5: Appointment.priority additional types (CodeableConcept) additional types from child elements (coding, text)

Element Appointment.priority is mapped to FHIR R4 element Appointment.priority as SourceIsBroaderThanTarget. The mappings for Appointment.priority do not cover the following types: CodeableConcept. The mappings for Appointment.priority do not cover the following types based on type expansion: coding, text. Seeking implementer feedback on this property and how interoperable it is.

Using an extension to record a CodeableConcept for named values may be tested at a future connectathon.

Primitive value for unsignedInt

The brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Detailed or expanded information should be put in the comment field.

Additional information to support the appointment provided when making the appointment.

Date/Time that the appointment is to take place.

Date/Time that the appointment is to conclude.

Number of minutes that the appointment is to take. This can be less than the duration between the start and end times. For example, where the actual time of appointment is only an estimate or if a 30 minute appointment is being requested, but any time would work. Also, if there is, for example, a planned 15 minute break in the middle of a long appointment, the duration may be 15 minutes less than the difference between the start and end.

The slots from the participants' schedules that will be filled by the appointment.

The date that this appointment was initially created. This could be different to the meta.lastModified value on the initial entry, as this could have been before the resource was created on the FHIR server, and should remain unchanged over the lifespan of the appointment.

This property is required for many use cases where the age of an appointment is considered in processing workflows for scheduling and billing of appointments.

Additional comments about the appointment.

Additional text to aid in facilitating the appointment. For instance, a comment might be, "patient should proceed immediately to infusion room upon arrival"

Where this is a planned appointment and the start/end dates are not set then this field can be used to provide additional guidance on the details of the appointment request, including any restrictions on when to book it.

unique id for the element within a resource (for internal references)

An Extension

R5: Appointment.note additional types (Annotation) additional types from child elements (time)

Element Appointment.note is mapped to FHIR R4 element Appointment.comment as SourceIsBroaderThanTarget. The mappings for Appointment.note do not cover the following types: Annotation. The mappings for Appointment.note do not cover the following types based on type expansion: time. Additional text to aid in facilitating the appointment. For instance, a note might be, "patient should proceed immediately to infusion room upon arrival"

Where this is a planned appointment and the start/end dates are not set then this field can be used to provide additional guidance on the details of the appointment request, including any restrictions on when to book it.

Typically only the concept.text will be used, however occasionally a reference to some generic documentation (or specific) and also supports coded instructions if/when they are required.

The actual value

While Appointment.comment contains information for internal use, Appointment.patientInstructions is used to capture patient facing information about the Appointment (e.g. please bring your referral or fast from 8pm night before).

unique id for the element within a resource (for internal references)

An Extension

R5: Appointment.patientInstruction additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/DocumentReference), CodeableReference(http://hl7.org/fhir/StructureDefinition/Binary), CodeableReference(http://hl7.org/fhir/StructureDefinition/Communication))

Element Appointment.patientInstruction is mapped to FHIR R4 element Appointment.patientInstruction as SourceIsBroaderThanTarget. The mappings for Appointment.patientInstruction do not cover the following types: CodeableReference.

The actual value

The service request this appointment is allocated to assess (e.g. incoming referral or procedure request).

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

An Extension

R5: Appointment.basedOn

Element Appointment.basedOn is mapped to FHIR R4 element Appointment.basedOn as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Appointment.basedOn with unmapped reference targets: CarePlan, DeviceRequest, MedicationRequest.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

List of participants involved in the appointment.

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

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.

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.

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).

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.

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.

Role of participant in the appointment.

The role of the participant can be used to declare what the actor will be doing in the scope of this appointment.

If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning.

This value SHALL be the same when creating an AppointmentResponse so that they can be matched, and subsequently update the Appointment.

Role of participant in encounter.

A Person, Location/HealthcareService or Device that is participating in the appointment.

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

An Extension

R5: Appointment.participant.actor

Element Appointment.participant.actor is mapped to FHIR R4 element Appointment.participant.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Appointment.participant.actor with unmapped reference targets: CareTeam, Group. Where a CareTeam is provided, this does not imply that the entire team is included, just a single member from the group with the appropriate role. Where multiple members are required, please include the CareTeam the required number of times.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Whether this participant is required to be present at the meeting. This covers a use-case where two doctors need to meet to discuss the results for a specific patient, and the patient is not required to be present.

Is the Participant required to attend the appointment.

unique id for the element within a resource (for internal references)

An Extension

R5: Appointment.participant.required additional types (boolean) additional types from child elements (value)

Element Appointment.participant.required is mapped to FHIR R4 element Appointment.participant.required as SourceIsBroaderThanTarget. The mappings for Appointment.participant.required do not cover the following types: boolean. The mappings for Appointment.participant.required do not cover the following types based on type expansion: value. For the use-case where two doctors need to meet to discuss the results for a specific patient, and the patient is not required to be present include the patient in the subject field, but do not include them as a participant - this was formerly done prior to R5 with required='information-only'.

Primitive value for code

Participation status of the actor.

The Participation status of an appointment.

Participation period of the actor.

A set of date ranges (potentially including times) that the appointment is preferred to be scheduled within.

The duration (usually in minutes) could also be provided to indicate the length of the appointment to fill and populate the start/end times for the actual allocated time. However, in other situations the duration may be calculated by the scheduling system.

This does not introduce a capacity for recurring appointments.