This page is part of the FHIR Specification (v0.0.82: DSTU 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5R4BR4R3R2
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.
5.9.1 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, planned accommodation or planned encounter locations. In
this case the status element is set to 'planned'.
5.9.2 Boundaries and Relationships
Appointment information is out of scope for Encounter, the Appointment resource (yet to be defined) needs 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.
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.
The Location indicates where the patient has been during the encounter (he might visit multiple locations, e.g. to an MRI room
for examinations, while Accommodation keeps information about the bed in which a patient stays during a hospitalization.
In future versions of FHIR, some kind of charge posting vehicle (e.g. Account) will be added.
5.9.5 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 usecase.
5.9.6 Search Parameters
Search parameters for this resource. The standard parameters also apply. See Searching for more information about searching in REST, messaging, and services.
. Page versions: R5 R4B R4 R3 R2
<!-- from Resource: extension, modifierExtension, language, text, and contained --> <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known § --></identifier> <status value="[code]"/><!-- 1..1 planned | in progress | onleave | finished | cancelled § --> <class value="[code]"/><!-- 1..1 inpatient | outpatient | ambulatory | emergency + § --> <type><!-- 0..* CodeableConcept Specific type of encounter § --></type> <subject><!-- 0..1 Resource(Patient) The patient present at the encounter § --></subject> <participant> <!-- 0..* List of participants involved in the encounter § --> <type><!-- 0..* CodeableConcept Role of participant in encounter § --></type> <individual><!-- 0..1 Resource(Practitioner|RelatedPerson) Persons involved in the encounter other than the patient § --></individual> </participant> <period><!-- 0..1 Period The start and end time of the encounter --></period> <length><!-- 0..1 Duration Quantity of time the encounter lasted --></length> <reason><!-- 0..1 CodeableConcept Reason the encounter takes place (code) § --></reason> <indication><!-- 0..1 Resource(Any) Reason the encounter takes place (resource) --></indication> <priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter --></priority> <hospitalization> <!-- 0..1 Details about an admission to a clinic --> <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier> <origin><!-- 0..1 Resource(Location) The location from which the patient came before admission --></origin> <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource> <period><!-- 0..1 Period Period during which the patient was admitted --></period> <accomodation> <!-- 0..* Where the patient stays during this encounter --> <bed><!-- 0..1 Resource(Location) The bed that is assigned to the patient --></bed> <period><!-- 0..1 Period Period during which the patient was assigned the bed --></period> </accomodation> <diet><!-- 0..1 CodeableConcept Dietary restrictions for the patient --></diet> <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy> <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc --></specialArrangement> <destination><!-- 0..1 Resource(Location) Location to which the patient is discharged --></destination> <dischargeDisposition><!-- 0..1 CodeableConcept Category or kind of location after discharge --></dischargeDisposition> <dischargeDiagnosis><!-- 0..1 Resource(Any) The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete --></dischargeDiagnosis> <reAdmission value="[boolean]"/><!-- 0..1 Is this hospitalization a readmission? --> </hospitalization> <location> <!-- 0..* List of locations the patient has been at --> <location><!-- 1..1 Resource(Location) Location the encounter takes place --></location> <period><!-- 1..1 Period Time period during which the patient was present at the location --></period> </location> <serviceProvider><!-- 0..1 Resource(Organization) Department or team providing care --></serviceProvider> <partOf><!-- 0..1 Resource(Encounter) Another Encounter this encounter is part of --></partOf> </Encounter>
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