CH LAB-Order (R4)
2.0.0-ballot - ballot Switzerland flag

This page is part of the CH LAB-Order (R4) (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Bundle: Referral 6-histopath


Laboratory Order

Case study 6: Suspected Melanoma, order for histopathology examination

A 45-year-old female patient came for her regular skin check and this lesion was noted: Junctions nevi consisting of seborrheic area top end and atypical network constructed of many seperate dots, structures , etc , suggesting melanocytic involvement. Excision. Attachement of dermatoscopic images // TODO Specimen: 29 x 11 x 5 mm skin ellipse Body Site: Back paralumbar left

The skin sample, including the order form and the dermatoscopic image are sent to the laboratory.

Matching FHIR questionnaire that meets this specification: 6-histopath.xml 6-histopath.json


Order-Referral-Form 6-histopath

Order-Referral-Form 6-histopath

Additional Document Content


2. http://example.com/fhir/Patient/KlebsiellaKeller (Patient/KlebsiellaKeller)

id: KlebsiellaKeller

meta:

identifier: 012/08.111114

name: Klebsiella Keller

gender: FEMALE

birthDate: Dec 12, 1975

maritalStatus: verheiratet (Details : {$ech-11-maritalstatus code '2' = '2', given as 'verheiratet'})

Communications

-LanguagePreferred
*Deutsch (Schweiz) (Details : {urn:ietf:bcp:47 code 'de-CH' = 'German (Region=Schweiz))true


3. http://example.com/fhir/Practitioner/MarcMustermann (Practitioner/MarcMustermann)

Generated Narrative: Practitioner

Resource Practitioner "MarcMustermann"

Profile: CH Core Practitioner

identifier: id: 7601000050700, id: A123309

name: Marc Mustermann (OFFICIAL)

telecom: ph: 033 333 22 11(WORK), marc.mustermann@gruppenpraxis.ch


4. http://example.com/fhir/Organization/Arztpraxis (Organization/Arztpraxis)

Generated Narrative: Organization

Resource Organization "Arztpraxis"

Profile: CH Core Organization

identifier: id: 7601000235503

name: Arztpraxis Messen

Contacts

-TelecomAddress
*+41555545566, info@arztpraxis.ch, http://www.arztpraxis.chDoktorgasse 2 Messen 3254 CH


5. http://example.com/fhir/PractitionerRole/MarcMustermannArztpraxis (PractitionerRole/MarcMustermannArztpraxis)

Generated Narrative: PractitionerRole

Resource PractitionerRole "MarcMustermannArztpraxis"

Profile: CH Core PractitionerRole

practitioner: See above (Practitioner/MarcMustermann)

organization: See above (Organization/Arztpraxis)


6. http://example.com/fhir/Questionnaire/6-histopath (Questionnaire/6-histopath)

