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12.14 Resource Appointment - Content

Patient Administration icon Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Device, Patient, Practitioner, RelatedPerson

A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s).

12.14.1 Scope and Usage

Appointment resources are used to provide information about a planned meeting that may be in the future or past. The resource only describes a single meeting, a series of repeating visits would require multiple appointment resources to be created for each instance. Examples include a scheduled surgery, a follow-up for a clinical visit, a scheduled conference call between clinicians to discuss a case (where the patient is a subject, but not a participant), the reservation of a piece of diagnostic equipment for a particular use, etc. The visit scheduled by an appointment may be in person or remote (by phone, video conference, etc.) All that matters is that the time and usage of one or more individuals, locations and/or pieces of equipment is being fully or partially reserved for a designated period of time.

This definition takes the concepts of appointments in a clinical setting and also extends them to be relevant in the community healthcare space, and to ease exposure to other appointment / calendar standards widely used outside of healthcare.

12.14.1.1 The basic workflow to create an appointment

  • Discovery/Addressing

    Before an appointment can be made, the address/endpoint details of the resource that we want to schedule an appointment with must be determined. This is often based on the healthcare service type and any formatting information which indicates how to make the request. This is typically handled via the Schedule resource.

  • Checking Availability on the Schedule (optional)

    This optional step permits the checking of any existing available times (Slot resources associated with a selected Schedule) that can be booked against. Just because a time is indicated as available doesn't guarantee that an appointment can be made. The booking system that is going to process the request may make other qualifying decisions to determine if the appointment can be made, such as permissions, assessments, availability of other resources, etc.

    This step is optional, as the creation of the appointment is never a guaranteed action. But by performing this availability check, you can increase the chances of making a successful booking.

  • Making the Appointment Request

    When an appointment is required, a requester creates new Appointment resource with the Appointment.status="proposed".
    All included participants (optional or mandatory) should have the status="needs-action" to allow filtering and displaying appointments to user-participants for accepting or rejecting new and updated requests. Based on internal system business rules, certain statuses may be automatically updated, for example: "reject because the requested participant is on vacation" or "this type of user is not allowed to request those specific appointments".

  • Replying to the request

    The reply process is simply performed by the person/system handling the requests, updating the participant statuses on the appointment as needed. If there are multiple systems involved, then these will create AppointmentResponse entries with the desired statuses.

    Once all participants have their participation status created/updated (and the main system marking the appointment participant records with the AppointmentResponse statuses) then the overall status of the Appointment is updated.

  • Checking the overall status (Requester)

    The requester (organizer) of the appointment checks for the overall status of the appointment (and appointment responses, where applicable) using FHIR pub-sub techniques.

    Where the participant statuses indicate that a re-scheduling is required, then the process may start again, with other systems replying to a new set of times.

  • Waitlisting the Appointment (optional)

    This optional step permits creating a waitlisted appointment. This could occur if an appointment needs to be booked into a time that is not ideal for the patient due to lack of available time slots. In this workflow, there would be two appointments, the booked appointment in the time slot that is currently available, and the waitlisted appointment with a requestedPeriod spanning the time that the patient would prefer if new slots become available.

    If new time slots become available during the requestedPeriod, the scheduling system, or staff at the scheduling organization, can notify the patient that a new time slot is available. If the patient chooses, the waitlisted appointment would then be booked into that specific slot, and the previously booked appointment would be canceled. The specific business process for notifying patients of new availability is not specified, and is up to the implementing system to determine.

12.14.1.2 There are 2 typical workflows that occur with appointments

  • Outlook Style - Community

    These types of requests are typically handled by selecting a specific time from a list of available slots, then making the request for that timeslot.

  • Hospital Scheduling - Clinical

    Clinical scheduling is often far more complex in its requirements and processing. Often this involves checking multiple availabilities across multiple systems and timing with other internal systems, not just those exposed by the Slot resources.

    Consideration should be given to situations where scheduling needs to be handled in more of a queue-like process.

    Implementation Note: Note: This type of clinical appointment scheduling has not been specifically covered with this definition of the Appointment resource (and other related resources), however if you would like to contribute to the modification of this resource to cover these use cases, please contact the HL7 Patient Administration work-group.

12.14.1.3 Recurring Appointments

There are 2 main forms of recurring appointments recognized by FHIR:

  • (recurring) Regular meetings which occur based on a template, usually pre-allocated with a well defined frequency and a set purpose
  • (series) An appointment that has a series of follow up appointments which are more adhoc/irregular in nature
    This type does not typically pre-allocate bookings, but are re-booked each time based on loose guidance. These could also have different services on each re-booking (potentially via a protocol)

12.14.1.3.1 Recurring (template/pattern)

The recurring appointment uses the recurrenceTemplate property to define when all of the occurrences of the appointment should occur. This value only exists on the original booking for the appointment, for all the subsequent occurrences the originatingAppointment refers back to original for the template details.

Accepting a recurring appointment can be done either as accepting the entire series (using AppointmentResponse.recurring=true) or can accept each occurrence individually (using AppointmentResponse.recurring=false along with AppointmentResponse.occurrenceDate or AppointmentResponse.recurrenceId to indicate which repetition specifically)

Note that in the template the timezone property defines which timezone the start/end times apply. This is required as the time properties only have the offset (+10), and not the zone (Australia/Melbourne), which means that they cannot be used by the template to generate 9am every Wednesday all year (as Melbourne changes to +11 during daylight saving time).

12.14.1.3.2 Series (simple chain)

A series appointment has no template information, and thus don't use the recurrenceTemplate property. Often when first booked it is likely not known that it will become a series of bookings, and only on conclusion of the encounter it is decided to follow-up and then book a new appointment (or even book it later on) and relate the new booking to the previous in the series through the previousAppointment property. This style of recurring appointment likely won't use the originatingAppointment property either.

As each appointment in a series is a separate appointment and booked as needed, the acceptance of requests here is just as it would be normally if they didn't have a sequence.

As each occurrence is booked independently there are no specific issues with timezones, as each instance exactly defines when it occurs (there is no template).

Note to Implementers: We are seeking input from the implementer community on the recurring appointment functionality and specifically if there is a need for a "recur forever" or similar flag.

Feedback here icon.

12.14.2 Boundaries and Relationships

12.14.2.1 Appointment Request/Response Pattern

When using a request-response style of appointment this is done using Appointment and AppointmentResponse resources.
The request is made in the form of an Appointment with a proposed or pending status, and the list of actors with a participation status of "needs-action".

