FHIR Release 3 (STU)

This page is part of the FHIR Specification (v3.0.2: STU 3). 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: R3 R2

12.14 Resource ReferralRequest - Content

Patient Care Work GroupMaturity Level: 1 Trial UseCompartments: Patient, Practitioner

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 organization.

12.14.1 Scope and Usage

ReferralRequest is one of the request resources in the FHIR workflow specification.

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 consultation 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).

12.14.2 Boundaries and Relationships

ReferralRequest is closely related to other types of "request" resources, particularly 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 is 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 request 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. Additionally, in some workflows more than one type of resource or even both might exist, such as upon receiving a ReferralRequest a practitioner might 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 Task resource 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.

This resource is referenced by Appointment, CarePlan, Claim, ClinicalImpression, DiagnosticReport, Encounter, EpisodeOfCare, ExplanationOfBenefit, ImagingStudy, MedicationRequest, MedicationStatement, Observation, Procedure and QuestionnaireResponse

12.14.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest DomainResourceA request for referral or transfer of care
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness identifier
... definition Σ0..*Reference(ActivityDefinition | PlanDefinition)Instantiates protocol or definition
... basedOn Σ0..*Reference(ReferralRequest | CarePlan | ProcedureRequest)Request fulfilled by this request
... replaces Σ0..*Reference(ReferralRequest)Request(s) replaced by this request
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... status ?!Σ1..1codedraft | active | suspended | cancelled | completed | entered-in-error | unknown
RequestStatus (Required)
... intent ?!Σ1..1codeproposal | plan | order
RequestIntent (Required)
... type Σ0..1CodeableConceptReferral/Transition of care request type
SNOMED CT Patient Referral (Example)
... priority Σ0..1codeUrgency of referral / transfer of care request
RequestPriority (Required)
... serviceRequested Σ0..*CodeableConceptActions requested as part of the referral
Practice Setting Code Value Set (Example)
... subject Σ1..1Reference(Patient | Group)Patient referred to care or transfer
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating encounter
... occurrence[x] Σ0..1When the service(s) requested in the referral should occur
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... authoredOn Σ0..1dateTimeDate of creation/activation
... requester ΣI0..1BackboneElementWho/what is requesting service
+ onBehalfOf can only be specified if agent is practitioner or device
.... agent Σ1..1Reference(Practitioner | Organization | Patient | RelatedPerson | Device)Individual making the request
.... onBehalfOf ΣI0..1Reference(Organization)Organization agent is acting for
... specialty 0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
PractitionerSpecialty (Example)
... recipient Σ0..*Reference(Practitioner | Organization | HealthcareService)Receiver of referral / transfer of care request
... reasonCode Σ0..*CodeableConceptReason for referral / transfer of care request
SNOMED CT Clinical Findings (Example)
... reasonReference Σ0..*Reference(Condition | Observation)Why is service needed?
... description 0..1stringA textual description of the referral
... supportingInfo 0..*Reference(Any)Additonal information to support referral or transfer of care request
... note 0..*AnnotationComments made about referral request
... relevantHistory 0..*Reference(Provenance)Key events in history of request

doco Documentation for this format

UML Diagram (Legend)

