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8.11 Resource Encounter - Content

Patient Administration

Work Group

Maturity Level: 2

Trial Use

Security Category: Patient

Compartments: Encounter, Patient, Practitioner, RelatedPerson

An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.

8.11.1 Scope and Usage

A patient encounter is further characterized by the setting in which it takes place. Amongst them are ambulatory, emergency, home health, inpatient and virtual encounters. An Encounter encompasses the lifecycle from pre-admission, the actual encounter (for ambulatory encounters), and admission, stay and discharge (for inpatient encounters). During the encounter the patient may move from practitioner to practitioner and location to location.

Because of the broad scope of Encounter, not all elements will be relevant in all settings. For this reason, admission/discharge related information is kept in a separate Hospitalization component within Encounter. The class element is used to distinguish between these settings, which will guide further validation and application of business rules.

There is also substantial variance from organization to organization (and between jurisdictions and countries) on which business events translate to the start of a new Encounter, or what level of aggregation is used for Encounter. For example, each single visit of a practitioner during a hospitalization may lead to a new instance of Encounter, but depending on local practice and the systems involved, it may well be that this is aggregated to a single instance for a whole hospitalization. Even more aggregation may occur where jurisdictions introduce groups of Encounters for financial or other reasons. Encounters can be aggregated or grouped under other Encounters using the partOf element. See below for examples.

Encounter instances may exist before the actual encounter takes place to convey pre-admission information, including using Encounters elements to reflect the planned start date or planned encounter locations. In this case the status element is set to 'planned'.

The Hospitalization component is intended to store the extended information relating to a hospitalization event. It is always expected to be the same period as the encounter itself. Where the period is different, another encounter instance should be used to capture this information as a partOf this encounter instance.

The Procedure and encounter have references to each other, and these should be to different procedures; one for the procedure that was performed during the encounter (stored in Procedure.encounter), and another for cases where an encounter is a result of another procedure (stored in Encounter.indication) such as a follow-up encounter to resolve complications from an earlier procedure.

8.11.1.1 Status Management

During the life-cycle of an encounter it will pass through many statuses. Typically these are in order or the organization's workflow: planned, in-progress, finished/cancelled.
This status information is often used for other things, and often an analysis of the status history is required. This could be done by scanning through all the versions of the encounter, checking the period of each, and then doing some form of post processing. To ease the burden of this (or where a system doesn't support resource histories) a status history component is included.

There is no direct indication purely by the status field as to whether an encounter is considered "admitted".
The context of the encounter and business practices/policies/workflows/types can influence this definition. (e.g., acute care facility, aged care center, outpatient clinic, emergency department, community-based clinic).
Statuses of "arrived", "triaged" or "in progress" could be considered the start of the admission, and also have the presence of the hospitalization sub-component entered.

The "on leave" status might or might not be a part of the admission, for example if the patient was permitted to go home for a weekend or some other form of external event.
The location is also likely to be filled in with a location status of "present".
For other examples such as an outpatient visit (day procedure - colonoscopy), the patient could also be considered to be admitted, hence the encounter doesn't have a fixed definition of admitted. At a minimum, we do believe that a patient IS admitted when the status is in-progress.

8.11.2 Boundaries and Relationships

The Encounter resource is not to be used to store appointment information, the Appointment resource is intended to be used for that. Note that in many systems outpatient encounters (which are in scope for Encounter) and Appointment are used concurrently. In FHIR, Appointment is used for establishing a date for the encounter, while Encounter is applicable to information about the actual Encounter, i.e., the patient showing up.
As such, an encounter in the "planned" status is not identical to the appointment that scheduled it, but it is the encounter prior to its actual occurrence, with the expectation that encounter will be updated as it progresses to completion. Patient arrival at a location does not necessarily mean the start of the encounter (e.g. a patient arrives an hour earlier than he is actually seen by a practitioner).

An appointment is normally used for the planning stage of an appointment, searching, locating an available time, then making the appointment. Once this process is completed and the appointment is about to start, then the appointment will be marked as fulfilled, and linked to the newly created encounter.
This new encounter may start in an "arrived" status when they are admitted at a location of the facility, and then will move to the ward where another part-of encounter may begin.

Communication resources are used for a simultaneous interaction between a practitioner and a patient where there is no direct contact. Examples include a phone message, or transmission of some correspondence documentation.
There is no duration recorded for a communication resource, but it could contain sent and received times.

Standard Extension: Associated Encounter
This extension should be used to reference an encounter where there is no property that already defines this association on the resource.

8.11.3 References

This resource is referenced by AdverseEvent, AllergyIntolerance, CarePlan, CareTeam, ChargeItem, Claim, ClinicalImpression, Communication, CommunicationRequest, Composition, Condition, Contract, DeviceRequest, DiagnosticReport, DocumentReference, itself, ExplanationOfBenefit, Flag, GuidanceResponse, ImagingStudy, Immunization, List, Media, MedicationAdministration, MedicationDispense, MedicationRequest, MedicationStatement, NutritionOrder, Observation, Procedure, QuestionnaireResponse, RequestGroup, RiskAssessment, ServiceRequest, Task and VisionPrescription.

This resource implements the Event pattern.