Participants in the appointment respond with their acceptance (or not) to the appointment by creating AppointmentResponse resources.
Once all the participants have replied, then the Appointment resource is able to be updated with an overall status which collates the results of all the participants and presents the approved details of the appointment.

The participant type property can be used to represent a specific role that a practitioner is required to perform for the appointment. This could be specified without an actor when the actual practitioner is not known, and will be filled in closer to the scheduled time.
This property must be the same between the Appointment-participant and the AppointmentResponse so that the appropriate values can be allocated. If you need multiple actors of a specific type, then multiple participants with that type value are included on the appointment.

The Appointment resource represents an intention to perform a service. An Appointment does NOT represent an authorization. Authorization is typically provided via a ServiceRequest when required. Details about the fulfillment of the appointment are handled by the Encounter resource.

12.14.2.2 Appointment Statuses and Encounters

Appointments can be considered as Administrative only, and the Encounter is expected to have clinical implications. Both resources align with the Clinical Workflow Process Life Cycle pattern.

In general, it is expected that appointments will result in the creation of an Encounter. The encounter is typically created when the service starts, not when the patient arrives. When the patient arrives, an appointment can be marked with a status of Arrived.

In an Emergency Room context, the appointment Resource is probably not appropriate to be used. In these cases, an Encounter should be created.

The Appointment request pattern used is different from the order-response pattern used elsewhere in FHIR.
This is due to the close relationship to the iCal standard. Many non-clinical systems use generic non-health appointment systems which implement this standard, and the desire to integrate with the consumer who has no access to health based software is highly desirable.
The mappings to the iCal standard have been provided to guide implementation of gateways between FHIR servers and iCal systems.

12.14.2.3 Appointment Locations and Participation

The location of the appointment is to be defined by using a participant that references a Location or HealthcareService resource.
This permits the location to also have its availability checked via a schedule and any conflicts more easily managed.

12.14.3 References to this Resource

12.14.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Appointment TU DomainResource A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s)
+ Rule: Either start and end are specified, or neither
+ Rule: Only proposed or cancelled appointments can be missing start/end dates
+ Rule: Cancellation reason is only used for appointments that have been cancelled, or noshow
+ Rule: The start must be less than or equal to the end
+ Guideline: An appointment may have an originatingAppointment or recurrenceTemplate, but not both
+ Rule: Cancellation date is only used for appointments that have been cancelled, or noshow

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ 0..* Identifier External Ids for this item

... status ?!ΣC 1..1 code proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist
Binding: Appointment Status (Required)
... cancellationReason ΣC 0..1 CodeableConcept The coded reason for the appointment being cancelled
Binding: Appointment Cancellation Reason (Example)
... class Σ 0..* CodeableConcept Classification when becoming an encounter
Binding: EncounterClass icon (Preferred)

... serviceCategory Σ 0..* CodeableConcept A broad categorization of the service that is to be performed during this appointment
Binding: Service Category (Example)

... serviceType Σ 0..* CodeableReference(HealthcareService) The specific service that is to be performed during this appointment
Binding: Service Type (Example)

... specialty Σ 0..* CodeableConcept The specialty of a practitioner that would be required to perform the service requested in this appointment
Binding: Practice Setting Code Value Set (Preferred)

... appointmentType Σ 0..1 CodeableConcept The style of appointment or patient that has been booked in the slot (not service type)
Binding: hl7VS-appointmentReasonCodes icon (Preferred)
... reason Σ 0..* CodeableReference(Condition | Procedure | Observation | ImmunizationRecommendation) Reason this appointment is scheduled
Binding: Encounter Reason Codes (Preferred)

... priority 0..1 CodeableConcept Used to make informed decisions if needing to re-prioritize
Binding: ActPriority icon (Example)
... description 0..1 string Shown on a subject line in a meeting request, or appointment list
... replaces 0..* Reference(Appointment) Appointment replaced by this Appointment

... virtualService 0..* VirtualServiceDetail Connection details of a virtual service (e.g. conference call)

... supportingInformation 0..* Reference(Any) Additional information to support the appointment

... previousAppointment 0..1 Reference(Appointment) The previous appointment in a series
... originatingAppointment C 0..1 Reference(Appointment) The originating appointment in a recurring set of appointments
... start ΣC 0..1 instant When appointment is to take place
... end ΣC 0..1 instant When appointment is to conclude
... minutesDuration 0..1 positiveInt Can be less than start/end (e.g. estimate)
... requestedPeriod 0..* Period Potential date/time interval(s) requested to allocate the appointment within

... slot 0..* Reference(Slot) The slots that this appointment is filling

... account 0..* Reference(Account) The set of accounts that may be used for billing for this Appointment

... created 0..1 dateTime The date that this appointment was initially created
... cancellationDate C 0..1 dateTime When the appointment was cancelled
... note 0..* Annotation Additional comments

... patientInstruction 0..* CodeableReference(DocumentReference | Binary | Communication) Detailed information and instructions for the patient

... basedOn 0..* Reference(CarePlan | DeviceRequest | MedicationRequest | ServiceRequest | RequestOrchestration | NutritionOrder | VisionPrescription | ImmunizationRecommendation) The request this appointment is allocated to assess

... subject Σ 0..1 Reference(Patient | Group) The patient or group associated with the appointment
... participant C 1..* BackboneElement Participants involved in appointment
+ Rule: Either the type or actor on the participant SHALL be specified

.... type ΣC 0..* CodeableConcept Role of participant in the appointment
Binding: Participant Type (Extensible)

.... period 0..1 Period Participation period of the actor
.... actor ΣC 0..1 Reference(Patient | Group | Practitioner | PractitionerRole | CareTeam | RelatedPerson | Device | HealthcareService | Location) The individual, device, location, or service participating in the appointment
.... required Σ 0..1 boolean The participant is required to attend (optional when false)
.... status Σ 1..1 code accepted | declined | tentative | needs-action
Binding: Participation Status (Required)
... recurrenceId 0..1 positiveInt The sequence number in the recurrence
... occurrenceChanged 0..1 boolean Indicates that this appointment varies from a recurrence pattern
... recurrenceTemplate C 0..* BackboneElement Details of the recurrence pattern/template used to generate occurrences