ReferralRequest (DomainResource)Business identifier that uniquely identifies the referral/care transfer request instanceidentifier : Identifier [0..*]A protocol, guideline, orderset or other definition that is adhered to in whole or in part by this requestdefinition : Reference [0..*] ActivityDefinition|PlanDefinition Indicates any plans, proposals or orders that this request is intended to satisfy - in whole or in partbasedOn : Reference [0..*] ReferralRequest|CarePlan| ProcedureRequest Completed or terminated request(s) whose function is taken by this new requestreplaces : Reference [0..*] ReferralRequest The business identifier of the logical "grouping" request/order that this referral is a part ofgroupIdentifier : Identifier [0..1]The status of the authorization/intention reflected by the referral request record (this element modifies the meaning of other elements)status : code [1..1] The status of the referral. (Strength=Required)RequestStatus! Distinguishes the "level" of authorization/demand implicit in this request (this element modifies the meaning of other elements)intent : code [1..1] Codes identifying the stage lifecycle stage of a request (Strength=Required)RequestIntent! An indication of the type of referral (or where applicable the type of transfer of care) requesttype : CodeableConcept [0..1] Codes for types of referral; e.g. consult, transfer, temporary transfer. (Strength=Example)SNOMED CT Patient Referral?? An indication of the urgency of referral (or where applicable the type of transfer of care) requestpriority : code [0..1] Codes indicating the relative priority of the referral. (Strength=Required)RequestPriority! The service(s) that is/are requested to be provided to the patient. For example: cardiac pacemaker insertionserviceRequested : CodeableConcept [0..*] Codes indicating the types of services that might be requested as part of a referral. (Strength=Example)Practice Setting Code Value S...?? The patient who is the subject of a referral or transfer of care requestsubject : Reference [1..1] Patient|Group The encounter at which the request for referral or transfer of care is initiatedcontext : Reference [0..1] Encounter|EpisodeOfCare The period of time within which the services identified in the referral/transfer of care is specified or required to occuroccurrence[x] : Type [0..1] dateTime|Period Date/DateTime of creation for draft requests and date of activation for active requestsauthoredOn : dateTime [0..1]Indication of the clinical domain or discipline to which the referral or transfer of care request is sent. For example: Cardiology Gastroenterology Diabetologyspecialty : CodeableConcept [0..1] Codes indicating the types of capability the referred to service provider must have. (Strength=Example)PractitionerSpecialty?? The healthcare provider(s) or provider organization(s) who/which is to receive the referral/transfer of care requestrecipient : Reference [0..*] Practitioner|Organization| HealthcareService Description of clinical condition indicating why referral/transfer of care is requested. For example: Pathological Anomalies, Disabled (physical or mental), Behavioral ManagementreasonCode : CodeableConcept [0..*] Codes indicating why the referral is being requested. (Strength=Example)SNOMED CT Clinical Findings?? Indicates another resource whose existence justifies this requestreasonReference : Reference [0..*] Condition|Observation The reason element gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summarydescription : string [0..1]Any additional (administrative, financial or clinical) information required to support request for referral or transfer of care. For example: 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 PlansupportingInfo : Reference [0..*] Any Comments made about the referral request by any of the participantsnote : Annotation [0..*]Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resourcerelevantHistory : Reference [0..*] Provenance RequesterThe device, practitioner, etc. who initiated the requestagent : Reference [1..1] Practitioner|Organization|Patient| RelatedPerson|Device The organization the device or practitioner was acting on behalf ofonBehalfOf : Reference [0..1] Organization The individual who initiated the request and has responsibility for its activationrequester[0..1]

XML Template

<ReferralRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <definition><!-- 0..* Reference(ActivityDefinition|PlanDefinition) Instantiates protocol or definition --></definition>
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|ProcedureRequest) Request fulfilled by this request --></basedOn>
 <replaces><!-- 0..* Reference(ReferralRequest) Request(s) replaced by this request --></replaces>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <status value="[code]"/><!-- 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | order -->
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <priority value="[code]"/><!-- 0..1 Urgency of referral / transfer of care request -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <subject><!-- 1..1 Reference(Patient|Group) Patient referred to care or transfer --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context>
 <occurrence[x]><!-- 0..1 dateTime|Period When the service(s) requested in the referral should occur --></occurrence[x]>
 <authoredOn value="[dateTime]"/><!-- 0..1 Date of creation/activation -->
 <requester>  <!-- 0..1 Who/what is requesting service -->
  <agent><!-- 1..1 Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) Individual making the request --></agent>
  <onBehalfOf><!-- ?? 0..1 Reference(Organization) Organization agent is acting for --></onBehalfOf>
 </requester>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>
 <recipient><!-- 0..* Reference(Practitioner|Organization|HealthcareService) Receiver of referral / transfer of care request --></recipient>
 <reasonCode><!-- 0..* CodeableConcept Reason for referral / transfer of care request --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation) Why is service needed? --></reasonReference>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <supportingInfo><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInfo>
 <note><!-- 0..* Annotation Comments made about referral request --></note>
 <relevantHistory><!-- 0..* Reference(Provenance) Key events in history of request --></relevantHistory>
</ReferralRequest>