Structure

Name	Flags	Card.	Type	Description & Constraints
Encounter	TU		DomainResource	An interaction during which services are provided to the patient Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!Σ	1..1	code	planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled + EncounterStatus (Required)
statusHistory		0..*	BackboneElement	List of past encounter statuses
status		1..1	code	planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled + EncounterStatus (Required)
period		1..1	Period	The time that the episode was in the specified status
class	Σ	1..1	Coding	Classification of patient encounter ActEncounterCode (Extensible)
classHistory		0..*	BackboneElement	List of past encounter classes
class		1..1	Coding	inpatient \| outpatient \| ambulatory \| emergency + ActEncounterCode (Extensible)
period		1..1	Period	The time that the episode was in the specified class
type	Σ	0..*	CodeableConcept	Specific type of encounter EncounterType (Example)
serviceType	Σ	0..1	CodeableConcept	Specific type of service ServiceType (Example)
priority		0..1	CodeableConcept	Indicates the urgency of the encounter ActPriority (Example)
subject	Σ	0..1	Reference(Patient \| Group)	The patient or group present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	Σ	0..*	BackboneElement	List of participants involved in the encounter
type	Σ	0..*	CodeableConcept	Role of participant in encounter ParticipantType (Extensible)
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner \| PractitionerRole \| RelatedPerson)	Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	Σ	0..*	CodeableConcept	Coded reason the encounter takes place Encounter Reason Codes (Preferred)
reasonReference	Σ	0..*	Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation)	Reason the encounter takes place (reference)
diagnosis	Σ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
condition	Σ	1..1	Reference(Condition \| Procedure)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) DiagnosisRole (Preferred)
rank		0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization		0..1	BackboneElement	Details about the admission to a healthcare service
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location \| Organization)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) AdmitSource (Preferred)
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission hl7VS-re-admissionIndicator (Example)
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Diet (Example)
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) SpecialCourtesy (Preferred)
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. SpecialArrangements (Preferred)
destination		0..1	Reference(Location \| Organization)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge DischargeDisposition (Example)
location		0..*	BackboneElement	List of locations where the patient has been
location		1..1	Reference(Location)	Location the encounter takes place
status		0..1	code	planned \| active \| reserved \| completed EncounterLocationStatus (Required)
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) LocationType (Example)
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

UML Diagram (Legend)

XML Template

<Encounter xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known --></identifier>
 <status value="[code]"/><!-- 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled + -->
 <statusHistory>  <!-- 0..* List of past encounter statuses -->
  <status value="[code]"/><!-- 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled + -->
  <period><!-- 1..1 Period The time that the episode was in the specified status --></period>
 </statusHistory>
 <class><!-- 1..1 Coding Classification of patient encounter  --></class>
 <classHistory>  <!-- 0..* List of past encounter classes -->
  <class><!-- 1..1 Coding inpatient | outpatient | ambulatory | emergency +  --></class>
  <period><!-- 1..1 Period The time that the episode was in the specified class --></period>
 </classHistory>
 <type><!-- 0..* CodeableConcept Specific type of encounter --></type>
 <serviceType><!-- 0..1 CodeableConcept Specific type of service --></serviceType>
 <priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter  --></priority>
 <subject><!-- 0..1 Reference(Group|Patient) The patient or group present at the encounter --></subject>
 <episodeOfCare><!-- 0..* Reference(EpisodeOfCare) Episode(s) of care that this encounter should be recorded against --></episodeOfCare>
 <basedOn><!-- 0..* Reference(ServiceRequest) The ServiceRequest that initiated this encounter --></basedOn>
 <participant>  <!-- 0..* List of participants involved in the encounter -->
  <type><!-- 0..* CodeableConcept Role of participant in encounter --></type>
  <period><!-- 0..1 Period Period of time during the encounter that the participant participated --></period>
  <individual><!-- 0..1 Reference(Practitioner|PractitionerRole|RelatedPerson) Persons involved in the encounter other than the patient --></individual>
 </participant>
 <appointment><!-- 0..* Reference(Appointment) The appointment that scheduled this encounter --></appointment>
 <period><!-- 0..1 Period The start and end time of the encounter --></period>
 <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length>
 <reasonCode><!-- 0..* CodeableConcept Coded reason the encounter takes place --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|ImmunizationRecommendation|
   Observation|Procedure) Reason the encounter takes place (reference) --></reasonReference>
 <diagnosis>  <!-- 0..* The list of diagnosis relevant to this encounter -->
  <condition><!-- 1..1 Reference(Condition|Procedure) The diagnosis or procedure relevant to the encounter --></condition>
  <use><!-- 0..1 CodeableConcept Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) --></use>
  <rank value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each role type) -->
 </diagnosis>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account>
 <hospitalization>  <!-- 0..1 Details about the admission to a healthcare service -->
  <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier>
  <origin><!-- 0..1 Reference(Location|Organization) The location/organization from which the patient came before admission --></origin>
  <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource>
  <reAdmission><!-- 0..1 CodeableConcept The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission  --></reAdmission>
  <dietPreference><!-- 0..* CodeableConcept Diet preferences reported by the patient --></dietPreference>
  <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy>
  <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc. --></specialArrangement>
  <destination><!-- 0..1 Reference(Location|Organization) Location/organization to which the patient is discharged --></destination>
  <dischargeDisposition><!-- 0..1 CodeableConcept Category or kind of location after discharge --></dischargeDisposition>
 </hospitalization>
 <location>  <!-- 0..* List of locations where the patient has been -->
  <location><!-- 1..1 Reference(Location) Location the encounter takes place --></location>
  <status value="[code]"/><!-- 0..1 planned | active | reserved | completed -->
  <physicalType><!-- 0..1 CodeableConcept The physical type of the location (usually the level in the location hierachy - bed room ward etc.) --></physicalType>
  <period><!-- 0..1 Period Time period during which the patient was present at the location --></period>
 </location>
 <serviceProvider><!-- 0..1 Reference(Organization) The organization (facility) responsible for this encounter --></serviceProvider>
 <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf>
</Encounter>

