4.7 Resource ReferralRequest - Content

4.7.1 Scope and Usage

This resource is used to share relevant information required to support a referral request or a transfer of care request from one practitioner or organization to another. It is intended for use when a patient is required to be referred to another provider for a consultation/second opinion and/or for short term or longer term management of one or more health issues or problems.

Examples include:

• Request for a consult from a specialist
• Referral for support from community services
• District nursing services referral
• Request for Aged care placement assessment
• Request for a pharmacist medication review
• Referral for physiotherapy or occupational therapy

ReferralRequest is also intended for use when there is a complete and more permanent transfer of care responsibility from one practitioner/organization to another (for example, as in the case of requesting the transfer of care for a patient from an acute care setting to rehabilitation, aged care, or a skilled nursing facility).

4.7.2 Boundaries and Relationships

ReferralRequest is closely related to other types of "request" resources, particularly DiagnosticOrder and ProcedureRequest. In fact, for some services, it may be appropriate to use any one of these resources to request that the service be performed. Which one is used may be driven by organizational practice and by context. When it is unclear which to use, the following principles may be helpful:

• ProcedureRequest or DiagnosticOrder are typically used when the requesting clinician has and wishes to exercise the authority (and expertise) to decide exactly what action will be done.
• A ReferralRequest is used when the requesting practitioner is seeking another practitioner or organization to use their own expertise and/or authority to determine the specific action to take.
• Whether an activity is deemed to be a procedure or only a diagnostic order is typically driven by how invasive the diagnostic process is. More invasive processes are typically represented as procedures, though the dividing line may vary by organization.

Irrespective of the guidance above, systems should be prepared for some degree of overlap between these resources and should be prepared to execute searches against multiple resources in cases where differentiation cannot be guaranteed. As well, in some workflows more than one type of resource or even all three might exist; E.g., upon receiving a ReferralRequest a practitioner might initiate a DiagnosticOrder. The diagnostic service might then initiate a ProcedureRequest.

A "referral" is often thought of as a document that contains a great deal of information about the patient being referred. This resource does not actually contain the clinical background information for the patient. Instead, it supports references to the numerous other resources that define this information. For example, Condition, Family History, Allergy/Intolerance, Alerts, Medication, Diagnostic Reports, etc. Alternatively, some systems may choose to bundle up a ReferralRequest and this referenced information into a Document for delivery to the recipient. However, REST, Messaging and Services are also valid architectures for managing referrals and may be more appropriate where active workflow management is needed.

The details of the type of care desired as part of a referral may be conveyed using any of the "request" or "order" resources, likely with a status of "proposed". The CarePlan resource can be used to describe more sophisticated requests for combinations of services. Likewise, ReferralRequest may be referenced as part of a CarePlan.

A ReferralRequest may be targeted (identifying a specific Practitioner or Organization to perform the requested care) or untargeted (merely identifying the type of care desired). The Order and OrderResponse resources may be used to help manage such workflows.

A ReferralRequest might be fulfilled by a DiagnosticReport, Encounter, Procedure, or other assessment-related resource.

A ReferralRequest should not be confused with an Appointment, as appointments are intended for booking/scheduling purposes.

• Structure
• UML
• XML
• JSON
• All

Structure

Name	Flags	Card.	Type	Description & Constraints
ReferralRequest			DomainResource	A request for referral or transfer of care
status	?! Σ	1..1	code	draft | requested | active | cancelled | accepted | rejected | completed ReferralStatus (Required)
identifier		0..*	Identifier	Business identifier
date	Σ	0..1	dateTime	Date of creation/activation
type	Σ	0..1	CodeableConcept	Referral/Transition of care request type
specialty		0..1	CodeableConcept	The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty (Example)
priority	Σ	0..1	CodeableConcept	Urgency of referral / transfer of care request DiagnosticOrderPriority (Example)
patient	Σ	0..1	Reference(Patient)	Patient referred to care or transfer
requester	Σ	0..1	Reference(Practitioner | Organization | Patient)	Requester of referral / transfer of care
recipient	Σ	0..*	Reference(Practitioner | Organization)	Receiver of referral / transfer of care request
encounter		0..1	Reference(Encounter)	Originating encounter
dateSent	Σ	0..1	dateTime	Date referral/transfer of care request is sent
reason	Σ	0..1	CodeableConcept	Reason for referral / transfer of care request
description		0..1	string	A textual description of the referral
serviceRequested	Σ	0..*	CodeableConcept	Actions requested as part of the referral Practice Setting Code Value Set (Example)
supportingInformation	Σ	0..*	Reference(Any)	Additonal information to support referral or transfer of care request
fulfillmentTime	Σ	0..1	Period	Requested service(s) fulfillment time
Documentation for this format

<ReferralRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <status value="[code]"/><!-- 1..1 draft | requested | active | cancelled | accepted | rejected | completed -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <date value="[dateTime]"/><!-- 0..1 Date of creation/activation -->
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>
 <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority>
 <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient>
 <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) Requester of referral / transfer of care --></requester>
 <recipient><!-- 0..* Reference(Practitioner|Organization) Receiver of referral / transfer of care request --></recipient>
 <encounter><!-- 0..1 Reference(Encounter) Originating encounter --></encounter>
 <dateSent value="[dateTime]"/><!-- 0..1 Date referral/transfer of care request is sent -->
 <reason><!-- 0..1 CodeableConcept Reason for referral / transfer of care request --></reason>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <supportingInformation><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInformation>
 <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime>
</ReferralRequest>