JSON Template

{doco
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "definition" : [{ Reference(ActivityDefinition|PlanDefinition) }], // Instantiates protocol or definition
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|ProcedureRequest) }], // Request fulfilled by this request
  "replaces" : [{ Reference(ReferralRequest) }], // Request(s) replaced by this request
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  draft | active | suspended | cancelled | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | order
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "priority" : "<code>", // Urgency of referral / transfer of care request
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "subject" : { Reference(Patient|Group) }, // R!  Patient referred to care or transfer
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter
  // occurrence[x]: When the service(s) requested in the referral should occur. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "authoredOn" : "<dateTime>", // Date of creation/activation
  "requester" : { // Who/what is requesting service
    "agent" : { Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) }, // R!  Individual making the request
    "onBehalfOf" : { Reference(Organization) } // C? Organization agent is acting for
  },
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for
  "recipient" : [{ Reference(Practitioner|Organization|HealthcareService) }], // Receiver of referral / transfer of care request
  "reasonCode" : [{ CodeableConcept }], // Reason for referral / transfer of care request
  "reasonReference" : [{ Reference(Condition|Observation) }], // Why is service needed?
  "description" : "<string>", // A textual description of the referral
  "supportingInfo" : [{ Reference(Any) }], // Additonal information to support referral or transfer of care request
  "note" : [{ Annotation }], // Comments made about referral request
  "relevantHistory" : [{ Reference(Provenance) }] // Key events in history of request
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ReferralRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ReferralRequest.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ReferralRequest.definition [ Reference(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates protocol or definition
  fhir:ReferralRequest.basedOn [ Reference(ReferralRequest|CarePlan|ProcedureRequest) ], ... ; # 0..* Request fulfilled by this request
  fhir:ReferralRequest.replaces [ Reference(ReferralRequest) ], ... ; # 0..* Request(s) replaced by this request
  fhir:ReferralRequest.groupIdentifier [ Identifier ]; # 0..1 Composite request this is part of
  fhir:ReferralRequest.status [ code ]; # 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown
  fhir:ReferralRequest.intent [ code ]; # 1..1 proposal | plan | order
  fhir:ReferralRequest.type [ CodeableConcept ]; # 0..1 Referral/Transition of care request type
  fhir:ReferralRequest.priority [ code ]; # 0..1 Urgency of referral / transfer of care request
  fhir:ReferralRequest.serviceRequested [ CodeableConcept ], ... ; # 0..* Actions requested as part of the referral
  fhir:ReferralRequest.subject [ Reference(Patient|Group) ]; # 1..1 Patient referred to care or transfer
  fhir:ReferralRequest.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating encounter
  # ReferralRequest.occurrence[x] : 0..1 When the service(s) requested in the referral should occur. One of these 2
    fhir:ReferralRequest.occurrenceDateTime [ dateTime ]
    fhir:ReferralRequest.occurrencePeriod [ Period ]
  fhir:ReferralRequest.authoredOn [ dateTime ]; # 0..1 Date of creation/activation
  fhir:ReferralRequest.requester [ # 0..1 Who/what is requesting service
    fhir:ReferralRequest.requester.agent [ Reference(Practitioner|Organization|Patient|RelatedPerson|Device) ]; # 1..1 Individual making the request
    fhir:ReferralRequest.requester.onBehalfOf [ Reference(Organization) ]; # 0..1 Organization agent is acting for
  ];
  fhir:ReferralRequest.specialty [ CodeableConcept ]; # 0..1 The clinical specialty (discipline) that the referral is requested for
  fhir:ReferralRequest.recipient [ Reference(Practitioner|Organization|HealthcareService) ], ... ; # 0..* Receiver of referral / transfer of care request
  fhir:ReferralRequest.reasonCode [ CodeableConcept ], ... ; # 0..* Reason for referral / transfer of care request
  fhir:ReferralRequest.reasonReference [ Reference(Condition|Observation) ], ... ; # 0..* Why is service needed?
  fhir:ReferralRequest.description [ string ]; # 0..1 A textual description of the referral
  fhir:ReferralRequest.supportingInfo [ Reference(Any) ], ... ; # 0..* Additonal information to support referral or transfer of care request
  fhir:ReferralRequest.note [ Annotation ], ... ; # 0..* Comments made about referral request
  fhir:ReferralRequest.relevantHistory [ Reference(Provenance) ], ... ; # 0..* Key events in history of request
]