JSON Template

{
  "resourceType" : "Encounter",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
  "status" : "<code>", // R!  planned | arrived | triaged | in-progress | onleave | finished | cancelled +
  "statusHistory" : [{ // List of past encounter statuses
    "status" : "<code>", // R!  planned | arrived | triaged | in-progress | onleave | finished | cancelled +
    "period" : { Period } // R!  The time that the episode was in the specified status
  }],
  "class" : { Coding }, // R!  Classification of patient encounter 
  "classHistory" : [{ // List of past encounter classes
    "class" : { Coding }, // R!  inpatient | outpatient | ambulatory | emergency + 
    "period" : { Period } // R!  The time that the episode was in the specified class
  }],
  "type" : [{ CodeableConcept }], // Specific type of encounter
  "serviceType" : { CodeableConcept }, // Specific type of service
  "priority" : { CodeableConcept }, // Indicates the urgency of the encounter 
  "subject" : { Reference(Group|Patient) }, // The patient or group present at the encounter
  "episodeOfCare" : [{ Reference(EpisodeOfCare) }], // Episode(s) of care that this encounter should be recorded against
  "basedOn" : [{ Reference(ServiceRequest) }], // The ServiceRequest that initiated this encounter
  "participant" : [{ // List of participants involved in the encounter
    "type" : [{ CodeableConcept }], // Role of participant in encounter
    "period" : { Period }, // Period of time during the encounter that the participant participated
    "individual" : { Reference(Practitioner|PractitionerRole|RelatedPerson) } // Persons involved in the encounter other than the patient
  }],
  "appointment" : [{ Reference(Appointment) }], // The appointment that scheduled this encounter
  "period" : { Period }, // The start and end time of the encounter
  "length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
  "reasonCode" : [{ CodeableConcept }], // Coded reason the encounter takes place
  "reasonReference" : [{ Reference(Condition|ImmunizationRecommendation|
   Observation|Procedure) }], // Reason the encounter takes place (reference)
  "diagnosis" : [{ // The list of diagnosis relevant to this encounter
    "condition" : { Reference(Condition|Procedure) }, // R!  The diagnosis or procedure relevant to the encounter
    "use" : { CodeableConcept }, // Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
    "rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
  }],
  "account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
  "hospitalization" : { // Details about the admission to a healthcare service
    "preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
    "origin" : { Reference(Location|Organization) }, // The location/organization from which the patient came before admission
    "admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
    "reAdmission" : { CodeableConcept }, // The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission 
    "dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
    "specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
    "specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc.
    "destination" : { Reference(Location|Organization) }, // Location/organization to which the patient is discharged
    "dischargeDisposition" : { CodeableConcept } // Category or kind of location after discharge
  },
  "location" : [{ // List of locations where the patient has been
    "location" : { Reference(Location) }, // R!  Location the encounter takes place
    "status" : "<code>", // planned | active | reserved | completed
    "physicalType" : { CodeableConcept }, // The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
    "period" : { Period } // Time period during which the patient was present at the location
  }],
  "serviceProvider" : { Reference(Organization) }, // The organization (facility) responsible for this encounter
  "partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Encounter;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Encounter.identifier [ Identifier ], ... ; # 0..* Identifier(s) by which this encounter is known
  fhir:Encounter.status [ code ]; # 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled +
  fhir:Encounter.statusHistory [ # 0..* List of past encounter statuses
    fhir:Encounter.statusHistory.status [ code ]; # 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled +
    fhir:Encounter.statusHistory.period [ Period ]; # 1..1 The time that the episode was in the specified status
  ], ...;
  fhir:Encounter.class [ Coding ]; # 1..1 Classification of patient encounter
  fhir:Encounter.classHistory [ # 0..* List of past encounter classes
    fhir:Encounter.classHistory.class [ Coding ]; # 1..1 inpatient | outpatient | ambulatory | emergency +
    fhir:Encounter.classHistory.period [ Period ]; # 1..1 The time that the episode was in the specified class
  ], ...;
  fhir:Encounter.type [ CodeableConcept ], ... ; # 0..* Specific type of encounter
  fhir:Encounter.serviceType [ CodeableConcept ]; # 0..1 Specific type of service
  fhir:Encounter.priority [ CodeableConcept ]; # 0..1 Indicates the urgency of the encounter
  fhir:Encounter.subject [ Reference(Group|Patient) ]; # 0..1 The patient or group present at the encounter
  fhir:Encounter.episodeOfCare [ Reference(EpisodeOfCare) ], ... ; # 0..* Episode(s) of care that this encounter should be recorded against
  fhir:Encounter.basedOn [ Reference(ServiceRequest) ], ... ; # 0..* The ServiceRequest that initiated this encounter
  fhir:Encounter.participant [ # 0..* List of participants involved in the encounter
    fhir:Encounter.participant.type [ CodeableConcept ], ... ; # 0..* Role of participant in encounter
    fhir:Encounter.participant.period [ Period ]; # 0..1 Period of time during the encounter that the participant participated
    fhir:Encounter.participant.individual [ Reference(Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Persons involved in the encounter other than the patient
  ], ...;
  fhir:Encounter.appointment [ Reference(Appointment) ], ... ; # 0..* The appointment that scheduled this encounter
  fhir:Encounter.period [ Period ]; # 0..1 The start and end time of the encounter
  fhir:Encounter.length [ Duration ]; # 0..1 Quantity of time the encounter lasted (less time absent)
  fhir:Encounter.reasonCode [ CodeableConcept ], ... ; # 0..* Coded reason the encounter takes place
  fhir:Encounter.reasonReference [ Reference(Condition|ImmunizationRecommendation|Observation|Procedure) ], ... ; # 0..* Reason the encounter takes place (reference)
  fhir:Encounter.diagnosis [ # 0..* The list of diagnosis relevant to this encounter
    fhir:Encounter.diagnosis.condition [ Reference(Condition|Procedure) ]; # 1..1 The diagnosis or procedure relevant to the encounter
    fhir:Encounter.diagnosis.use [ CodeableConcept ]; # 0..1 Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
    fhir:Encounter.diagnosis.rank [ positiveInt ]; # 0..1 Ranking of the diagnosis (for each role type)
  ], ...;
  fhir:Encounter.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this Encounter
  fhir:Encounter.hospitalization [ # 0..1 Details about the admission to a healthcare service
    fhir:Encounter.hospitalization.preAdmissionIdentifier [ Identifier ]; # 0..1 Pre-admission identifier
    fhir:Encounter.hospitalization.origin [ Reference(Location|Organization) ]; # 0..1 The location/organization from which the patient came before admission
    fhir:Encounter.hospitalization.admitSource [ CodeableConcept ]; # 0..1 From where patient was admitted (physician referral, transfer)
    fhir:Encounter.hospitalization.reAdmission [ CodeableConcept ]; # 0..1 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
    fhir:Encounter.hospitalization.dietPreference [ CodeableConcept ], ... ; # 0..* Diet preferences reported by the patient
    fhir:Encounter.hospitalization.specialCourtesy [ CodeableConcept ], ... ; # 0..* Special courtesies (VIP, board member)
    fhir:Encounter.hospitalization.specialArrangement [ CodeableConcept ], ... ; # 0..* Wheelchair, translator, stretcher, etc.
    fhir:Encounter.hospitalization.destination [ Reference(Location|Organization) ]; # 0..1 Location/organization to which the patient is discharged
    fhir:Encounter.hospitalization.dischargeDisposition [ CodeableConcept ]; # 0..1 Category or kind of location after discharge
  ];
  fhir:Encounter.location [ # 0..* List of locations where the patient has been
    fhir:Encounter.location.location [ Reference(Location) ]; # 1..1 Location the encounter takes place
    fhir:Encounter.location.status [ code ]; # 0..1 planned | active | reserved | completed
    fhir:Encounter.location.physicalType [ CodeableConcept ]; # 0..1 The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
    fhir:Encounter.location.period [ Period ]; # 0..1 Time period during which the patient was present at the location
  ], ...;
  fhir:Encounter.serviceProvider [ Reference(Organization) ]; # 0..1 The organization (facility) responsible for this encounter
  fhir:Encounter.partOf [ Reference(Encounter) ]; # 0..1 Another Encounter this encounter is part of
]