.... timezone 0..1 CodeableConcept The timezone of the occurrences
Binding: IANA Timezones (Required)
.... recurrenceType 1..1 CodeableConcept The frequency of the recurrence
Binding: Appointment Recurrence Type (Preferred)
.... lastOccurrenceDate 0..1 date The date when the recurrence should end
.... occurrenceCount 0..1 positiveInt The number of planned occurrences
.... occurrenceDate 0..* date Specific dates for a recurring set of appointments (no template)

.... weeklyTemplate 0..1 BackboneElement Information about weekly recurring appointments
..... monday 0..1 boolean Recurs on Mondays
..... tuesday 0..1 boolean Recurs on Tuesday
..... wednesday 0..1 boolean Recurs on Wednesday
..... thursday 0..1 boolean Recurs on Thursday
..... friday 0..1 boolean Recurs on Friday
..... saturday 0..1 boolean Recurs on Saturday
..... sunday 0..1 boolean Recurs on Sunday
..... weekInterval 0..1 positiveInt Recurs every nth week
.... monthlyTemplate 0..1 BackboneElement Information about monthly recurring appointments
..... dayOfMonth 0..1 positiveInt Recurs on a specific day of the month
..... nthWeekOfMonth 0..1 Coding Indicates which week of the month the appointment should occur
Binding: Week Of Month (Required)
..... dayOfWeek 0..1 Coding Indicates which day of the week the appointment should occur
Binding: Days Of Week (Required)
..... monthInterval 1..1 positiveInt Recurs every nth month
.... yearlyTemplate 0..1 BackboneElement Information about yearly recurring appointments
..... yearInterval 1..1 positiveInt Recurs every nth year
.... excludingDate 0..* date Any dates that should be excluded from the series

.... excludingRecurrenceId 0..* positiveInt Any recurrence IDs that should be excluded from the recurrence


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Appointment (DomainResource)This records identifiers associated with this appointment concern that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)identifier : Identifier [0..*]The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)AppointmentStatus! » « This element has or is affected by some invariantsC »The coded reason for the appointment being cancelled. This is often used in reporting/billing/further processing to determine if further actions are required, or specific fees applycancellationReason : CodeableConcept [0..1] « null (Strength=Example) AppointmentCancellationReason?? » « This element has or is affected by some invariantsC »Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variationsclass : CodeableConcept [0..*] « null (Strength=Preferred)EncounterClass? »A broad categorization of the service that is to be performed during this appointmentserviceCategory : CodeableConcept [0..*] « null (Strength=Example)ServiceCategory?? »The specific service that is to be performed during this appointmentserviceType : CodeableReference [0..*] « HealthcareService; null (Strength=Example) ServiceType?? »The specialty of a practitioner that would be required to perform the service requested in this appointmentspecialty : CodeableConcept [0..*] « null (Strength=Preferred)PracticeSettingCodeValueSet? »The style of appointment or patient that has been booked in the slot (not service type)appointmentType : CodeableConcept [0..1] « null (Strength=Preferred) Hl7VSAppointmentReasonCodes? »The reason that this appointment is being scheduled. This is more clinical than administrative. This can be coded, or as specified using information from another resource. When the patient arrives and the encounter begins it may be used as the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedurereason : CodeableReference [0..*] « Condition|Procedure|Observation| ImmunizationRecommendation; null (Strength=Preferred)EncounterReasonCodes? »The priority of the appointment. Can be used to make informed decisions if needing to re-prioritize appointments. (The iCal Standard specifies 0 as undefined, 1 as highest, 9 as lowest priority)priority : CodeableConcept [0..1] « Indicates the urgency of the appointment. (Strength=Example)ActPriority?? »The brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Detailed or expanded information should be put in the note fielddescription : string [0..1]Appointment replaced by this Appointment in cases where there is a cancellation, the details of the cancellation can be found in the cancellationReason property (on the referenced resource)replaces : Reference [0..*] « Appointment »Connection details of a virtual service (e.g. conference call)virtualService : VirtualServiceDetail [0..*]Additional information to support the appointment provided when making the appointmentsupportingInformation : Reference [0..*] « Any »The previous appointment in a series of related appointmentspreviousAppointment : Reference [0..1] « Appointment »The originating appointment in a recurring set of related appointmentsoriginatingAppointment : Reference [0..1] « Appointment » « This element has or is affected by some invariantsC »Date/Time that the appointment is to take placestart : instant [0..1] « This element has or is affected by some invariantsC »Date/Time that the appointment is to concludeend : instant [0..1] « This element has or is affected by some invariantsC »Number of minutes that the appointment is to take. This can be less than the duration between the start and end times. For example, where the actual time of appointment is only an estimate or if a 30 minute appointment is being requested, but any time would work. Also, if there is, for example, a planned 15 minute break in the middle of a long appointment, the duration may be 15 minutes less than the difference between the start and endminutesDuration : positiveInt [0..1]A set of date ranges (potentially including times) that the appointment is preferred to be scheduled within. The duration (usually in minutes) could also be provided to indicate the length of the appointment to fill and populate the start/end times for the actual allocated time. However, in other situations the duration may be calculated by the scheduling systemrequestedPeriod : Period [0..*]The slots from the participants' schedules that will be filled by the appointmentslot : Reference [0..*] « Slot »The set of accounts that is expected to be used for billing the activities that result from this Appointmentaccount : Reference [0..*] « Account »The date that this appointment was initially created. This could be different to the meta.lastModified value on the initial entry, as this could have been before the resource was created on the FHIR server, and should remain unchanged over the lifespan of the appointmentcreated : dateTime [0..1]The date/time describing when the appointment was cancelledcancellationDate : dateTime [0..1] « This element has or is affected by some invariantsC »Additional notes/comments about the appointmentnote : Annotation [0..*]While Appointment.note contains information for internal use, Appointment.patientInstructions is used to capture patient facing information about the Appointment (e.g. please bring your referral or fast from 8pm night before)patientInstruction : CodeableReference [0..*] « DocumentReference| Binary|Communication »The request this appointment is allocated to assess (e.g. incoming referral or procedure request)basedOn : Reference [0..*] « CarePlan|DeviceRequest| MedicationRequest|ServiceRequest|RequestOrchestration| NutritionOrder|VisionPrescription|ImmunizationRecommendation »The patient or group associated with the appointment, if they are to be present (usually) then they should also be included in the participant backbone elementsubject : Reference [0..1] « Patient|Group »The sequence number that identifies a specific appointment in a recurring patternrecurrenceId : positiveInt [0..1]This appointment varies from the recurring patternoccurrenceChanged : boolean [0..1]ParticipantRole of participant in the appointmenttype : CodeableConcept [0..*] « null (Strength=Extensible)ParticipantType+ » « This element has or is affected by some invariantsC »Participation period of the actorperiod : Period [0..1]The individual, device, location, or service participating in the appointmentactor : Reference [0..1] « Patient|Group|Practitioner| PractitionerRole|CareTeam|RelatedPerson|Device| HealthcareService|Location » « This element has or is affected by some invariantsC »Whether this participant is required to be present at the meeting. If false, the participant is optionalrequired : boolean [0..1]Participation status of the actorstatus : code [1..1] « null (Strength=Required)ParticipationStatus! »RecurrenceTemplateThe timezone of the recurring appointment occurrencestimezone : CodeableConcept [0..1] « IANA Timezones (BCP 175). (Strength=Required)IANATimezones! »How often the appointment series should recurrecurrenceType : CodeableConcept [1..1] « null (Strength=Preferred)AppointmentRecurrenceType? »Recurring appointments will not occur after this datelastOccurrenceDate : date [0..1]How many appointments are planned in the recurrenceoccurrenceCount : positiveInt [0..1]The list of specific dates that will have appointments generatedoccurrenceDate : date [0..*]Any dates, such as holidays, that should be excluded from the recurrenceexcludingDate : date [0..*]Any dates, such as holidays, that should be excluded from the recurrenceexcludingRecurrenceId : positiveInt [0..*]WeeklyTemplateIndicates that recurring appointments should occur on Mondaysmonday : boolean [0..1]Indicates that recurring appointments should occur on Tuesdaystuesday : boolean [0..1]Indicates that recurring appointments should occur on Wednesdayswednesday : boolean [0..1]Indicates that recurring appointments should occur on Thursdaysthursday : boolean [0..1]Indicates that recurring appointments should occur on Fridaysfriday : boolean [0..1]Indicates that recurring appointments should occur on Saturdayssaturday : boolean [0..1]Indicates that recurring appointments should occur on Sundayssunday : boolean [0..1]The interval defines if the recurrence is every nth week. The default is every week, so it is expected that this value will be 2 or more. e.g. For recurring every second week this interval would be 2, or every third week the interval would be 3weekInterval : positiveInt [0..1]MonthlyTemplateIndicates that appointments in the series of recurring appointments should occur on a specific day of the monthdayOfMonth : positiveInt [0..1]Indicates which week within a month the appointments in the series of recurring appointments should occur onnthWeekOfMonth : Coding [0..1] « null (Strength=Required)WeekOfMonth! »Indicates which day of the week the recurring appointments should occur each nth weekdayOfWeek : Coding [0..1] « null (Strength=Required)DaysOfWeek! »Indicates that recurring appointments should occur every nth monthmonthInterval : positiveInt [1..1]YearlyTemplateAppointment recurs every nth yearyearInterval : positiveInt [1..1]List of participants involved in the appointmentparticipant[1..*]Information about weekly recurring appointmentsweeklyTemplate[0..1]Information about monthly recurring appointmentsmonthlyTemplate[0..1]Information about yearly recurring appointmentsyearlyTemplate[0..1]The details of the recurrence pattern or template that is used to generate recurring appointmentsrecurrenceTemplate[0..*]

XML Template

<Appointment xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this item --></identifier>
 <status value="[code]"/><!-- I 1..1 proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist -->
 <cancellationReason><!-- I 0..1 CodeableConcept The coded reason for the appointment being cancelled --></cancellationReason>
 <class><!-- 0..* CodeableConcept Classification when becoming an encounter icon --></class>
 <serviceCategory><!-- 0..* CodeableConcept A broad categorization of the service that is to be performed during this appointment --></serviceCategory>
 <serviceType><!-- 0..* CodeableReference(HealthcareService) The specific service that is to be performed during this appointment --></serviceType>
 <specialty><!-- 0..* CodeableConcept The specialty of a practitioner that would be required to perform the service requested in this appointment --></specialty>
 <appointmentType><!-- 0..1 CodeableConcept The style of appointment or patient that has been booked in the slot (not service type) icon --></appointmentType>
 <reason><!-- 0..* CodeableReference(Condition|ImmunizationRecommendation|
   Observation|Procedure) Reason this appointment is scheduled --></reason>
 <priority><!-- 0..1 CodeableConcept Used to make informed decisions if needing to re-prioritize icon --></priority>
 <description value="[string]"/><!-- 0..1 Shown on a subject line in a meeting request, or appointment list -->
 <replaces><!-- 0..* Reference(Appointment) Appointment replaced by this Appointment --></replaces>
 <virtualService><!-- 0..* VirtualServiceDetail Connection details of a virtual service (e.g. conference call) --></virtualService>
 <supportingInformation><!-- 0..* Reference(Any) Additional information to support the appointment --></supportingInformation>
 <previousAppointment><!-- 0..1 Reference(Appointment) The previous appointment in a series --></previousAppointment>
 <originatingAppointment><!-- I 0..1 Reference(Appointment) The originating appointment in a recurring set of appointments --></originatingAppointment>
 <start value="[instant]"/><!-- I 0..1 When appointment is to take place -->
 <end value="[instant]"/><!-- I 0..1 When appointment is to conclude -->
 <minutesDuration value="[positiveInt]"/><!-- 0..1 Can be less than start/end (e.g. estimate) -->
 <requestedPeriod><!-- 0..* Period Potential date/time interval(s) requested to allocate the appointment within --></requestedPeriod>
 <slot><!-- 0..* Reference(Slot) The slots that this appointment is filling --></slot>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Appointment --></account>
 <created value="[dateTime]"/><!-- 0..1 The date that this appointment was initially created -->
 <cancellationDate value="[dateTime]"/><!-- I 0..1 When the appointment was cancelled -->
 <note><!-- 0..* Annotation Additional comments --></note>
 <patientInstruction><!-- 0..* CodeableReference(Binary|Communication|
   DocumentReference) Detailed information and instructions for the patient --></patientInstruction>
 <basedOn><!-- 0..* Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|
   MedicationRequest|NutritionOrder|RequestOrchestration|ServiceRequest|
   VisionPrescription) The request this appointment is allocated to assess --></basedOn>
 <subject><!-- 0..1 Reference(Group|Patient) The patient or group associated with the appointment --></subject>
 <participant>  <!-- 1..* Participants involved in appointment -->
  <type><!-- I 0..* CodeableConcept Role of participant in the appointment --></type>
  <period><!-- 0..1 Period Participation period of the actor --></period>
  <actor><!-- I 0..1 Reference(CareTeam|Device|Group|HealthcareService|Location|
    Patient|Practitioner|PractitionerRole|RelatedPerson) The individual, device, location, or service participating in the appointment --></actor>
  <required value="[boolean]"/><!-- 0..1 The participant is required to attend (optional when false) -->
  <status value="[code]"/><!-- 1..1 accepted | declined | tentative | needs-action -->
 </participant>
 <recurrenceId value="[positiveInt]"/><!-- 0..1 The sequence number in the recurrence -->
 <occurrenceChanged value="[boolean]"/><!-- 0..1 Indicates that this appointment varies from a recurrence pattern -->
 <recurrenceTemplate>  <!-- I 0..* Details of the recurrence pattern/template used to generate occurrences -->
  <timezone><!-- 0..1 CodeableConcept The timezone of the occurrences --></timezone>
  <recurrenceType><!-- 1..1 CodeableConcept The frequency of the recurrence --></recurrenceType>
  <lastOccurrenceDate value="[date]"/><!-- 0..1 The date when the recurrence should end -->
  <occurrenceCount value="[positiveInt]"/><!-- 0..1 The number of planned occurrences -->
  <occurrenceDate value="[date]"/><!-- 0..* Specific dates for a recurring set of appointments (no template) -->
  <weeklyTemplate>  <!-- 0..1 Information about weekly recurring appointments -->
   <monday value="[boolean]"/><!-- 0..1 Recurs on Mondays -->
   <tuesday value="[boolean]"/><!-- 0..1 Recurs on Tuesday -->
   <wednesday value="[boolean]"/><!-- 0..1 Recurs on Wednesday -->
   <thursday value="[boolean]"/><!-- 0..1 Recurs on Thursday -->
   <friday value="[boolean]"/><!-- 0..1 Recurs on Friday -->
   <saturday value="[boolean]"/><!-- 0..1 Recurs on Saturday -->
   <sunday value="[boolean]"/><!-- 0..1 Recurs on Sunday -->
   <weekInterval value="[positiveInt]"/><!-- 0..1 Recurs every nth week -->
  </weeklyTemplate>
  <monthlyTemplate>  <!-- 0..1 Information about monthly recurring appointments -->
   <dayOfMonth value="[positiveInt]"/><!-- 0..1 Recurs on a specific day of the month -->
   <nthWeekOfMonth><!-- 0..1 Coding Indicates which week of the month the appointment should occur --></nthWeekOfMonth>
   <dayOfWeek><!-- 0..1 Coding Indicates which day of the week the appointment should occur --></dayOfWeek>
   <monthInterval value="[positiveInt]"/><!-- 1..1 Recurs every nth month -->
  </monthlyTemplate>
  <yearlyTemplate>  <!-- 0..1 Information about yearly recurring appointments -->
   <yearInterval value="[positiveInt]"/><!-- 1..1 Recurs every nth year -->
  </yearlyTemplate>
  <excludingDate value="[date]"/><!-- 0..* Any dates that should be excluded from the series -->
  <excludingRecurrenceId value="[positiveInt]"/><!-- 0..* Any recurrence IDs that should be excluded from the recurrence -->
 </recurrenceTemplate>
</Appointment>