Changes since DSTU2

ReferralRequest
ReferralRequest.definition
  • Added Element
ReferralRequest.basedOn
  • Added Element
ReferralRequest.replaces
  • Added Element
ReferralRequest.groupIdentifier
  • Added Element
ReferralRequest.status
  • Change value set from http://hl7.org/fhir/ValueSet/referralstatus to http://hl7.org/fhir/ValueSet/request-status
ReferralRequest.intent
  • Added Element
ReferralRequest.priority
  • Type changed from CodeableConcept to code
  • Add Binding http://hl7.org/fhir/ValueSet/request-priority (required)
ReferralRequest.subject
  • Renamed from patient to subject
  • Min Cardinality changed from 0 to 1
  • Add Reference(Group)
ReferralRequest.context
  • Renamed from encounter to context
  • Add Reference(EpisodeOfCare)
ReferralRequest.occurrence[x]
  • Added Element
ReferralRequest.authoredOn
  • Renamed from date to authoredOn
ReferralRequest.requester
  • Remove Reference(Practitioner), Remove Reference(Organization), Remove Reference(Patient)
ReferralRequest.requester.agent
  • Added Element
ReferralRequest.requester.onBehalfOf
  • Added Element
ReferralRequest.recipient
  • Add Reference(HealthcareService)
ReferralRequest.reasonCode
  • Renamed from reason to reasonCode
  • Max Cardinality changed from 1 to *
ReferralRequest.reasonReference
  • Added Element
ReferralRequest.supportingInfo
  • Renamed from supportingInformation to supportingInfo
ReferralRequest.note
  • Added Element
ReferralRequest.relevantHistory
  • Added Element
ReferralRequest.dateSent
  • deleted
ReferralRequest.fulfillmentTime
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and 2 r3 resources are invalid (2 errors).).

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest DomainResourceA request for referral or transfer of care
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness identifier
... definition Σ0..*Reference(ActivityDefinition | PlanDefinition)Instantiates protocol or definition
... basedOn Σ0..*Reference(ReferralRequest | CarePlan | ProcedureRequest)Request fulfilled by this request
... replaces Σ0..*Reference(ReferralRequest)Request(s) replaced by this request
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... status ?!Σ1..1codedraft | active | suspended | cancelled | completed | entered-in-error | unknown
RequestStatus (Required)
... intent ?!Σ1..1codeproposal | plan | order
RequestIntent (Required)
... type Σ0..1CodeableConceptReferral/Transition of care request type
SNOMED CT Patient Referral (Example)
... priority Σ0..1codeUrgency of referral / transfer of care request
RequestPriority (Required)
... serviceRequested Σ0..*CodeableConceptActions requested as part of the referral
Practice Setting Code Value Set (Example)
... subject Σ1..1Reference(Patient | Group)Patient referred to care or transfer
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating encounter
... occurrence[x] Σ0..1When the service(s) requested in the referral should occur
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... authoredOn Σ0..1dateTimeDate of creation/activation
... requester ΣI0..1BackboneElementWho/what is requesting service
+ onBehalfOf can only be specified if agent is practitioner or device
.... agent Σ1..1Reference(Practitioner | Organization | Patient | RelatedPerson | Device)Individual making the request
.... onBehalfOf ΣI0..1Reference(Organization)Organization agent is acting for
... specialty 0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
PractitionerSpecialty (Example)
... recipient Σ0..*Reference(Practitioner | Organization | HealthcareService)Receiver of referral / transfer of care request
... reasonCode Σ0..*CodeableConceptReason for referral / transfer of care request
SNOMED CT Clinical Findings (Example)
... reasonReference Σ0..*Reference(Condition | Observation)Why is service needed?
... description 0..1stringA textual description of the referral
... supportingInfo 0..*Reference(Any)Additonal information to support referral or transfer of care request
... note 0..*AnnotationComments made about referral request
... relevantHistory 0..*Reference(Provenance)Key events in history of request