Changes since R3

Encounter

Encounter.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-status|4.0.0 to http://hl7.org/fhir/ValueSet/encounter-status|4.1.0

Encounter.statusHistory.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-status|4.0.0 to http://hl7.org/fhir/ValueSet/encounter-status|4.1.0

Encounter.location.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-location-status|4.0.0 to http://hl7.org/fhir/ValueSet/encounter-location-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 10 tests that all execute ok. All tests pass round-trip testing and 3 r3 resources are invalid (0 errors).)

Structure

Name	Flags	Card.	Type	Description & Constraints
Encounter	TU		DomainResource	An interaction during which services are provided to the patient Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!Σ	1..1	code	planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled + EncounterStatus (Required)
statusHistory		0..*	BackboneElement	List of past encounter statuses
status		1..1	code	planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled + EncounterStatus (Required)
period		1..1	Period	The time that the episode was in the specified status
class	Σ	1..1	Coding	Classification of patient encounter ActEncounterCode (Extensible)
classHistory		0..*	BackboneElement	List of past encounter classes
class		1..1	Coding	inpatient \| outpatient \| ambulatory \| emergency + ActEncounterCode (Extensible)
period		1..1	Period	The time that the episode was in the specified class
type	Σ	0..*	CodeableConcept	Specific type of encounter EncounterType (Example)
serviceType	Σ	0..1	CodeableConcept	Specific type of service ServiceType (Example)
priority		0..1	CodeableConcept	Indicates the urgency of the encounter ActPriority (Example)
subject	Σ	0..1	Reference(Patient \| Group)	The patient or group present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	Σ	0..*	BackboneElement	List of participants involved in the encounter
type	Σ	0..*	CodeableConcept	Role of participant in encounter ParticipantType (Extensible)
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner \| PractitionerRole \| RelatedPerson)	Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	Σ	0..*	CodeableConcept	Coded reason the encounter takes place Encounter Reason Codes (Preferred)
reasonReference	Σ	0..*	Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation)	Reason the encounter takes place (reference)
diagnosis	Σ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
condition	Σ	1..1	Reference(Condition \| Procedure)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) DiagnosisRole (Preferred)
rank		0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization		0..1	BackboneElement	Details about the admission to a healthcare service
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location \| Organization)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) AdmitSource (Preferred)
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission hl7VS-re-admissionIndicator (Example)
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Diet (Example)
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) SpecialCourtesy (Preferred)
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. SpecialArrangements (Preferred)
destination		0..1	Reference(Location \| Organization)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge DischargeDisposition (Example)
location		0..*	BackboneElement	List of locations where the patient has been
location		1..1	Reference(Location)	Location the encounter takes place
status		0..1	code	planned \| active \| reserved \| completed EncounterLocationStatus (Required)
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) LocationType (Example)
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

UML Diagram (Legend)

XML Template

<Encounter xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known --></identifier>
 <status value="[code]"/><!-- 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled + -->
 <statusHistory>  <!-- 0..* List of past encounter statuses -->
  <status value="[code]"/><!-- 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled + -->
  <period><!-- 1..1 Period The time that the episode was in the specified status --></period>
 </statusHistory>
 <class><!-- 1..1 Coding Classification of patient encounter  --></class>
 <classHistory>  <!-- 0..* List of past encounter classes -->
  <class><!-- 1..1 Coding inpatient | outpatient | ambulatory | emergency +  --></class>
  <period><!-- 1..1 Period The time that the episode was in the specified class --></period>
 </classHistory>
 <type><!-- 0..* CodeableConcept Specific type of encounter --></type>
 <serviceType><!-- 0..1 CodeableConcept Specific type of service --></serviceType>
 <priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter  --></priority>
 <subject><!-- 0..1 Reference(Group|Patient) The patient or group present at the encounter --></subject>
 <episodeOfCare><!-- 0..* Reference(EpisodeOfCare) Episode(s) of care that this encounter should be recorded against --></episodeOfCare>
 <basedOn><!-- 0..* Reference(ServiceRequest) The ServiceRequest that initiated this encounter --></basedOn>
 <participant>  <!-- 0..* List of participants involved in the encounter -->
  <type><!-- 0..* CodeableConcept Role of participant in encounter --></type>
  <period><!-- 0..1 Period Period of time during the encounter that the participant participated --></period>
  <individual><!-- 0..1 Reference(Practitioner|PractitionerRole|RelatedPerson) Persons involved in the encounter other than the patient --></individual>
 </participant>
 <appointment><!-- 0..* Reference(Appointment) The appointment that scheduled this encounter --></appointment>
 <period><!-- 0..1 Period The start and end time of the encounter --></period>
 <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length>
 <reasonCode><!-- 0..* CodeableConcept Coded reason the encounter takes place --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|ImmunizationRecommendation|
   Observation|Procedure) Reason the encounter takes place (reference) --></reasonReference>
 <diagnosis>  <!-- 0..* The list of diagnosis relevant to this encounter -->
  <condition><!-- 1..1 Reference(Condition|Procedure) The diagnosis or procedure relevant to the encounter --></condition>
  <use><!-- 0..1 CodeableConcept Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) --></use>
  <rank value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each role type) -->
 </diagnosis>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Encounter --></account>
 <hospitalization>  <!-- 0..1 Details about the admission to a healthcare service -->
  <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier>
  <origin><!-- 0..1 Reference(Location|Organization) The location/organization from which the patient came before admission --></origin>
  <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource>
  <reAdmission><!-- 0..1 CodeableConcept The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission  --></reAdmission>
  <dietPreference><!-- 0..* CodeableConcept Diet preferences reported by the patient --></dietPreference>
  <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy>
  <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc. --></specialArrangement>
  <destination><!-- 0..1 Reference(Location|Organization) Location/organization to which the patient is discharged --></destination>
  <dischargeDisposition><!-- 0..1 CodeableConcept Category or kind of location after discharge --></dischargeDisposition>
 </hospitalization>
 <location>  <!-- 0..* List of locations where the patient has been -->
  <location><!-- 1..1 Reference(Location) Location the encounter takes place --></location>
  <status value="[code]"/><!-- 0..1 planned | active | reserved | completed -->
  <physicalType><!-- 0..1 CodeableConcept The physical type of the location (usually the level in the location hierachy - bed room ward etc.) --></physicalType>
  <period><!-- 0..1 Period Time period during which the patient was present at the location --></period>
 </location>
 <serviceProvider><!-- 0..1 Reference(Organization) The organization (facility) responsible for this encounter --></serviceProvider>
 <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf>
</Encounter>

