2nd DSTU Draft For Comment
This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
Generated Questionnaire for ReferralRequest
<?xml version="1.0" encoding="UTF-8"?>
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="qs1"/>
<contained>
<ValueSet>
<id value="vs2"/>
<url value="urn:uuid:558d265c-e36b-4c98-9ad3-fdfc5395c084"/>
<name value="Type options for ReferralRequest.requester"/>
<description value="Type options for ReferralRequest.requester"/>
<status value="active"/>
<expansion>
<timestamp value="2015-02-23T09:23:41+11:00"/>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="Practitioner"/>
<display value="Practitioner"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="Organization"/>
<display value="Organization"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="Patient"/>
<display value="Patient"/>
</contains>
</expansion>
</ValueSet>
</contained>
<contained>
<ValueSet>
<id value="vs3"/>
<url value="urn:uuid:30cd34bd-0042-4c96-b499-70dc3f4dbc7a"/>
<name value="Type options for ReferralRequest.recipient"/>
<description value="Type options for ReferralRequest.recipient"/>
<status value="active"/>
<expansion>
<timestamp value="2015-02-23T09:23:41+11:00"/>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="Practitioner"/>
<display value="Practitioner"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="Organization"/>
<display value="Organization"/>
</contains>
</expansion>
</ValueSet>
</contained>
<identifier>
<system value="urn:ietf:rfc:3986"/>
</identifier>
<status value="draft"/>
<date value="2015-02-23T09:07:27+11:00"/>
<publisher value="HL7 FHIR Project (Patient Care)"/>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Used to record and send details about a request for referral service or transfer of a patient to the care of another provider or provider organisation."/>
</extension>
<linkId value="ReferralRequest"/>
<title value="A request for referral or tranfer of care"/>
<required value="true"/>
<repeats value="false"/>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The logical id of the resource, as used in the url for the resoure. 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. Bundles always have an id, though it is usually a generated UUID."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="string"/>
</extension>
<linkId value="ReferralRequest.id"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.id.value"/>
<text value="Logical id of this artefact"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource."/>
</extension>
<linkId value="ReferralRequest.meta"/>
<text value="Metadata about the resource"/>
<required value="false"/>
<repeats value="true"/>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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 as much as possible."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="uri"/>
</extension>
<linkId value="ReferralRequest.implicitRules"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.implicitRules.value"/>
<text value="A set of rules under which this content was created"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="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)."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="code"/>
</extension>
<linkId value="ReferralRequest.language"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.language.value"/>
<text value="language"/>
<type value="choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="A human-readable narrative that contains a summary of the resource, and may 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."/>
</extension>
<linkId value="ReferralRequest.text"/>
<text value="Text summary of the resource, for human interpretation"/>
<required value="false"/>
<repeats value="true"/>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again."/>
</extension>
<linkId value="ReferralRequest.contained"/>
<text value="Contained, inline Resources"/>
<required value="false"/>
<repeats value="true"/>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The workflow status of the referral or transfer of care request."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="code"/>
</extension>
<linkId value="ReferralRequest.status"/>
<required value="true"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.status.value"/>
<text value="status"/>
<type value="choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Business Id that uniquely identifies the referral/care transfer request instance."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Identifier"/>
</extension>
<linkId value="ReferralRequest.identifier"/>
<text value="Identifier of request"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.identifier.label"/>
<text value="label:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.identifier.system"/>
<text value="system:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.identifier.value"/>
<text value="value:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="An indication of the type of referral (or where applicable the type of transfer of care) request. Examples of referral type:
- consultation;
second opinion;
third opinion
- Assume management
- Request for procedure(s)
HL7 v2.8 Example - Table 0336:
S = second opinion
p = patient preference
o = provider ordered
w = work load."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="CodeableConcept"/>
</extension>
<linkId value="ReferralRequest.type"/>
<text value="Referral/Transition of care request type"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.type.coding"/>
<text value="code:"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.type.text"/>
<text value="text:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Indication of the clinical domain or discipline to which the referral or transfer of care request is sent. Examples:
Cardiology
Gastroenterology
Diabetology."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="CodeableConcept"/>
</extension>
<linkId value="ReferralRequest.specialty"/>
<text value="The clinical specialty (discipline) that the referral is requested for"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.specialty.coding"/>
<text value="code:"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.specialty.text"/>
<text value="text:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="An indication of the urgency of referral (or where applicable the type of transfer of care) request."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="CodeableConcept"/>
</extension>
<linkId value="ReferralRequest.priority"/>
<text value="Urgency of referral / transfer of care request"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.priority.coding"/>
<text value="code:"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.priority.text"/>
<text value="text:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The patient who is the subject of a referral or transfer of care request. Referral of family, group or community is to be catered for by profiles."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.patient"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Patient?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.patient.value"/>
<text value="Patient referred to care or transfer"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The healthcare provider or provider organization who/which initaited the referral/transfer of care request. Can also be Patient (a self referral)."/>
</extension>
<linkId value="ReferralRequest.requester"/>
<text value="Requester of referral / transfer of care"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.requester._type"/>
<text value="type"/>
<type value="choice"/>
<required value="false"/>
<repeats value="false"/>
<options>
<reference value="#vs2"/>
</options>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.requester._Practitioner"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Practitioner?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.requester._Practitioner.value"/>
<text value="Practitioner"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.requester._Organization"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Organization?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.requester._Organization.value"/>
<text value="Organization"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.requester._Patient"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Patient?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.requester._Patient.value"/>
<text value="Patient"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The healthcare provider(s) or provider organization(s) who/which is to receive the referral/transfer of care request. There will be a primary receiver.
