Generated Narrative: StructureDefinition profile-communicationrequest Name Flags Card. Type Description & Constraints CommunicationRequest CommunicationRequest #xD; contained S 0..* Resource Contained, inline Resources #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:Coverage-Information S 0..* (Complex) CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information #xD; identifier S 0..* Identifier Unique identifier #xD; basedOn S 1..1 Reference(Resource) Fulfills plan or proposal #xD; replaces 0..* Reference(CRD Communication Request) Request(s) replaced by this request #xD; status S 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown Example General: draft #xD; doNotPerform 0..0 True if request is prohibiting action #xD; subject S 1..1 Reference(CRD Patient) Focus of message #xD; encounter 0..1 Reference(CRD Encounter) Encounter created as part of #xD; payload S 1..* BackboneElement Message payload #xD; Slices for extension 1..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:codeableConcept S 1..1 (Complex) R5: content additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CommunicationRequest.payload.content #xD; extension 0..0 Extension #xD; value[x] #xD; Slices for extension Content/Rules for all slices #xD; extension:BillingOptions S 0..* CodeableConcept Expected Billing Code(s) URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options Binding: CRD Billing Codes Value Set (extensible) #xD; occurrence[x] S 0..1 dateTime, Period When scheduled #xD; authoredOn S 1..1 dateTime When request transitioned to being actionable #xD; requester S 1..1 Reference(CRD Practitioner S | HRex PractitionerRole Profile S) Who/what is requesting service #xD; recipient S 0..* Reference(CRD Practitioner S | HRex PractitionerRole Profile S | CRD Organization S) Message recipient #xD; sender S 0..1 Reference(CRD Practitioner S | HRex PractitionerRole Profile S | CRD Organization S) Message sender #xD; reasonCode S 0..* CodeableConcept Why is communication needed? #xD; reasonReference S 0..* Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core DiagnosticReport Profile for Laboratory Results Reporting(7.0.0) | US Core DiagnosticReport Profile for Report and Note Exchange(7.0.0) | US Core DocumentReference Profile(7.0.0) | Observation) Why is communication needed? #xD; Documentation for this format
HL7 International / Financial Management
This profile specifies constraints on the CommunicationRequest resource to support coverage requirements discovery.
A request for information to be sent to a receiver
A request to convey information; e.g. the CDS system proposes that an alert be sent to a responsible provider, the CDS system proposes that the public health agency be notified about a reportable condition.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
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).
Text summary of the resource, for human interpretation
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.
Any references found in this resource, with the exception of 'Patient' could potentially be resource-specific and thus transmitted as contained resources.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Questionnaire is only allowed when doc-needed exists
extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists()
If covered is set to 'not-covered', then 'pa-needed' must not exist.
extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not()
'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'.
extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists()
If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' cannot be 'withpa'.
extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa')
'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()
If 'info-needed' is OTH, then reason must be specified
extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists()
If reason.coding is present and is not from the extensible value set, then reason.text must be present
extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons')
If doc-purpose is present with a value other than 'conditional', then reason must be present
extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists()
If any of 'covered', 'pa-needed', or 'doc-needed' is set to 'indeterminate', then reason must be present to explain the issue that is preventing the payer from making a coverage determination.
extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'indeterminate').count() >= 1 implies extension.where(url = 'reason').exists()
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Business identifiers assigned to this communication request by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Allows identification of the communication request as it is known by various participating systems and in a way that remains consistent across servers.
A plan or proposal that is fulfilled in whole or in part by this request.
Allows tracing of authorization for the request and tracking whether proposals/recommendations were acted upon.
Completed or terminated request(s) whose function is taken by this new request.
potentially relevant for CRD in some situations.
Allows tracing the continuation of a therapy or administrative process instantiated through multiple requests.
A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition, prescription or similar form.
Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
draft | active | on-hold | revoked | completed | entered-in-error | unknown
This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order, for order-dispatch or when referenced by an appointment.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid.
The status of the communication request.
Captures the reason for the current state of the CommunicationRequest.
This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the CommunicationRequest was created at all is captured in reasonCode, not here. [distinct reason codes for different statuses can be enforced using invariants if they are universal bindings].
Codes identifying the reason for the current state of a request.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
The type of message to be sent such as alert, notification, reminder, instruction, etc.
There may be multiple axes of categorization and one communication request may serve multiple purposes.
Codes for general categories of communications such as alerts, instruction, etc.
Characterizes how quickly the proposed act must be initiated. Includes concepts such as stat, urgent, routine.
If missing, this task should be performed with normal priority
Codes indicating the relative importance of a communication request.
If true indicates that the CommunicationRequest is asking for the specified action to *not* occur.
The attributes provided with the request qualify what is not to be done.
If do not perform is not specified, the request is a positive request e.g. "do perform"
If true this element negates the specified action. For Example, instead of a request for a communication, it is a request for the communication to not occur.
A channel that was used for this communication (e.g. email, fax).
Codes for communication mediums such as phone, fax, email, in person, etc.
The patient or group that is the focus of this communication request.
Resources that pertain to this communication request
Other resources that pertain to this communication request and to which this communication request should be associated.
Don't use CommunicationRequest.about element when a more specific element exists, such as basedOn, reasonReference, or replaces.
The Encounter during which this CommunicationRequest was created or to which the creation of this record is tightly associated.
Text, attachment(s), or resource(s) to be communicated to the recipient.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
R5: `CommunicationRequest.payload.content[x]` additional types (CodeableConcept)
If the actual communication request being authored is conveying resources or an attachment, the CRD client SHALL either determine a coded way to indicate what information sharing is being requested or shall omit sharing the CommunicationRequest - i.e. do not bother calling the hook service.
Extensions are always sliced by (at least) url
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
The communicated content (or for multi-part communications, one portion of the communication).
The content can be codified or textual. As an example of codified content, when working with machine generated communications, the payload may be drawn from a finite, terminology defined set of communications, especially for short, status update kinds of communications where more of a natural language approach isn't appropriate. If the content isn't codified, contentCodeableConcept.text can be used. When using contentCodeableConcept, the CodeableConcept is what is being communicated and is not a categorization of the content.
Additional content defined by implementations
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.
Identifies billing codes that could potentially be used for this clinical code
This will typically only be populated if the ordering and performing systems are the same
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.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Plain text representation of the concept
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.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Extensions that cannot be ignored even if unrecognized
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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The time when this communication is to occur.
When request transitioned to being actionable
For draft requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation.
The device, individual, or organization who initiated the request and has responsibility for its activation.
The entity (e.g. person, organization, clinical information system, device, group, or care team) which is the intended target of the communication.
The entity (e.g. person, organization, clinical information system, or device) which is to be the source of the communication.
Describes why the request is being made in coded or textual form.
Textual reasons can be captured using reasonCode.text.
Codes for describing reasons for the occurrence of a communication.
Indicates another resource whose existence justifies this request.
Observations **SHOULD** use US Core profiles when applicable, but not all relevant observations have appropriate US Core profiles (and there are too many to practically list all US Core profiles).
Comments made about communication request
Comments made about the request by the requester, sender, recipient, subject or other participants.
.inboundRelationship(typeCode=SUBJ].source[classCode=ANNGEN, moodCode=EVN].value[xsi:type=ST]