Name Flags Card. Type Description & Constraints <a href="StructureDefinition-ch-lab-order-servicerequest-definitions.html#ServiceRequest" title="This IG follows the IHE Scheduled Workflow (SWF) Profile: An Order Filler accepts from an Order Placer a single Order that it equates to a Filler Order (which is concept commonly used in HL7) or Laboratory Service Request (Concept commonly used in DICOM). Consequently one CH Lab-Order Document contains one CH LAB-Order ServiceRequest which depicts one Placer Order equal one Filler Order equal one Imaging Service Request.">ServiceRequest 0..* ChOrfServiceRequest CH LAB-Order ServiceRequest category 1..* CodeableConcept Classification of Service Request: order of lab-test, request for test-results or request for second opinion Binding: Service Request Categories for Questionnaires (required): High-level kind of a clinical document at a macro level. specimen 0..* Reference(Specimen) Must be present, if order is request for test Documentation for this format
Definition for ServiceRequest in the context of CH LAB-Order
Quality Improvement and Clinical Knowledge (QUICK)
This IG follows the IHE Scheduled Workflow (SWF) Profile: An Order Filler accepts from an Order Placer a single Order that it equates to a Filler Order (which is concept commonly used in HL7) or Laboratory Service Request (Concept commonly used in DICOM). Consequently one CH Lab-Order Document contains one CH LAB-Order ServiceRequest which depicts one Placer Order equal one Filler Order equal one Imaging Service Request.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
orderDetail SHALL only be present if code is present
exists(f:code) or not(exists(f:orderDetail))
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Location and Time of ServiceRequest Fulfillment.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Requested Encounter Details for ServiceRequest Fulfillment.
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.
The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Instantiates FHIR protocol or definition
The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Note: This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Instantiates external protocol or definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Plan/proposal/order fulfilled by this request.
The request takes the place of the referenced completed or terminated request(s).
Handled by message location of ORC (ORC.1=RO or RU)
A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.
Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.
draft | active | on-hold | revoked | completed | entered-in-error | unknown
The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see [Event Pattern](event.html) for general discussion) or using the [Task](http://hl7.org/fhir/R4/task.html) resource.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Whether the request is a proposal, plan, an original order or a reflex order.
This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
.moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
Classification of Service Request: order of lab-test, request for test-results or request for second opinion
A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").
There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.
Used for filtering what service request are retrieved and displayed.
High-level kind of a clinical document at a macro level.
.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="INT"].code
Indicates how quickly the ServiceRequest should be addressed with respect to other requests.
If missing, this task should be performed with normal priority
Identifies the level of importance to be assigned to actioning the request.
True if service/procedure should not be performed
Set this to true if the record is saying that the service/procedure should NOT be performed.
In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.
Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.
If missing, the request is a positive request e.g. "do perform"
If true this element negates the specified action. For Example, instead of a request for a procedure, it is a request for the procedure to not occur.
A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.
Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.
Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available [here](valueset-diagnostic-requests.html).
Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.
For information from the medical record intended to support the delivery of the requested services, use the `supportingInformation` element.
Codified order entry details which are based on order context.
An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).
When ordering a service the number of service items may need to be specified separately from the the service item.
The principle target of a particular form content is one patient (for obstetrical and neonatal use cases see...).
Encounter in which the request was created
An encounter that provides additional information about the healthcare context in which this request is made.
.inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
The date/time at which the requested service should occur.
If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.
A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.
boolean: precondition.negationInd (inversed - so negationInd = true means asNeeded=false CodeableConcept: precondition.observationEventCriterion[code="Assertion"].value
When the request transitioned to being actionable.
The person/organization responsible for the form content
The individual who initiated the request and has responsibility for its activation.
This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.
Desired type of performer for doing the requested service.
This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.
Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.
If multiple performers are present, it is interpreted as a list of *alternative* performers without any preference regardless of order. If order of preference is needed use the [request-performerOrder extension](http://hl7.org/fhir/R4/extension-request-performerorder.html). Use CareTeam to represent a group of performers (for example, Practitioner A *and* Practitioner B).
PRT, Practitioner: PRD-2/PRD-7 where PRD-3 = RT; Organization: PRD-10 where PRD-3 = RT
The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.
A location type where services are delivered.
A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.
Explanation/Justification for procedure or service
An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in `supportingInfo`.
This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use `CodeableConcept.text` element if the data is free (uncoded) text as shown in the [CT Scan example](servicerequest-example-di.html).
Diagnosis or problem codes justifying the reason for requesting the service investigation.
Explanation/Justification for service or service
Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo`.
This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to *Observation* or *Condition* should be used if available. Otherwise when referencing *DiagnosticReport* it should contain a finding in `DiagnosticReport.conclusion` and/or `DiagnosticReport.conclusionCode`. When using a reference to *DocumentReference*, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in `ServiceRequest.reasonCode` if the data is free (uncoded) text as shown in the [CT Scan example](servicerequest-example-di.html).
Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.
Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.
To represent information about how the services are to be delivered use the `instructions` element.
Must be present, if order is request for test
One or more specimens that the laboratory procedure will use.
Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the [Specimen](http://hl7.org/fhir/R4/specimen.html) resource points to the ServiceRequest.
Anatomic location where the procedure should be performed. This is the target site.
Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension [procedure-targetBodyStructure](http://hl7.org/fhir/R4/extension-procedure-targetbodystructure.html).
Knowing where the procedure is performed is important for tracking if multiple sites are possible.
Codes describing anatomical locations. May include laterality.
Any other notes and comments made about the service request. For example, internal billing notes.
.inboundRelationship(typeCode=SUBJ].source[classCode=ANNGEN, moodCode=EVN].value[xsi:type=ST]
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.
The annotation - text content (as markdown)
The text of the annotation in markdown format.
Use Appointment.patientInstruction (referenced via ServiceRequest.extension) for patient-oriented instructions
Instructions in terms that are understood by the patient or consumer.
Key events in the history of the request.
This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.
.inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]