JSON Template

{doco
  "resourceType" : "Appointment",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this item
  "status" : "<code>", // I R!  proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist
  "cancellationReason" : { CodeableConcept }, // I The coded reason for the appointment being cancelled
  "class" : [{ CodeableConcept }], // Classification when becoming an encounter icon
  "serviceCategory" : [{ CodeableConcept }], // A broad categorization of the service that is to be performed during this appointment
  "serviceType" : [{ CodeableReference(HealthcareService) }], // The specific service that is to be performed during this appointment
  "specialty" : [{ CodeableConcept }], // The specialty of a practitioner that would be required to perform the service requested in this appointment
  "appointmentType" : { CodeableConcept }, // The style of appointment or patient that has been booked in the slot (not service type) icon
  "reason" : [{ CodeableReference(Condition|ImmunizationRecommendation|
   Observation|Procedure) }], // Reason this appointment is scheduled
  "priority" : { CodeableConcept }, // Used to make informed decisions if needing to re-prioritize icon
  "description" : "<string>", // Shown on a subject line in a meeting request, or appointment list
  "replaces" : [{ Reference(Appointment) }], // Appointment replaced by this Appointment
  "virtualService" : [{ VirtualServiceDetail }], // Connection details of a virtual service (e.g. conference call)
  "supportingInformation" : [{ Reference(Any) }], // Additional information to support the appointment
  "previousAppointment" : { Reference(Appointment) }, // The previous appointment in a series
  "originatingAppointment" : { Reference(Appointment) }, // I The originating appointment in a recurring set of appointments
  "start" : "<instant>", // I When appointment is to take place
  "end" : "<instant>", // I When appointment is to conclude
  "minutesDuration" : "<positiveInt>", // Can be less than start/end (e.g. estimate)
  "requestedPeriod" : [{ Period }], // Potential date/time interval(s) requested to allocate the appointment within
  "slot" : [{ Reference(Slot) }], // The slots that this appointment is filling
  "account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Appointment
  "created" : "<dateTime>", // The date that this appointment was initially created
  "cancellationDate" : "<dateTime>", // I When the appointment was cancelled
  "note" : [{ Annotation }], // Additional comments
  "patientInstruction" : [{ CodeableReference(Binary|Communication|
   DocumentReference) }], // Detailed information and instructions for the patient
  "basedOn" : [{ Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|
   MedicationRequest|NutritionOrder|RequestOrchestration|ServiceRequest|
   VisionPrescription) }], // The request this appointment is allocated to assess
  "subject" : { Reference(Group|Patient) }, // The patient or group associated with the appointment
  "participant" : [{ // R!  Participants involved in appointment
    "type" : [{ CodeableConcept }], // I Role of participant in the appointment
    "period" : { Period }, // Participation period of the actor
    "actor" : { Reference(CareTeam|Device|Group|HealthcareService|Location|
    Patient|Practitioner|PractitionerRole|RelatedPerson) }, // I The individual, device, location, or service participating in the appointment
    "required" : <boolean>, // The participant is required to attend (optional when false)
    "status" : "<code>" // R!  accepted | declined | tentative | needs-action
  }],
  "recurrenceId" : "<positiveInt>", // The sequence number in the recurrence
  "occurrenceChanged" : <boolean>, // Indicates that this appointment varies from a recurrence pattern
  "recurrenceTemplate" : [{ // I Details of the recurrence pattern/template used to generate occurrences
    "timezone" : { CodeableConcept }, // The timezone of the occurrences
    "recurrenceType" : { CodeableConcept }, // R!  The frequency of the recurrence
    "lastOccurrenceDate" : "<date>", // The date when the recurrence should end
    "occurrenceCount" : "<positiveInt>", // The number of planned occurrences
    "occurrenceDate" : ["<date>"], // Specific dates for a recurring set of appointments (no template)
    "weeklyTemplate" : { // Information about weekly recurring appointments
      "monday" : <boolean>, // Recurs on Mondays
      "tuesday" : <boolean>, // Recurs on Tuesday
      "wednesday" : <boolean>, // Recurs on Wednesday
      "thursday" : <boolean>, // Recurs on Thursday
      "friday" : <boolean>, // Recurs on Friday
      "saturday" : <boolean>, // Recurs on Saturday
      "sunday" : <boolean>, // Recurs on Sunday
      "weekInterval" : "<positiveInt>" // Recurs every nth week
    },
    "monthlyTemplate" : { // Information about monthly recurring appointments
      "dayOfMonth" : "<positiveInt>", // Recurs on a specific day of the month
      "nthWeekOfMonth" : { Coding }, // Indicates which week of the month the appointment should occur
      "dayOfWeek" : { Coding }, // Indicates which day of the week the appointment should occur
      "monthInterval" : "<positiveInt>" // R!  Recurs every nth month
    },
    "yearlyTemplate" : { // Information about yearly recurring appointments
      "yearInterval" : "<positiveInt>" // R!  Recurs every nth year
    },
    "excludingDate" : ["<date>"], // Any dates that should be excluded from the series
    "excludingRecurrenceId" : ["<positiveInt>"] // Any recurrence IDs that should be excluded from the recurrence
  }]
}

Turtle Template

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


[ a fhir:Appointment;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* External Ids for this item
  fhir:status [ code ] ; # 1..1 I proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist
  fhir:cancellationReason [ CodeableConcept ] ; # 0..1 I The coded reason for the appointment being cancelled
  fhir:class  ( [ CodeableConcept ] ... ) ; # 0..* Classification when becoming an encounter
  fhir:serviceCategory  ( [ CodeableConcept ] ... ) ; # 0..* A broad categorization of the service that is to be performed during this appointment
  fhir:serviceType  ( [ CodeableReference(HealthcareService) ] ... ) ; # 0..* The specific service that is to be performed during this appointment
  fhir:specialty  ( [ CodeableConcept ] ... ) ; # 0..* The specialty of a practitioner that would be required to perform the service requested in this appointment
  fhir:appointmentType [ CodeableConcept ] ; # 0..1 The style of appointment or patient that has been booked in the slot (not service type)
  fhir:reason  ( [ CodeableReference(Condition|ImmunizationRecommendation|Observation|Procedure) ] ... ) ; # 0..* Reason this appointment is scheduled
  fhir:priority [ CodeableConcept ] ; # 0..1 Used to make informed decisions if needing to re-prioritize
  fhir:description [ string ] ; # 0..1 Shown on a subject line in a meeting request, or appointment list
  fhir:replaces  ( [ Reference(Appointment) ] ... ) ; # 0..* Appointment replaced by this Appointment
  fhir:virtualService  ( [ VirtualServiceDetail ] ... ) ; # 0..* Connection details of a virtual service (e.g. conference call)
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Additional information to support the appointment
  fhir:previousAppointment [ Reference(Appointment) ] ; # 0..1 The previous appointment in a series
  fhir:originatingAppointment [ Reference(Appointment) ] ; # 0..1 I The originating appointment in a recurring set of appointments
  fhir:start [ instant ] ; # 0..1 I When appointment is to take place
  fhir:end [ instant ] ; # 0..1 I When appointment is to conclude
  fhir:minutesDuration [ positiveInt ] ; # 0..1 Can be less than start/end (e.g. estimate)
  fhir:requestedPeriod  ( [ Period ] ... ) ; # 0..* Potential date/time interval(s) requested to allocate the appointment within
  fhir:slot  ( [ Reference(Slot) ] ... ) ; # 0..* The slots that this appointment is filling
  fhir:account  ( [ Reference(Account) ] ... ) ; # 0..* The set of accounts that may be used for billing for this Appointment
  fhir:created [ dateTime ] ; # 0..1 The date that this appointment was initially created
  fhir:cancellationDate [ dateTime ] ; # 0..1 I When the appointment was cancelled
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Additional comments
  fhir:patientInstruction  ( [ CodeableReference(Binary|Communication|DocumentReference) ] ... ) ; # 0..* Detailed information and instructions for the patient
  fhir:basedOn  ( [ Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|MedicationRequest|
  NutritionOrder|RequestOrchestration|ServiceRequest|VisionPrescription) ] ... ) ; # 0..* The request this appointment is allocated to assess
  fhir:subject [ Reference(Group|Patient) ] ; # 0..1 The patient or group associated with the appointment
  fhir:participant ( [ # 1..* Participants involved in appointment
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* I Role of participant in the appointment
    fhir:period [ Period ] ; # 0..1 Participation period of the actor
    fhir:actor [ Reference(CareTeam|Device|Group|HealthcareService|Location|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 I The individual, device, location, or service participating in the appointment
    fhir:required [ boolean ] ; # 0..1 The participant is required to attend (optional when false)
    fhir:status [ code ] ; # 1..1 accepted | declined | tentative | needs-action
  ] ... ) ;
  fhir:recurrenceId [ positiveInt ] ; # 0..1 The sequence number in the recurrence
  fhir:occurrenceChanged [ boolean ] ; # 0..1 Indicates that this appointment varies from a recurrence pattern
  fhir:recurrenceTemplate ( [ # 0..* I Details of the recurrence pattern/template used to generate occurrences
    fhir:timezone [ CodeableConcept ] ; # 0..1 The timezone of the occurrences
    fhir:recurrenceType [ CodeableConcept ] ; # 1..1 The frequency of the recurrence
    fhir:lastOccurrenceDate [ date ] ; # 0..1 The date when the recurrence should end
    fhir:occurrenceCount [ positiveInt ] ; # 0..1 The number of planned occurrences
    fhir:occurrenceDate  ( [ date ] ... ) ; # 0..* Specific dates for a recurring set of appointments (no template)
    fhir:weeklyTemplate [ # 0..1 Information about weekly recurring appointments
      fhir:monday [ boolean ] ; # 0..1 Recurs on Mondays
      fhir:tuesday [ boolean ] ; # 0..1 Recurs on Tuesday
      fhir:wednesday [ boolean ] ; # 0..1 Recurs on Wednesday
      fhir:thursday [ boolean ] ; # 0..1 Recurs on Thursday
      fhir:friday [ boolean ] ; # 0..1 Recurs on Friday
      fhir:saturday [ boolean ] ; # 0..1 Recurs on Saturday
      fhir:sunday [ boolean ] ; # 0..1 Recurs on Sunday
      fhir:weekInterval [ positiveInt ] ; # 0..1 Recurs every nth week
    ] ;
    fhir:monthlyTemplate [ # 0..1 Information about monthly recurring appointments
      fhir:dayOfMonth [ positiveInt ] ; # 0..1 Recurs on a specific day of the month
      fhir:nthWeekOfMonth [ Coding ] ; # 0..1 Indicates which week of the month the appointment should occur
      fhir:dayOfWeek [ Coding ] ; # 0..1 Indicates which day of the week the appointment should occur
      fhir:monthInterval [ positiveInt ] ; # 1..1 Recurs every nth month
    ] ;
    fhir:yearlyTemplate [ # 0..1 Information about yearly recurring appointments
      fhir:yearInterval [ positiveInt ] ; # 1..1 Recurs every nth year
    ] ;
    fhir:excludingDate  ( [ date ] ... ) ; # 0..* Any dates that should be excluded from the series
    fhir:excludingRecurrenceId  ( [ positiveInt ] ... ) ; # 0..* Any recurrence IDs that should be excluded from the recurrence
  ] ... ) ;
]

Changes from both R4 and R4B

Appointment
Appointment.cancellationReason
  • Renamed from cancelationReason to cancellationReason
Appointment.class
  • Added Element
Appointment.serviceType
  • Type changed from CodeableConcept to CodeableReference
Appointment.reason
  • Renamed from reasonCode to reason
  • Type changed from CodeableConcept to CodeableReference
Appointment.priority
  • Type changed from unsignedInt to CodeableConcept
Appointment.replaces
  • Added Element
Appointment.virtualService
  • Added Element
Appointment.previousAppointment
  • Added Element
Appointment.originatingAppointment
  • Added Element
Appointment.account
  • Added Element
Appointment.cancellationDate
  • Added Element
Appointment.note
  • Renamed from comment to note
  • Max Cardinality changed from 1 to *
  • Type changed from string to Annotation
Appointment.patientInstruction
  • Max Cardinality changed from 1 to *
  • Type changed from string to CodeableReference
Appointment.basedOn
  • Type Reference: Added Target Types CarePlan, DeviceRequest, MedicationRequest, RequestOrchestration, NutritionOrder, VisionPrescription, ImmunizationRecommendation
Appointment.subject
  • Added Element
Appointment.participant.actor
  • Type Reference: Added Target Types Group, CareTeam
Appointment.participant.required
  • Type changed from code to boolean
  • Remove Binding `http://hl7.org/fhir/ValueSet/participantrequired|4.0.0` (required)
Appointment.recurrenceId
  • Added Element
Appointment.occurrenceChanged
  • Added Element
Appointment.recurrenceTemplate
  • Added Element
Appointment.recurrenceTemplate.timezone
  • Added Element
Appointment.recurrenceTemplate.recurrenceType
  • Added Mandatory Element
Appointment.recurrenceTemplate.lastOccurrenceDate
  • Added Element
Appointment.recurrenceTemplate.occurrenceCount
  • Added Element
Appointment.recurrenceTemplate.occurrenceDate
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.monday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.tuesday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.wednesday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.thursday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.friday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.saturday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.sunday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.weekInterval
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.dayOfMonth
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.nthWeekOfMonth
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.dayOfWeek
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.monthInterval
  • Added Mandatory Element
Appointment.recurrenceTemplate.yearlyTemplate
  • Added Element
Appointment.recurrenceTemplate.yearlyTemplate.yearInterval
  • Added Mandatory Element
Appointment.recurrenceTemplate.excludingDate
  • Added Element
Appointment.recurrenceTemplate.excludingRecurrenceId
  • Added Element
Appointment.reasonReference
  • Deleted (->Appointment.reason.reference)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Appointment TU DomainResource A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s)
+ Rule: Either start and end are specified, or neither
+ Rule: Only proposed or cancelled appointments can be missing start/end dates
+ Rule: Cancellation reason is only used for appointments that have been cancelled, or noshow
+ Rule: The start must be less than or equal to the end
+ Guideline: An appointment may have an originatingAppointment or recurrenceTemplate, but not both
+ Rule: Cancellation date is only used for appointments that have been cancelled, or noshow

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ 0..* Identifier External Ids for this item

... status ?!ΣC 1..1 code proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist
Binding: Appointment Status (Required)
... cancellationReason ΣC 0..1 CodeableConcept The coded reason for the appointment being cancelled
Binding: Appointment Cancellation Reason (Example)
... class Σ 0..* CodeableConcept Classification when becoming an encounter
Binding: EncounterClass icon (Preferred)

... serviceCategory Σ 0..* CodeableConcept A broad categorization of the service that is to be performed during this appointment
Binding: Service Category (Example)

... serviceType Σ 0..* CodeableReference(HealthcareService) The specific service that is to be performed during this appointment
Binding: Service Type (Example)

... specialty Σ 0..* CodeableConcept The specialty of a practitioner that would be required to perform the service requested in this appointment
Binding: Practice Setting Code Value Set (Preferred)

... appointmentType Σ 0..1 CodeableConcept The style of appointment or patient that has been booked in the slot (not service type)
Binding: hl7VS-appointmentReasonCodes icon (Preferred)
... reason Σ 0..* CodeableReference(Condition | Procedure | Observation | ImmunizationRecommendation) Reason this appointment is scheduled
Binding: Encounter Reason Codes (Preferred)

... priority 0..1 CodeableConcept Used to make informed decisions if needing to re-prioritize
Binding: ActPriority icon (Example)
... description 0..1 string Shown on a subject line in a meeting request, or appointment list
... replaces 0..* Reference(Appointment) Appointment replaced by this Appointment

... virtualService 0..* VirtualServiceDetail Connection details of a virtual service (e.g. conference call)