JSON Template

{
  "resourceType" : "Encounter",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
  "status" : "<code>", // R!  planned | arrived | triaged | in-progress | onleave | finished | cancelled +
  "statusHistory" : [{ // List of past encounter statuses
    "status" : "<code>", // R!  planned | arrived | triaged | in-progress | onleave | finished | cancelled +
    "period" : { Period } // R!  The time that the episode was in the specified status
  }],
  "class" : { Coding }, // R!  Classification of patient encounter 
  "classHistory" : [{ // List of past encounter classes
    "class" : { Coding }, // R!  inpatient | outpatient | ambulatory | emergency + 
    "period" : { Period } // R!  The time that the episode was in the specified class
  }],
  "type" : [{ CodeableConcept }], // Specific type of encounter
  "serviceType" : { CodeableConcept }, // Specific type of service
  "priority" : { CodeableConcept }, // Indicates the urgency of the encounter 
  "subject" : { Reference(Group|Patient) }, // The patient or group present at the encounter
  "episodeOfCare" : [{ Reference(EpisodeOfCare) }], // Episode(s) of care that this encounter should be recorded against
  "basedOn" : [{ Reference(ServiceRequest) }], // The ServiceRequest that initiated this encounter
  "participant" : [{ // List of participants involved in the encounter
    "type" : [{ CodeableConcept }], // Role of participant in encounter
    "period" : { Period }, // Period of time during the encounter that the participant participated
    "individual" : { Reference(Practitioner|PractitionerRole|RelatedPerson) } // Persons involved in the encounter other than the patient
  }],
  "appointment" : [{ Reference(Appointment) }], // The appointment that scheduled this encounter
  "period" : { Period }, // The start and end time of the encounter
  "length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
  "reasonCode" : [{ CodeableConcept }], // Coded reason the encounter takes place
  "reasonReference" : [{ Reference(Condition|ImmunizationRecommendation|
   Observation|Procedure) }], // Reason the encounter takes place (reference)
  "diagnosis" : [{ // The list of diagnosis relevant to this encounter
    "condition" : { Reference(Condition|Procedure) }, // R!  The diagnosis or procedure relevant to the encounter
    "use" : { CodeableConcept }, // Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
    "rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
  }],
  "account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Encounter
  "hospitalization" : { // Details about the admission to a healthcare service
    "preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
    "origin" : { Reference(Location|Organization) }, // The location/organization from which the patient came before admission
    "admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
    "reAdmission" : { CodeableConcept }, // The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission 
    "dietPreference" : [{ CodeableConcept }], // Diet preferences reported by the patient
    "specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
    "specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc.
    "destination" : { Reference(Location|Organization) }, // Location/organization to which the patient is discharged
    "dischargeDisposition" : { CodeableConcept } // Category or kind of location after discharge
  },
  "location" : [{ // List of locations where the patient has been
    "location" : { Reference(Location) }, // R!  Location the encounter takes place
    "status" : "<code>", // planned | active | reserved | completed
    "physicalType" : { CodeableConcept }, // The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
    "period" : { Period } // Time period during which the patient was present at the location
  }],
  "serviceProvider" : { Reference(Organization) }, // The organization (facility) responsible for this encounter
  "partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Encounter;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Encounter.identifier [ Identifier ], ... ; # 0..* Identifier(s) by which this encounter is known
  fhir:Encounter.status [ code ]; # 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled +
  fhir:Encounter.statusHistory [ # 0..* List of past encounter statuses
    fhir:Encounter.statusHistory.status [ code ]; # 1..1 planned | arrived | triaged | in-progress | onleave | finished | cancelled +
    fhir:Encounter.statusHistory.period [ Period ]; # 1..1 The time that the episode was in the specified status
  ], ...;