doco Documentation for this format

UML Diagram (Legend)

ReferralRequest (DomainResource)Business identifier that uniquely identifies the referral/care transfer request instanceidentifier : Identifier [0..*]A protocol, guideline, orderset or other definition that is adhered to in whole or in part by this requestdefinition : Reference [0..*] ActivityDefinition|PlanDefinition Indicates any plans, proposals or orders that this request is intended to satisfy - in whole or in partbasedOn : Reference [0..*] ReferralRequest|CarePlan| ProcedureRequest Completed or terminated request(s) whose function is taken by this new requestreplaces : Reference [0..*] ReferralRequest The business identifier of the logical "grouping" request/order that this referral is a part ofgroupIdentifier : Identifier [0..1]The status of the authorization/intention reflected by the referral request record (this element modifies the meaning of other elements)status : code [1..1] The status of the referral. (Strength=Required)RequestStatus! Distinguishes the "level" of authorization/demand implicit in this request (this element modifies the meaning of other elements)intent : code [1..1] Codes identifying the stage lifecycle stage of a request (Strength=Required)RequestIntent! An indication of the type of referral (or where applicable the type of transfer of care) requesttype : CodeableConcept [0..1] Codes for types of referral; e.g. consult, transfer, temporary transfer. (Strength=Example)SNOMED CT Patient Referral?? An indication of the urgency of referral (or where applicable the type of transfer of care) requestpriority : code [0..1] Codes indicating the relative priority of the referral. (Strength=Required)RequestPriority! The service(s) that is/are requested to be provided to the patient. For example: cardiac pacemaker insertionserviceRequested : CodeableConcept [0..*] Codes indicating the types of services that might be requested as part of a referral. (Strength=Example)Practice Setting Code Value S...?? The patient who is the subject of a referral or transfer of care requestsubject : Reference [1..1] Patient|Group The encounter at which the request for referral or transfer of care is initiatedcontext : Reference [0..1] Encounter|EpisodeOfCare The period of time within which the services identified in the referral/transfer of care is specified or required to occuroccurrence[x] : Type [0..1] dateTime|Period Date/DateTime of creation for draft requests and date of activation for active requestsauthoredOn : dateTime [0..1]Indication of the clinical domain or discipline to which the referral or transfer of care request is sent. For example: Cardiology Gastroenterology Diabetologyspecialty : CodeableConcept [0..1] Codes indicating the types of capability the referred to service provider must have. (Strength=Example)PractitionerSpecialty?? The healthcare provider(s) or provider organization(s) who/which is to receive the referral/transfer of care requestrecipient : Reference [0..*] Practitioner|Organization| HealthcareService Description of clinical condition indicating why referral/transfer of care is requested. For example: Pathological Anomalies, Disabled (physical or mental), Behavioral ManagementreasonCode : CodeableConcept [0..*] Codes indicating why the referral is being requested. (Strength=Example)SNOMED CT Clinical Findings?? Indicates another resource whose existence justifies this requestreasonReference : Reference [0..*] Condition|Observation The reason element gives a short description of why the referral is being made, the description expands on this to support a more complete clinical summarydescription : string [0..1]Any additional (administrative, financial or clinical) information required to support request for referral or transfer of care. For example: 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 PlansupportingInfo : Reference [0..*] Any Comments made about the referral request by any of the participantsnote : Annotation [0..*]Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resourcerelevantHistory : Reference [0..*] Provenance RequesterThe device, practitioner, etc. who initiated the requestagent : Reference [1..1] Practitioner|Organization|Patient| RelatedPerson|Device The organization the device or practitioner was acting on behalf ofonBehalfOf : Reference [0..1] Organization The individual who initiated the request and has responsibility for its activationrequester[0..1]