Structure

LinkIdTextCardinalityTypeFlagsDescription & Constraintsdoco
.. LabOrderFormExampleQuestionnairehttp://fhir.ch/ig/ch-lab-order/Questionnaire/6-histopath#1.0.0
... orderAuftrag1..1group
.... order.placerOrderIdentifierAuftragsnummer des Auftraggebers0..1string
.... order.placerOrderIdentifierDomainIdentifier Domain der Auftragsnummer des Auftraggebers0..1stringicon
.... order.fillerOrderIdentifierAuftragsnummer des Auftragsempfängers0..1string
.... order.fillerOrderIdentifierDomainIdentifier Domain der Auftragsnummer des Auftragsempfängers0..1stringicon
.... order.precedentDocumentIdentifierIdentifier des Vorgängerdokuments0..1stringicon
.... order.notificationContactDocumentDringender Benachrichtigungskontakt für dieses Dokument0..1group
..... order.notificationContactDocument.practitionerZu benachrichtigende Person0..1group
...... order.notificationContactDocument.practitioner.titleTitel0..1string
...... order.notificationContactDocument.practitioner.familyNameName0..1string
...... order.notificationContactDocument.practitioner.givenNameVorname0..1string
...... order.notificationContactDocument.practitioner.phoneTelefon0..1string
...... order.notificationContactDocument.practitioner.emailE-Mail0..1string
.... order.notificationContactDocumentResponseDringender Benachrichtigungskontakt für die Antwort auf dieses Dokument0..1group
..... order.notificationContactDocumentResponse.practitionerZu benachrichtigende Person0..1group
...... order.notificationContactDocumentResponse.practitioner.titleTitel0..1string
...... order.notificationContactDocumentResponse.practitioner.familyNameName0..1string
...... order.notificationContactDocumentResponse.practitioner.givenNameVorname0..1string
...... order.notificationContactDocumentResponse.practitioner.phoneTelefon0..1string
...... order.notificationContactDocumentResponse.practitioner.emailE-Mail0..1string
.... order.priorityAuftragspriorität0..1choiceOptions: 4 options
... receiverEmpfänger0..1group
.... receiver.practitionerEmpfangende Person0..1group
..... receiver.practitioner.titleTitel0..1string
..... receiver.practitioner.familyNameName0..1string
..... receiver.practitioner.givenNameVorname0..1string
..... receiver.practitioner.glnGLN0..1string
..... receiver.practitioner.zsrZSR0..1string
..... receiver.practitioner.phoneTelefon0..1string
..... receiver.practitioner.emailE-Mail0..1string
.... receiver.organizationEmpfangende Organisation0..1group
..... receiver.organization.nameName der Organisation0..1string
..... receiver.organization.glnGLN0..1string
..... receiver.organization.streetAddressLineStrasse, Hausnummer, Postfach etc.0..*string
..... receiver.organization.postalCodePLZ0..1string
..... receiver.organization.cityOrt0..1string
..... receiver.organization.countryLand0..1string
... patientPatient1..1group
.... patient.familyNameName0..1string
.... patient.maidenNameLedigname0..1string
.... patient.givenNameVorname0..1string
.... patient.localPidLokale Patienten-ID0..1string
.... patient.birthDateGeburtsdatum0..1date
.... patient.genderGeschlecht0..1choiceOptions: 3 options
.... patient.maritalStatusZivilstand0..1choiceDefinition: Patient.maritalStatus
Options: 8 options
.... patient.phoneTelefon0..1string
.... patient.emailE-Mail0..1string
.... patient.streetAddressLineStrasse, Hausnummer, Postfach etc.0..*string
.... patient.postalCodePLZ0..1string
.... patient.cityOrt0..1string
.... patient.countryLand0..1string
.... patient.languageOfCorrespondanceKorrespondenssprache0..1choiceDefinition: Patient.communication:languageOfCorrespondance
Value Set: DocumentEntry.languageCode
.... patient.contactpersonKontaktperson0..1groupDefinition: Patient.contact
..... patient.contactperson.relationshipBeziehung0..1stringDefinition: Patient.contact.relationship.text
..... patient.contactperson.familyNameName0..1stringDefinition: Patient.contact.name.family
..... patient.contactperson.givenNameVorname0..1stringDefinition: Patient.contact.name.given
..... patient.contactperson.phoneTelefon0..*stringDefinition: Patient.contact.telecom.value
..... patient.contactperson.emailE-Mail0..1stringDefinition: Patient.contact.telecom.value
.... sender.authorVerantwortlicher1..1group
..... sender.author.practitionerVerantwortliche Person0..1group
...... sender.author.practitioner.titleTitel0..1string
...... sender.author.practitioner.familyNameName0..1string
...... sender.author.practitioner.givenNameVorname0..1string
...... sender.author.practitioner.glnGLN0..1string
...... sender.author.practitioner.zsrZSR0..1string
...... sender.author.practitioner.phoneTelefon0..1string
...... sender.author.practitioner.emailE-Mail0..1string
..... sender.author.organizationVerantwortliche Organisation0..1group
...... sender.author.organization.nameName der Organisation0..1string
...... sender.author.organization.streetAddressLineStrasse, Hausnummer, Postfach etc.0..*string
