Da Vinci Prior Authorization Support (PAS) FHIR IG
1.0.0 - STU 1

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.0.0: STU 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: PAS Service Request

Defining URL:http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest
Version:1.0.0
Name:PASServiceRequest
Title:PAS Service Request
Status:Active as of 2020-12-20T19:17:24+00:00
Definition:

PAS constraints on ServiceRequest resource mandating support for elements relevant to the generic services being requested on a prior authorization request

Publisher:HL7 International - Financial Management Work Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from ServiceRequest

Summary

Must-Support: 5 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

This structure is derived from ServiceRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..*ServiceRequestA request for a service to be performed
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-productOrServiceCodeEnd S0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
... intent 1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Fixed Value: order
... quantity[x] S0..1QuantityService amount
... subject S1..1Reference(PAS Beneficiary Patient)Individual or Entity the service is ordered for
... occurrence[x] S0..1PASTimingA timing schedule that specifies an event that may occur multiple times

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest I0..*ServiceRequestA request for a service to be performed
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-productOrServiceCodeEnd S0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierIdentifiers assigned to this order
... instantiatesCanonical Σ0..*canonical(ActivityDefinition | PlanDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | MedicationRequest)What request fulfills
... replaces Σ0..*Reference(ServiceRequest)What request replaces
... requisition Σ0..1IdentifierComposite Request ID
... status ?!Σ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.

... intent ?!Σ1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category Σ0..*CodeableConceptClassification of service
Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ0..1booleanTrue if service/procedure should not be performed
... code SΣ0..1CodeableConceptWhat is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... orderDetail ΣI0..*CodeableConceptAdditional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] SΣ0..1QuantityService amount
... subject SΣ1..1Reference(PAS Beneficiary Patient)Individual or Entity the service is ordered for
... encounter Σ0..1Reference(Encounter)Encounter in which the request was created
... occurrence[x] S0..1PASTimingA timing schedule that specifies an event that may occur multiple times
... asNeeded[x] Σ0..1Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBooleanboolean
.... asNeededCodeableConceptCodeableConcept
... authoredOn Σ0..1dateTimeDate request signed
... requester Σ0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)Who/what is requesting service
... performerType Σ0..1CodeableConceptPerformer role
Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)Requested performer
... locationCode Σ0..*CodeableConceptRequested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ0..*Reference(Location)Requested location
... reasonCode Σ0..*CodeableConceptExplanation/Justification for procedure or service
Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Explanation/Justification for service or service
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... supportingInfo 0..*Reference(Resource)Additional clinical information
... specimen Σ0..*Reference(Specimen)Procedure Samples
... bodySite Σ0..*CodeableConceptLocation on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..*AnnotationComments
... patientInstruction Σ0..1stringPatient or consumer-oriented instructions
... relevantHistory 0..*Reference(Provenance)Request provenance

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest I0..*ServiceRequestA request for a service to be performed
... extension-productOrServiceCodeEnd 0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
... code Σ0..1CodeableConceptWhat is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... quantity[x] Σ0..1QuantityService amount
... occurrence[x] 0..1PASTimingA timing schedule that specifies an event that may occur multiple times

doco Documentation for this format

This structure is derived from ServiceRequest

Summary

Must-Support: 5 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from ServiceRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..*ServiceRequestA request for a service to be performed
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-productOrServiceCodeEnd S0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
... intent 1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Fixed Value: order
... quantity[x] S0..1QuantityService amount
... subject S1..1Reference(PAS Beneficiary Patient)Individual or Entity the service is ordered for
... occurrence[x] S0..1PASTimingA timing schedule that specifies an event that may occur multiple times

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest I0..*ServiceRequestA request for a service to be performed
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-productOrServiceCodeEnd S0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierIdentifiers assigned to this order
... instantiatesCanonical Σ0..*canonical(ActivityDefinition | PlanDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | MedicationRequest)What request fulfills
... replaces Σ0..*Reference(ServiceRequest)What request replaces
... requisition Σ0..1IdentifierComposite Request ID
... status ?!Σ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.

... intent ?!Σ1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category Σ0..*CodeableConceptClassification of service
Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ0..1booleanTrue if service/procedure should not be performed
... code SΣ0..1CodeableConceptWhat is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... orderDetail ΣI0..*CodeableConceptAdditional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] SΣ0..1QuantityService amount
... subject SΣ1..1Reference(PAS Beneficiary Patient)Individual or Entity the service is ordered for
... encounter Σ0..1Reference(Encounter)Encounter in which the request was created
... occurrence[x] S0..1PASTimingA timing schedule that specifies an event that may occur multiple times
... asNeeded[x] Σ0..1Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBooleanboolean
.... asNeededCodeableConceptCodeableConcept
... authoredOn Σ0..1dateTimeDate request signed
... requester Σ0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)Who/what is requesting service
... performerType Σ0..1CodeableConceptPerformer role
Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)Requested performer
... locationCode Σ0..*CodeableConceptRequested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ0..*Reference(Location)Requested location
... reasonCode Σ0..*CodeableConceptExplanation/Justification for procedure or service
Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Explanation/Justification for service or service
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... supportingInfo 0..*Reference(Resource)Additional clinical information
... specimen Σ0..*Reference(Specimen)Procedure Samples
... bodySite Σ0..*CodeableConceptLocation on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..*AnnotationComments
... patientInstruction Σ0..1stringPatient or consumer-oriented instructions
... relevantHistory 0..*Reference(Provenance)Request provenance

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet / Code
ServiceRequest.languagepreferredCommonLanguages
Max Binding: AllLanguages
ServiceRequest.statusrequiredRequestStatus
ServiceRequest.intentrequiredFixed Value: order
ServiceRequest.categoryexampleServiceRequestCategoryCodes
ServiceRequest.priorityrequiredRequestPriority
ServiceRequest.coderequiredX12278RequestedServiceType
ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
ServiceRequest.performerTypeexampleParticipantRoles
ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
ServiceRequest.reasonCodeexampleProcedureReasonCodes
ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures