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

This page is part of the CH RAD-Order (R4) (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions


Official URL: Version: 2.0.0-ballot
Active as of 2024-05-17 Computable Name: CH_RAD_Order

Copyright/Legal: CC0-1.0


The CH RAD-Order Implementation Guide defines the content of a radiology order and covers the following use cases:

  • Referral for imaging
  • Referral for radiological intervention
  • Request for second opinion
  • Request for remote reporting
  • Request for previous imaging results

CH RAD-Order is intended for use in directional communication as well as for the use in the SWISS EPR.

This implementation guide is under STU ballot by HL7 Switzerland until September 30th, 2024 midnight.
Please add your feedback via the ‘Propose a change’-link in the footer on the page where you have comments.

Significant changes, open and closed issues.

Download: You can download this implementation guide in npm format from here.


This Implementation Guide uses FHIR defined resources. For details on HL7 FHIR R4 see

Because the Implementation Guide relies heavily on the FHIR Resources Questionnaire and QuestionnaireResponse, forms are addressed here as Questionnaires.

This Implementation Guide is derived from the CH Order & Referral by Form (CH ORF) Implementation Guide (CH ORF) which relies on HL7 Structured Data Capture Implementation Guide, see SDC and uses the Swiss Core Profiles, see CH Core.

There has been a discussion whether population of the resources such as Patient Resource, ServiceRequest Resource etc. with the content of the QuestionnaireResponse Resource should be done by the order placer application or rather by the order filler application. The argument for assigning the task to the order placer is a result of the following consideration: the authors of a particular implementation guide may decide to define a questionnaire and its rendering but to leave it open if in a particular implementation the questionnaire is implemented or if the representation towards the user is made (in accordance to the questionnaire definition) by other technical means. In such a case, there would be no QuestionnaireResponse Resource in the bundle because all content is already in concerning resources. In order to handle all FHIR exchange formats equal (as far as sensible), the authors decided to mandate the order placer application with the task.

Applications claiming for conformance with the ORF Implementation Guide shall:

  • Render (and in case of the Questionnaire Filler allow for data entry) all elements of a questionnaire in the user interface (e.g. on screen, in print). Grouping of items and the order of items within shall be adequately reproduced according to the questionnaire.
  • In case of an implementation without the resources Questionnaire and QuestionnaireResponse, the content of otherwise implemented user interfaces shall be in accordance to the questionnaire definition.
  • Be able to process all codes related to the generic elements in a Questionnaire.

Actors, transactions and safety considerations are covered in the corresponding sections of CH ORF.


CH RAD-Order allows coding of the requested imaging service by means of LOINC/RSNA RADIOL0GY PLAYBOOK.

Systems such as PIS and KIS may not yet support RADIOLOGY PLAYBOOK. For this reason, CH RAD-Order allows coding of the relevant dimensions by means of RADLEX.

The relevant dimensions are defined by PLAYBOOK such as:

Modality Region Focus Laterality Maneuvre Guidance for action (used for interventions)

Coding of these dimensions is done by RADLEX terms.

IMPORTANT NOTICE: Value sets, in particular those containing Radlex terms, are still experimental. Definitive value sets will be defined when CH-Rad-Order becomes operational.All coding is preliminary and not yet approved by eHealth Suisse.

Previous Images

Results from earlier can be provided be means of attachments or - in case of DICOM SOP Instances - by means of a DICOM Service (e.g. WADO-RS). The ImagingStudy Resource allows for indicating DICOM tags such as SOP Instance UID, Series instance UID etc. DICOM Imaging data as well as other data (pdf, jpeg etc.) can be attached by means of a document reference.

The implementation of a DICOM service requires prerequisites in terms of infrastructure and policies (e.g. access rights). CH RAD-Order does not give guidance about that.

IMPORTANT NOTICE: Questionnaire items allowing entry for DICOM tags (such as study instance ID, series instance ID etc.) are for illustration / experimental use. A real world application shall hopefully provide other means for the selection of images / reports etc.

IP Statements

This document is licensed under Creative Commons “No Rights Reserved” (CC0).

HL7®, HEALTH LEVEL SEVEN®, FHIR® and the FHIR ® are trademarks owned by Health Level Seven International, registered with the United States Patent and Trademark Office.

This implementation guide contains and references intellectual property owned by third parties (“Third Party IP”). Acceptance of these License Terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise.

This publication includes IP covered under the following statements.

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 ( and R4B ( are available.

Dependency Table

Package hl7.fhir.uv.extensions.r4#5.1.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package hl7.fhir.uv.extensions.r4#1.0.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package ihe.formatcode.fhir#1.2.0

Implementation Guide for IHE defined FormatCode vocabulary. (built Tue, Mar 12, 2024 16:59-0500-05:00)


Implementation Guide for Swiss Terminology (built Thu, May 16, 2024 10:33+0000+00:00)


FHIR implementation guide CH Core (built Thu, May 16, 2024 16:08+0000+00:00)

Package hl7.fhir.r4.examples#4.0.1

Example resources in the R4 version of the FHIR standard

Package hl7.fhir.uv.sdc#3.0.0

The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR.
This includes two components:
* Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains.
*Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)


Order & Referral by Form - Implementation Guide (CH ORF) (built Fri, May 17, 2024 06:30+0000+00:00)

Globals Table

There are no Global profiles defined