  fhir:Encounter.class [ Coding ]; # 1..1 Classification of patient encounter
  fhir:Encounter.classHistory [ # 0..* List of past encounter classes
    fhir:Encounter.classHistory.class [ Coding ]; # 1..1 inpatient | outpatient | ambulatory | emergency +
    fhir:Encounter.classHistory.period [ Period ]; # 1..1 The time that the episode was in the specified class
  ], ...;
  fhir:Encounter.type [ CodeableConcept ], ... ; # 0..* Specific type of encounter
  fhir:Encounter.serviceType [ CodeableConcept ]; # 0..1 Specific type of service
  fhir:Encounter.priority [ CodeableConcept ]; # 0..1 Indicates the urgency of the encounter
  fhir:Encounter.subject [ Reference(Group|Patient) ]; # 0..1 The patient or group present at the encounter
  fhir:Encounter.episodeOfCare [ Reference(EpisodeOfCare) ], ... ; # 0..* Episode(s) of care that this encounter should be recorded against
  fhir:Encounter.basedOn [ Reference(ServiceRequest) ], ... ; # 0..* The ServiceRequest that initiated this encounter
  fhir:Encounter.participant [ # 0..* List of participants involved in the encounter
    fhir:Encounter.participant.type [ CodeableConcept ], ... ; # 0..* Role of participant in encounter
    fhir:Encounter.participant.period [ Period ]; # 0..1 Period of time during the encounter that the participant participated
    fhir:Encounter.participant.individual [ Reference(Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Persons involved in the encounter other than the patient
  ], ...;
  fhir:Encounter.appointment [ Reference(Appointment) ], ... ; # 0..* The appointment that scheduled this encounter
  fhir:Encounter.period [ Period ]; # 0..1 The start and end time of the encounter
  fhir:Encounter.length [ Duration ]; # 0..1 Quantity of time the encounter lasted (less time absent)
  fhir:Encounter.reasonCode [ CodeableConcept ], ... ; # 0..* Coded reason the encounter takes place
  fhir:Encounter.reasonReference [ Reference(Condition|ImmunizationRecommendation|Observation|Procedure) ], ... ; # 0..* Reason the encounter takes place (reference)
  fhir:Encounter.diagnosis [ # 0..* The list of diagnosis relevant to this encounter
    fhir:Encounter.diagnosis.condition [ Reference(Condition|Procedure) ]; # 1..1 The diagnosis or procedure relevant to the encounter
    fhir:Encounter.diagnosis.use [ CodeableConcept ]; # 0..1 Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
    fhir:Encounter.diagnosis.rank [ positiveInt ]; # 0..1 Ranking of the diagnosis (for each role type)
  ], ...;
  fhir:Encounter.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this Encounter
  fhir:Encounter.hospitalization [ # 0..1 Details about the admission to a healthcare service
    fhir:Encounter.hospitalization.preAdmissionIdentifier [ Identifier ]; # 0..1 Pre-admission identifier
    fhir:Encounter.hospitalization.origin [ Reference(Location|Organization) ]; # 0..1 The location/organization from which the patient came before admission
    fhir:Encounter.hospitalization.admitSource [ CodeableConcept ]; # 0..1 From where patient was admitted (physician referral, transfer)
    fhir:Encounter.hospitalization.reAdmission [ CodeableConcept ]; # 0..1 The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
    fhir:Encounter.hospitalization.dietPreference [ CodeableConcept ], ... ; # 0..* Diet preferences reported by the patient
    fhir:Encounter.hospitalization.specialCourtesy [ CodeableConcept ], ... ; # 0..* Special courtesies (VIP, board member)
    fhir:Encounter.hospitalization.specialArrangement [ CodeableConcept ], ... ; # 0..* Wheelchair, translator, stretcher, etc.
    fhir:Encounter.hospitalization.destination [ Reference(Location|Organization) ]; # 0..1 Location/organization to which the patient is discharged
    fhir:Encounter.hospitalization.dischargeDisposition [ CodeableConcept ]; # 0..1 Category or kind of location after discharge
  ];
  fhir:Encounter.location [ # 0..* List of locations where the patient has been
    fhir:Encounter.location.location [ Reference(Location) ]; # 1..1 Location the encounter takes place
    fhir:Encounter.location.status [ code ]; # 0..1 planned | active | reserved | completed
    fhir:Encounter.location.physicalType [ CodeableConcept ]; # 0..1 The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
    fhir:Encounter.location.period [ Period ]; # 0..1 Time period during which the patient was present at the location
  ], ...;
  fhir:Encounter.serviceProvider [ Reference(Organization) ]; # 0..1 The organization (facility) responsible for this encounter
  fhir:Encounter.partOf [ Reference(Encounter) ]; # 0..1 Another Encounter this encounter is part of
]