XML Template

<ReferralRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <definition><!-- 0..* Reference(ActivityDefinition|PlanDefinition) Instantiates protocol or definition --></definition>
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|ProcedureRequest) Request fulfilled by this request --></basedOn>
 <replaces><!-- 0..* Reference(ReferralRequest) Request(s) replaced by this request --></replaces>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <status value="[code]"/><!-- 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | order -->
 <type><!-- 0..1 CodeableConcept Referral/Transition of care request type --></type>
 <priority value="[code]"/><!-- 0..1 Urgency of referral / transfer of care request -->
 <serviceRequested><!-- 0..* CodeableConcept Actions requested as part of the referral --></serviceRequested>
 <subject><!-- 1..1 Reference(Patient|Group) Patient referred to care or transfer --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating encounter --></context>
 <occurrence[x]><!-- 0..1 dateTime|Period When the service(s) requested in the referral should occur --></occurrence[x]>
 <authoredOn value="[dateTime]"/><!-- 0..1 Date of creation/activation -->
 <requester>  <!-- 0..1 Who/what is requesting service -->
  <agent><!-- 1..1 Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) Individual making the request --></agent>
  <onBehalfOf><!-- ?? 0..1 Reference(Organization) Organization agent is acting for --></onBehalfOf>
 </requester>
 <specialty><!-- 0..1 CodeableConcept The clinical specialty (discipline) that the referral is requested for --></specialty>
 <recipient><!-- 0..* Reference(Practitioner|Organization|HealthcareService) Receiver of referral / transfer of care request --></recipient>
 <reasonCode><!-- 0..* CodeableConcept Reason for referral / transfer of care request --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation) Why is service needed? --></reasonReference>
 <description value="[string]"/><!-- 0..1 A textual description of the referral -->
 <supportingInfo><!-- 0..* Reference(Any) Additonal information to support referral or transfer of care request --></supportingInfo>
 <note><!-- 0..* Annotation Comments made about referral request --></note>
 <relevantHistory><!-- 0..* Reference(Provenance) Key events in history of request --></relevantHistory>
</ReferralRequest>