...... sender.author.organization.postalCodePLZ0..1string
...... sender.author.organization.cityOrt0..1string
...... sender.author.organization.countryLand0..1string
.... sender.dataentererErfasser0..1group
..... sender.dataenterer.practitionerErfassende Person0..1group
...... sender.dataenterer.practitioner.familyNameName0..1string
...... sender.dataenterer.practitioner.givenNameVorname0..1string
...... sender.dataenterer.practitioner.phoneTelefon0..1string
...... sender.dataenterer.practitioner.emailE-Mail0..1string
... receiverCopiesKopieempfänger0..1group
.... receiverCopyKopieempfangende Organisation oder Person0..*groupDefinition: PractitionerRole
..... receiverCopy.organization.nameName der Organisation0..1stringDefinition: PractitionerRole.practitioner
...... receiverCopy.practitionerRole.practitioner.titleTitel0..1stringDefinition: HumanName.prefix
...... receiverCopy.practitionerRole.practitioner.familyNameName0..1stringDefinition: HumanName.family
...... receiverCopy.practitionerRole.practitioner.givenNameVorname0..1stringDefinition: HumanName.given
...... receiverCopy.practitionerRole.practitioner.phoneTelefon0..1stringDefinition: ContactPoint.value
...... receiverCopy.practitionerRole.practitioner.emailE-Mail0..1stringDefinition: ContactPoint.value
..... receiverCopy.titleTitel0..1stringDefinition: PractitionerRole.organization
...... receiverCopy.practitionerRole.organization.nameName der Organisation0..1stringDefinition: Organization.name
...... receiverCopy.practitionerRole.organization.streetAddressLineStrasse, Hausnummer, Postfach etc.0..*stringDefinition: Address.line
...... receiverCopy.practitionerRole.organization.postalCodePLZ0..1stringDefinition: Address.postalCode
...... receiverCopy.practitionerRole.organization.cityOrt0..1stringDefinition: Address.city
...... receiverCopy.practitionerRole.organization.countryLand0..1stringDefinition: Address.country
..... receiverCopy.familyNameName0..1string
..... receiverCopy.givenNameVorname0..1string
..... receiverCopy.phoneTelefon0..1string
..... receiverCopy.emailE-Mail0..1string
..... receiverCopy.streetAddressLineStrasse, Hausnummer, Postfach etc.0..*string
..... receiverCopy.postalCodePLZ0..1string
..... receiverCopy.cityOrt0..1string
..... receiverCopy.countryLand0..1string
.... receiverCopy.patientPatient selbst0..1booleanDefinition: Patient
.... receiverCopy.relatedPersonAndere Person0..*groupDefinition: RelatedPerson
..... receiverCopy.relatedPerson.familyNameName0..1stringDefinition: RelatedPerson.name.family
..... receiverCopy.relatedPerson.givenNameVorame0..1stringDefinition: RelatedPerson.name.given
..... receiverCopy.relatedPerson.phoneTelefon0..*stringDefinition: RelatedPerson.telecom.value
..... receiverCopy.relatedPerson.emailE-Mail0..1stringDefinition: RelatedPerson.telecom.value
..... receiverCopy.relatedPerson.streetAddressLineStrasse, Hausnummer, Postfach etc.0..*stringDefinition: RelatedPerson.address.line
..... receiverCopy.relatedPerson.postalCodePLZ0..1stringDefinition: RelatedPerson.address.postalCode
..... receiverCopy.relatedPerson.cityOrt0..1stringDefinition: RelatedPerson.address.city
..... receiverCopy.relatedPerson.countryLand0..1stringDefinition: RelatedPerson.address.country
... consentEinverständniserklärung0..1groupDefinition: http://fhir.ch/ig/ch-lab-order/StructureDefinition/ch-lab-order-servicerequest#ServiceRequest.supportingInfo
.... consent.treatmentEinverständnis des Patienten zur Behandlung0..1string
.... consent.patientPrivacyEinverständnis des Patienten zum Datenschutz0..1string
.... consent.researchEinverständnis des Patienten zur Forschung0..1string
.... consent.advancedCareDirectivePatientenverfügung0..1string
... coverageKostenträger0..1groupDefinition: http://fhir.ch/ig/ch-lab-order/StructureDefinition/ch-lab-order-servicerequest#ServiceRequest.insurance
.... coverage.uvgUnfallversicherung (nach UVG)0..1string
.... coverage.kvgGrundversicherung (nach KVG)0..1string
.... coverage.vvgZusatzversicherung (nach VVG)0..1string
.... coverage.vvgOtherAndere (nach VVG)0..1string
... previousResultVorheriges Untersuchungsresultat0..1groupDefinition: http://fhir.ch/ig/ch-lab-order/StructureDefinition/ch-lab-order-servicerequest#ServiceRequest.supportingInfo
.... previousResult.resultUntersuchungsresultat0..*string
... labSpecialtiesLabor Sparten0..1group
.... labSpecialties.pathologyPathology0..1booleanDefinition: 27898-6
..... labSpecialties.pathology.panelsPathology Panels0..1groupEnable When: labSpecialties.pathology = true
...... labSpecialties.pathology.panels.AutopsyAutopsy report0..1booleanDefinition: 18743-5
...... labSpecialties.pathology.panels.PathologyStudyPathology Study0..1booleanDefinition: 11526-1
...... labSpecialties.pathology.panels.SurgicalPathologyStudySurgical pathology study0..1booleanDefinition: 11529-5

doco Documentation for this format

Option Sets

Answer options for order.priority

  • iconhttp://hl7.org/fhir/request-priority#routine ("Routine")
  • iconhttp://hl7.org/fhir/request-priority#urgent ("Urgent")
  • iconhttp://hl7.org/fhir/request-priority#asap ("ASAP")
  • iconhttp://hl7.org/fhir/request-priority#stat ("STAT")

Answer options for patient.gender

  • iconhttp://hl7.org/fhir/administrative-gender#male ("Male")
  • iconhttp://hl7.org/fhir/administrative-gender#female ("Female")
  • iconhttp://hl7.org/fhir/administrative-gender#other ("Other")

Answer options for patient.maritalStatus

  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#1 ("ledig")
  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#2 ("verheiratet")
  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#3 ("verwitwet")
  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#4 ("geschieden")
  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#5 ("unverheiratet")
  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#6 ("in eingetragener Partnerschaft")
  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#7 ("aufgelöste Partnerschaft")
  • http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#9 ("unbekannt")


7. http://example.com/fhir/QuestionnaireResponse/6-histopath (QuestionnaireResponse/6-histopath)

LinkIdTextDefinitionAnswerdoco
.. 6-histopathQuestionnaireResponse
... orderAuftrag
... receiverEmpfänger
... patientPatient
... receiverCopiesKopieempfänger
... labSpecialtiesLabor Sparten

doco Documentation for this format


8. http://example.com/fhir/ServiceRequest/6-histopath (ServiceRequest/6-histopath)

Generated Narrative: ServiceRequest

Resource ServiceRequest "6-histopath"

Profile: CH ORF ServiceRequest

identifier: Placer Identifier: 123

status: ACTIVE

intent: ORIGINALORDER

category: Anforderung von histopathologischen Untersuchungen (ch-lab-order-servicerequest-categories#RequestForHistopathExam)

priority: URGENT

code: Pathology study (LOINC#11526-1)

subject: See above (Patient/KlebsiellaKeller)

requester: See above (PractitionerRole/MarcMustermannArztpraxis)

insurance: Coverage/HealthInsuranceCard

specimen: Specimen/Skin: Skin specimen