Changes since Release 3

Encounter

Encounter.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-status|4.0.0 to http://hl7.org/fhir/ValueSet/encounter-status|4.1.0

Encounter.statusHistory.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-status|4.0.0 to http://hl7.org/fhir/ValueSet/encounter-status|4.1.0

Encounter.location.status

Change value set from http://hl7.org/fhir/ValueSet/encounter-location-status|4.0.0 to http://hl7.org/fhir/ValueSet/encounter-location-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 10 tests that all execute ok. All tests pass round-trip testing and 3 r3 resources are invalid (0 errors).)

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

8.11.4.1 Terminology Bindings

Path	Definition	Type	Reference
Encounter.status	Current state of the encounter.	Required	EncounterStatus
Encounter.statusHistory.status	Current state of the encounter.	Required	EncounterStatus
Encounter.class	Classification of the encounter.	Extensible	ActEncounterCode
Encounter.classHistory.class	Classification of the encounter.	Extensible	ActEncounterCode
Encounter.type	The type of encounter.	Example	EncounterType
Encounter.serviceType	Broad categorization of the service that is to be provided.	Example	ServiceType
Encounter.priority	Indicates the urgency of the encounter.	Example	ActPriority
Encounter.participant.type	Role of participant in encounter.	Extensible	ParticipantType
Encounter.reasonCode	Reason why the encounter takes place.	Preferred	EncounterReasonCodes
Encounter.diagnosis.use	The type of diagnosis this condition represents.	Preferred	DiagnosisRole
Encounter.hospitalization.admitSource	From where the patient was admitted.	Preferred	AdmitSource
Encounter.hospitalization.reAdmission	The reason for re-admission of this hospitalization encounter.	Example	Hl7VSReAdmissionIndicator
Encounter.hospitalization.dietPreference	Medical, cultural or ethical food preferences to help with catering requirements.	Example	Diet
Encounter.hospitalization.specialCourtesy	Special courtesies.	Preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	Special arrangements.	Preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	Discharge Disposition.	Example	DischargeDisposition
Encounter.location.status	The status of the location.	Required	EncounterLocationStatus
Encounter.location.physicalType	Physical form of the location.	Example	LocationType

Path

Definition

Type

Reference

Encounter.status

Current state of the encounter.