JSON Template

{doco
  "resourceType" : "ReferralRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "definition" : [{ Reference(ActivityDefinition|PlanDefinition) }], // Instantiates protocol or definition
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|ProcedureRequest) }], // Request fulfilled by this request
  "replaces" : [{ Reference(ReferralRequest) }], // Request(s) replaced by this request
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  draft | active | suspended | cancelled | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | order
  "type" : { CodeableConcept }, // Referral/Transition of care request type
  "priority" : "<code>", // Urgency of referral / transfer of care request
  "serviceRequested" : [{ CodeableConcept }], // Actions requested as part of the referral
  "subject" : { Reference(Patient|Group) }, // R!  Patient referred to care or transfer
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating encounter
  // occurrence[x]: When the service(s) requested in the referral should occur. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "authoredOn" : "<dateTime>", // Date of creation/activation
  "requester" : { // Who/what is requesting service
    "agent" : { Reference(Practitioner|Organization|Patient|RelatedPerson|
    Device) }, // R!  Individual making the request
    "onBehalfOf" : { Reference(Organization) } // C? Organization agent is acting for
  },
  "specialty" : { CodeableConcept }, // The clinical specialty (discipline) that the referral is requested for
  "recipient" : [{ Reference(Practitioner|Organization|HealthcareService) }], // Receiver of referral / transfer of care request
  "reasonCode" : [{ CodeableConcept }], // Reason for referral / transfer of care request
  "reasonReference" : [{ Reference(Condition|Observation) }], // Why is service needed?
  "description" : "<string>", // A textual description of the referral
  "supportingInfo" : [{ Reference(Any) }], // Additonal information to support referral or transfer of care request
  "note" : [{ Annotation }], // Comments made about referral request
  "relevantHistory" : [{ Reference(Provenance) }] // Key events in history of request
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ReferralRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ReferralRequest.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ReferralRequest.definition [ Reference(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates protocol or definition
  fhir:ReferralRequest.basedOn [ Reference(ReferralRequest|CarePlan|ProcedureRequest) ], ... ; # 0..* Request fulfilled by this request
  fhir:ReferralRequest.replaces [ Reference(ReferralRequest) ], ... ; # 0..* Request(s) replaced by this request
  fhir:ReferralRequest.groupIdentifier [ Identifier ]; # 0..1 Composite request this is part of
  fhir:ReferralRequest.status [ code ]; # 1..1 draft | active | suspended | cancelled | completed | entered-in-error | unknown
  fhir:ReferralRequest.intent [ code ]; # 1..1 proposal | plan | order
  fhir:ReferralRequest.type [ CodeableConcept ]; # 0..1 Referral/Transition of care request type
  fhir:ReferralRequest.priority [ code ]; # 0..1 Urgency of referral / transfer of care request
  fhir:ReferralRequest.serviceRequested [ CodeableConcept ], ... ; # 0..* Actions requested as part of the referral
  fhir:ReferralRequest.subject [ Reference(Patient|Group) ]; # 1..1 Patient referred to care or transfer
  fhir:ReferralRequest.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating encounter
  # ReferralRequest.occurrence[x] : 0..1 When the service(s) requested in the referral should occur. One of these 2
    fhir:ReferralRequest.occurrenceDateTime [ dateTime ]
    fhir:ReferralRequest.occurrencePeriod [ Period ]
  fhir:ReferralRequest.authoredOn [ dateTime ]; # 0..1 Date of creation/activation
  fhir:ReferralRequest.requester [ # 0..1 Who/what is requesting service
    fhir:ReferralRequest.requester.agent [ Reference(Practitioner|Organization|Patient|RelatedPerson|Device) ]; # 1..1 Individual making the request
    fhir:ReferralRequest.requester.onBehalfOf [ Reference(Organization) ]; # 0..1 Organization agent is acting for
  ];
  fhir:ReferralRequest.specialty [ CodeableConcept ]; # 0..1 The clinical specialty (discipline) that the referral is requested for
  fhir:ReferralRequest.recipient [ Reference(Practitioner|Organization|HealthcareService) ], ... ; # 0..* Receiver of referral / transfer of care request
  fhir:ReferralRequest.reasonCode [ CodeableConcept ], ... ; # 0..* Reason for referral / transfer of care request
  fhir:ReferralRequest.reasonReference [ Reference(Condition|Observation) ], ... ; # 0..* Why is service needed?
  fhir:ReferralRequest.description [ string ]; # 0..1 A textual description of the referral
  fhir:ReferralRequest.supportingInfo [ Reference(Any) ], ... ; # 0..* Additonal information to support referral or transfer of care request
  fhir:ReferralRequest.note [ Annotation ], ... ; # 0..* Comments made about referral request
  fhir:ReferralRequest.relevantHistory [ Reference(Provenance) ], ... ; # 0..* Key events in history of request
]

Changes since DSTU2

ReferralRequest
ReferralRequest.definition
  • Added Element
ReferralRequest.basedOn
  • Added Element
ReferralRequest.replaces
  • Added Element
ReferralRequest.groupIdentifier
  • Added Element
ReferralRequest.status
  • Change value set from http://hl7.org/fhir/ValueSet/referralstatus to http://hl7.org/fhir/ValueSet/request-status
ReferralRequest.intent
  • Added Element
ReferralRequest.priority
  • Type changed from CodeableConcept to code
  • Add Binding http://hl7.org/fhir/ValueSet/request-priority (required)
ReferralRequest.subject
  • Renamed from patient to subject
  • Min Cardinality changed from 0 to 1
  • Add Reference(Group)
ReferralRequest.context
  • Renamed from encounter to context
  • Add Reference(EpisodeOfCare)
ReferralRequest.occurrence[x]
  • Added Element
ReferralRequest.authoredOn
  • Renamed from date to authoredOn
ReferralRequest.requester
  • Remove Reference(Practitioner), Remove Reference(Organization), Remove Reference(Patient)
ReferralRequest.requester.agent
  • Added Element
ReferralRequest.requester.onBehalfOf
  • Added Element
ReferralRequest.recipient
  • Add Reference(HealthcareService)
ReferralRequest.reasonCode
  • Renamed from reason to reasonCode
  • Max Cardinality changed from 1 to *
ReferralRequest.reasonReference
  • Added Element
ReferralRequest.supportingInfo
  • Renamed from supportingInformation to supportingInfo
ReferralRequest.note
  • Added Element
ReferralRequest.relevantHistory
  • Added Element
ReferralRequest.dateSent
  • deleted
ReferralRequest.fulfillmentTime
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and 2 r3 resources are invalid (2 errors).).

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

12.14.3.1 Terminology Bindings

PathDefinitionTypeReference
ReferralRequest.status The status of the referral.RequiredRequestStatus
ReferralRequest.intent Codes identifying the stage lifecycle stage of a requestRequiredRequestIntent
ReferralRequest.type Codes for types of referral; e.g. consult, transfer, temporary transfer.ExampleSNOMED CT Patient Referral
ReferralRequest.priority Codes indicating the relative priority of the referral.RequiredRequestPriority
ReferralRequest.serviceRequested Codes indicating the types of services that might be requested as part of a referral.ExamplePractice Setting Code Value Set
ReferralRequest.specialty Codes indicating the types of capability the referred to service provider must have.ExamplePractitionerSpecialty
ReferralRequest.reasonCode Codes indicating why the referral is being requested.ExampleSNOMED CT Clinical Findings

12.14.3.2 Constraints

  • rfr-1: On ReferralRequest.requester: onBehalfOf can only be specified if agent is practitioner or device (expression on ReferralRequest.requester: (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())

12.14.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
authored-ondateCreation or activation dateReferralRequest.authoredOn
based-onreferenceRequest being fulfilledReferralRequest.basedOn
(ReferralRequest, CarePlan, ProcedureRequest)
contextreferencePart of encounter or episode of careReferralRequest.context
(EpisodeOfCare, Encounter)
definitionreferenceInstantiates protocol or definitionReferralRequest.definition
(PlanDefinition, ActivityDefinition)
encounterreferenceOriginating encounterReferralRequest.context
(Encounter)
group-identifiertokenPart of common requestReferralRequest.groupIdentifier
identifiertokenBusiness identifierReferralRequest.identifier
intenttokenProposal, plan or orderReferralRequest.intent
occurrence-datedateWhen the service(s) requested in the referral should occurReferralRequest.occurrence
patientreferenceWho the referral is aboutReferralRequest.subject
(Patient)		31 Resources
prioritytokenThe priority assigned to the referralReferralRequest.priority
recipientreferenceThe person that the referral was sent toReferralRequest.recipient
(Practitioner, Organization, HealthcareService)
replacesreferenceRequest(s) replaced by this requestReferralRequest.replaces
(ReferralRequest)
requesterreferenceIndividual making the requestReferralRequest.requester.agent
(Practitioner, Organization, Device, Patient, RelatedPerson)
servicetokenActions requested as part of the referralReferralRequest.serviceRequested
specialtytokenThe specialty that the referral is forReferralRequest.specialty
statustokenThe status of the referralReferralRequest.status
subjectreferencePatient referred to care or transferReferralRequest.subject
(Group, Patient)
typetokenThe type of the referralReferralRequest.type6 Resources