{
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "status" : "<code>", // R!  draft | requested | active | cancelled | accepted | rejected | completed
  "identifier" : [{ Identifier }], // Business identifier
  "date" : "<dateTime>", // Date of creation/activation
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for
  "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request
  "patient" : { Reference(Patient) }, // Patient referred to care or transfer
  "requester" : { Reference(Practitioner|Organization|Patient) }, // Requester of referral / transfer of care
  "recipient" : [{ Reference(Practitioner|Organization) }], // Receiver of referral / transfer of care request
  "encounter" : { Reference(Encounter) }, // Originating encounter
  "dateSent" : "<dateTime>", // Date referral/transfer of care request is sent
  "reason" : { CodeableConcept }, // Reason for referral / transfer of care request
  "description" : "<string>", // A textual description of the referral
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "supportingInformation" : [{ Reference(Any) }], // Additonal information to support referral or transfer of care request
  "fulfillmentTime" : { Period } // Requested service(s) fulfillment time
}

Structure

Name	Flags	Card.	Type	Description & Constraints
ReferralRequest			DomainResource	A request for referral or transfer of care
status	?! Σ	1..1	code	draft | requested | active | cancelled | accepted | rejected | completed ReferralStatus (Required)
identifier		0..*	Identifier	Business identifier
date	Σ	0..1	dateTime	Date of creation/activation
type	Σ	0..1	CodeableConcept	Referral/Transition of care request type
specialty		0..1	CodeableConcept	The clinical specialty (discipline) that the referral is requested for PractitionerSpecialty (Example)
priority	Σ	0..1	CodeableConcept	Urgency of referral / transfer of care request DiagnosticOrderPriority (Example)
patient	Σ	0..1	Reference(Patient)	Patient referred to care or transfer
requester	Σ	0..1	Reference(Practitioner | Organization | Patient)	Requester of referral / transfer of care
recipient	Σ	0..*	Reference(Practitioner | Organization)	Receiver of referral / transfer of care request
encounter		0..1	Reference(Encounter)	Originating encounter
dateSent	Σ	0..1	dateTime	Date referral/transfer of care request is sent
reason	Σ	0..1	CodeableConcept	Reason for referral / transfer of care request
description		0..1	string	A textual description of the referral
serviceRequested	Σ	0..*	CodeableConcept	Actions requested as part of the referral Practice Setting Code Value Set (Example)
supportingInformation	Σ	0..*	Reference(Any)	Additonal information to support referral or transfer of care request
fulfillmentTime	Σ	0..1	Period	Requested service(s) fulfillment time
Documentation for this format

UML Diagram

XML Template

<ReferralRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <status value="[code]"/><!-- 1..1 draft | requested | active | cancelled | accepted | rejected | completed -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <date value="[dateTime]"/><!-- 0..1 Date of creation/activation -->
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>
 <priority><!-- 0..1 CodeableConcept Urgency of referral / transfer of care request --></priority>
 <patient><!-- 0..1 Reference(Patient) Patient referred to care or transfer --></patient>
 <requester><!-- 0..1 Reference(Practitioner|Organization|Patient) Requester of referral / transfer of care --></requester>
 <recipient><!-- 0..* Reference(Practitioner|Organization) Receiver of referral / transfer of care request --></recipient>
 <encounter><!-- 0..1 Reference(Encounter) Originating encounter --></encounter>
 <dateSent value="[dateTime]"/><!-- 0..1 Date referral/transfer of care request is sent -->
 <reason><!-- 0..1 CodeableConcept Reason for referral / transfer of care request --></reason>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <supportingInformation><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInformation>
 <fulfillmentTime><!-- 0..1 Period Requested service(s) fulfillment time --></fulfillmentTime>
</ReferralRequest>

JSON Template

{
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "status" : "<code>", // R!  draft | requested | active | cancelled | accepted | rejected | completed
  "identifier" : [{ Identifier }], // Business identifier
  "date" : "<dateTime>", // Date of creation/activation
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for
  "priority" : { CodeableConcept }, // Urgency of referral / transfer of care request
  "patient" : { Reference(Patient) }, // Patient referred to care or transfer
  "requester" : { Reference(Practitioner|Organization|Patient) }, // Requester of referral / transfer of care
  "recipient" : [{ Reference(Practitioner|Organization) }], // Receiver of referral / transfer of care request
  "encounter" : { Reference(Encounter) }, // Originating encounter
  "dateSent" : "<dateTime>", // Date referral/transfer of care request is sent
  "reason" : { CodeableConcept }, // Reason for referral / transfer of care request
  "description" : "<string>", // A textual description of the referral
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "supportingInformation" : [{ Reference(Any) }], // Additonal information to support referral or transfer of care request
  "fulfillmentTime" : { Period } // Requested service(s) fulfillment time
}