Required

EncounterStatus

Encounter.statusHistory.status

Current state of the encounter.

Required

EncounterStatus

Encounter.class

Classification of the encounter.

Extensible

ActEncounterCode

Encounter.classHistory.class

Classification of the encounter.

Extensible

ActEncounterCode

Encounter.type

The type of encounter.

Example

EncounterType

Encounter.serviceType

Broad categorization of the service that is to be provided.

Example

ServiceType

Encounter.priority

Indicates the urgency of the encounter.

Example

ActPriority

Encounter.participant.type

Role of participant in encounter.

Extensible

ParticipantType

Encounter.reasonCode

Reason why the encounter takes place.

Preferred

EncounterReasonCodes

Encounter.diagnosis.use

The type of diagnosis this condition represents.

Preferred

DiagnosisRole

Encounter.hospitalization.admitSource

From where the patient was admitted.

Preferred

AdmitSource

Encounter.hospitalization.reAdmission

The reason for re-admission of this hospitalization encounter.

Example

Hl7VSReAdmissionIndicator

Encounter.hospitalization.dietPreference

Medical, cultural or ethical food preferences to help with catering requirements.

Example

Diet

Encounter.hospitalization.specialCourtesy

Special courtesies.

Preferred

SpecialCourtesy

Encounter.hospitalization.specialArrangement

Special arrangements.

Preferred

SpecialArrangements

Encounter.hospitalization.dischargeDisposition

Discharge Disposition.

Example

DischargeDisposition

Encounter.location.status

The status of the location.

Required

EncounterLocationStatus

Encounter.location.physicalType

Physical form of the location.

Example

LocationType

8.11.5 Notes

The class element describes the setting (in/outpatient etc.) in which the Encounter took place. Since this is important for interpreting the context of the encounter, choosing the appropriate business rules to enforce and for the management of the process, this element is required.
In future versions of FHIR, some kind of charge posting vehicle (e.g. Account) will be added.

8.11.6 Example usage

As stated, Encounter allows a flexible nesting of Encounters using the partOf element. For example:

A patient is admitted for two weeks - This could be modeled using a single Encounter instance, in which the start and length are given for the duration of the whole stay. The admitting doctor and the responsible doctor during the stay are specified using the Participant component.
During the encounter, the patient moves from the admitting department to the Intensive Care unit and back - Three more detailed additional Encounters can be created, one for each location in which the patient stayed. Each of these Encounters has a single location (twice the admitting department and once the Intensive Care unit) and one or more participants at that location. These Encounters may use the partOf relationship to indicate these movements occurred during the longer overarching Encounter.
During the last part of the stay, the patient is visited by the members of the multi-disciplinary team that treated him for final evaluation - If relevant, for each of these short visits, an Encounter may be created with a single participant. Since these took place during the last part of the stay, the partOf element can be used to associate these short visits with either the third patient movement or the bigger overall encounter.

Exactly how the Encounter is used depends on information available in the source system, the relevance of exchange of each level of Encounter and demands specific to the communicating partners. The expectation is that for each domain of exchange, profiles are used to limit the flexibility of Encounter to meet the demands of the use case.

8.11.7 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
account	reference	The set of accounts that may be used for billing for this Encounter	Encounter.account (Account)
appointment	reference	The appointment that scheduled this encounter	Encounter.appointment (Appointment)
based-on	reference	The ServiceRequest that initiated this encounter	Encounter.basedOn (ServiceRequest)
class	token	Classification of patient encounter	Encounter.class
date	date	A date within the period the Encounter lasted	Encounter.period
diagnosis	reference	The diagnosis or procedure relevant to the encounter	Encounter.diagnosis.condition (Condition, Procedure)
episode-of-care	reference	Episode(s) of care that this encounter should be recorded against	Encounter.episodeOfCare (EpisodeOfCare)
identifier	token	Identifier(s) by which this encounter is known	Encounter.identifier
length	quantity	Length of encounter in days	Encounter.length
location	reference	Location the encounter takes place	Encounter.location.location (Location)
location-period	date	Time period during which the patient was present at the location	Encounter.location.period
part-of	reference	Another Encounter this encounter is part of	Encounter.partOf (Encounter)
participant	reference	Persons involved in the encounter other than the patient	Encounter.participant.individual (Practitioner, PractitionerRole, RelatedPerson)
participant-type	token	Role of participant in encounter	Encounter.participant.type
patient	reference	The patient or group present at the encounter	Encounter.subject.where(resolve() is Patient) (Group, Patient)
practitioner	reference	Persons involved in the encounter other than the patient	Encounter.participant.individual.where(resolve() is Practitioner) (Practitioner, PractitionerRole, RelatedPerson)
reason-code	token	Coded reason the encounter takes place	Encounter.reasonCode
reason-reference	reference	Reason the encounter takes place (reference)	Encounter.reasonReference (Condition, Observation, Procedure, ImmunizationRecommendation)
service-provider	reference	The organization (facility) responsible for this encounter	Encounter.serviceProvider (Organization)
special-arrangement	token	Wheelchair, translator, stretcher, etc.	Encounter.hospitalization.specialArrangement
status	token	planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled +	Encounter.status
subject	reference	The patient or group present at the encounter	Encounter.subject (Group, Patient)
type	token	Specific type of encounter	Encounter.type