But the request can be received by any number of "copied to" providers or organisations."/>
</extension>
<linkId value="ReferralRequest.recipient"/>
<text value="Receiver of referral / transfer of care request"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.recipient._type"/>
<text value="type"/>
<type value="choice"/>
<required value="false"/>
<repeats value="false"/>
<options>
<reference value="#vs3"/>
</options>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.recipient._Practitioner"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Practitioner?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.recipient._Practitioner.value"/>
<text value="Practitioner"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.recipient._Organization"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Organization?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.recipient._Organization.value"/>
<text value="Organization"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The encounter at which the request for referral or transfer of care is initiated."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.encounter"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Encounter?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.encounter.value"/>
<text value="Encounter"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Date/DateTime the request for referral or transfer of care is sent by the author."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="datetime"/>
</extension>
<linkId value="ReferralRequest.dateSent"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.dateSent.value"/>
<text value="Date referral/transfer of care request is sent"/>
<type value="dateTime"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Description of clinical condition indicating why referral/transfer of care is requested. Examples:
"2nd degree AV block"
Oral Health example ReferralReasonCode:
01 = Pathological Anomalies
02 = Disabled (physical or mental)
03 = Complexity of Treatment
04 = Seizure Disorders
05 = Extensive Surgery
06 = Surgical Complexity
07 = Rampant decay
08 = Medical History (to provide details upon request)
09 = Temporal Mandibular Joint Anomalies
10 = Accidental Injury
11 = Anaesthesia complications (local or general)
12 = Developmental Anomalies
13 = Behavioral Management."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="CodeableConcept"/>
</extension>
<linkId value="ReferralRequest.reason"/>
<text value="Reason for referral / Transfer of care request"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.reason.coding"/>
<text value="code:"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.reason.text"/>
<text value="text:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The reason gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summary. This would be a good candidate for a 'markdown' data type."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="string"/>
</extension>
<linkId value="ReferralRequest.description"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.description.value"/>
<text value="A textual description of the referral"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The service(s) that is/are requested to be provided to the patient. Examples:
"cardiac pacemaker insertion"
HL7 v3 Concept domain - ReferralReasonCode examples:
- Specialized medical assistance
- Other care requirement."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="CodeableConcept"/>
</extension>
<linkId value="ReferralRequest.serviceRequested"/>
<text value="Service(s) requested"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.serviceRequested.coding"/>
<text value="code:"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.serviceRequested.text"/>
<text value="text:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Any additional (administrative, financial or clinical) information required to support request for referral or transfer of care. Examples include:
Presenting problems/chief complaints
Medical History
Family History
Alerts
Allergy/Intolerance and Adverse Reactions
Medications
Observations/Assessments (may include cognitive and fundtional assessments)
Diagnostic Reports
Care Plan."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="ReferralRequest.supportingInformation"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/_search?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="ReferralRequest.supportingInformation.value"/>
<text value="Additonal information to support referral or transfer of care request"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The period of time within which the services identified in the referral/transfer of care is specified or required to occur."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Period"/>
</extension>
<linkId value="ReferralRequest.fulfillmentTime"/>
<text value="Requested service(s) fulfillment time"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="ReferralRequest.fulfillmentTime.low"/>
<text value="start:"/>
<type value="dateTime"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="ReferralRequest.fulfillmentTime.end"/>
<text value="end:"/>
<type value="dateTime"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</group>
</Questionnaire>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
© HL7.org 2011+. FHIR DSTU (v0.4.0-4167) generated on Mon, Feb 23, 2015 09:23+1100.
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