... supportingInformation 0..* Reference(Any) Additional information to support the appointment

... previousAppointment 0..1 Reference(Appointment) The previous appointment in a series
... originatingAppointment C 0..1 Reference(Appointment) The originating appointment in a recurring set of appointments
... start ΣC 0..1 instant When appointment is to take place
... end ΣC 0..1 instant When appointment is to conclude
... minutesDuration 0..1 positiveInt Can be less than start/end (e.g. estimate)
... requestedPeriod 0..* Period Potential date/time interval(s) requested to allocate the appointment within

... slot 0..* Reference(Slot) The slots that this appointment is filling

... account 0..* Reference(Account) The set of accounts that may be used for billing for this Appointment

... created 0..1 dateTime The date that this appointment was initially created
... cancellationDate C 0..1 dateTime When the appointment was cancelled
... note 0..* Annotation Additional comments

... patientInstruction 0..* CodeableReference(DocumentReference | Binary | Communication) Detailed information and instructions for the patient

... basedOn 0..* Reference(CarePlan | DeviceRequest | MedicationRequest | ServiceRequest | RequestOrchestration | NutritionOrder | VisionPrescription | ImmunizationRecommendation) The request this appointment is allocated to assess

... subject Σ 0..1 Reference(Patient | Group) The patient or group associated with the appointment
... participant C 1..* BackboneElement Participants involved in appointment
+ Rule: Either the type or actor on the participant SHALL be specified

.... type ΣC 0..* CodeableConcept Role of participant in the appointment
Binding: Participant Type (Extensible)

.... period 0..1 Period Participation period of the actor
.... actor ΣC 0..1 Reference(Patient | Group | Practitioner | PractitionerRole | CareTeam | RelatedPerson | Device | HealthcareService | Location) The individual, device, location, or service participating in the appointment
.... required Σ 0..1 boolean The participant is required to attend (optional when false)
.... status Σ 1..1 code accepted | declined | tentative | needs-action
Binding: Participation Status (Required)
... recurrenceId 0..1 positiveInt The sequence number in the recurrence
... occurrenceChanged 0..1 boolean Indicates that this appointment varies from a recurrence pattern
... recurrenceTemplate C 0..* BackboneElement Details of the recurrence pattern/template used to generate occurrences

.... timezone 0..1 CodeableConcept The timezone of the occurrences
Binding: IANA Timezones (Required)
.... recurrenceType 1..1 CodeableConcept The frequency of the recurrence
Binding: Appointment Recurrence Type (Preferred)
.... lastOccurrenceDate 0..1 date The date when the recurrence should end
.... occurrenceCount 0..1 positiveInt The number of planned occurrences
.... occurrenceDate 0..* date Specific dates for a recurring set of appointments (no template)

.... weeklyTemplate 0..1 BackboneElement Information about weekly recurring appointments
..... monday 0..1 boolean Recurs on Mondays
..... tuesday 0..1 boolean Recurs on Tuesday
..... wednesday 0..1 boolean Recurs on Wednesday
..... thursday 0..1 boolean Recurs on Thursday
..... friday 0..1 boolean Recurs on Friday
..... saturday 0..1 boolean Recurs on Saturday
..... sunday 0..1 boolean Recurs on Sunday
..... weekInterval 0..1 positiveInt Recurs every nth week
.... monthlyTemplate 0..1 BackboneElement Information about monthly recurring appointments
..... dayOfMonth 0..1 positiveInt Recurs on a specific day of the month
..... nthWeekOfMonth 0..1 Coding Indicates which week of the month the appointment should occur
Binding: Week Of Month (Required)
..... dayOfWeek 0..1 Coding Indicates which day of the week the appointment should occur
Binding: Days Of Week (Required)
..... monthInterval 1..1 positiveInt Recurs every nth month
.... yearlyTemplate 0..1 BackboneElement Information about yearly recurring appointments
..... yearInterval 1..1 positiveInt Recurs every nth year
.... excludingDate 0..* date Any dates that should be excluded from the series

.... excludingRecurrenceId 0..* positiveInt Any recurrence IDs that should be excluded from the recurrence


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Appointment (DomainResource)This records identifiers associated with this appointment concern that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)identifier : Identifier [0..*]The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)AppointmentStatus! » « This element has or is affected by some invariantsC »The coded reason for the appointment being cancelled. This is often used in reporting/billing/further processing to determine if further actions are required, or specific fees applycancellationReason : CodeableConcept [0..1] « null (Strength=Example) AppointmentCancellationReason?? » « This element has or is affected by some invariantsC »Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variationsclass : CodeableConcept [0..*] « null (Strength=Preferred)EncounterClass? »A broad categorization of the service that is to be performed during this appointmentserviceCategory : CodeableConcept [0..*] « null (Strength=Example)ServiceCategory?? »The specific service that is to be performed during this appointmentserviceType : CodeableReference [0..*] « HealthcareService; null (Strength=Example) ServiceType?? »The specialty of a practitioner that would be required to perform the service requested in this appointmentspecialty : CodeableConcept [0..*] « null (Strength=Preferred)PracticeSettingCodeValueSet? »The style of appointment or patient that has been booked in the slot (not service type)appointmentType : CodeableConcept [0..1] « null (Strength=Preferred) Hl7VSAppointmentReasonCodes? »The reason that this appointment is being scheduled. This is more clinical than administrative. This can be coded, or as specified using information from another resource. When the patient arrives and the encounter begins it may be used as the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedurereason : CodeableReference [0..*] « Condition|Procedure|Observation| ImmunizationRecommendation; null (Strength=Preferred)EncounterReasonCodes? »The priority of the appointment. Can be used to make informed decisions if needing to re-prioritize appointments. (The iCal Standard specifies 0 as undefined, 1 as highest, 9 as lowest priority)priority : CodeableConcept [0..1] « Indicates the urgency of the appointment. (Strength=Example)ActPriority?? »The brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Detailed or expanded information should be put in the note fielddescription : string [0..1]Appointment replaced by this Appointment in cases where there is a cancellation, the details of the cancellation can be found in the cancellationReason property (on the referenced resource)replaces : Reference [0..*] « Appointment »Connection details of a virtual service (e.g. conference call)virtualService : VirtualServiceDetail [0..*]Additional information to support the appointment provided when making the appointmentsupportingInformation : Reference [0..*] « Any »The previous appointment in a series of related appointmentspreviousAppointment : Reference [0..1] « Appointment »The originating appointment in a recurring set of related appointmentsoriginatingAppointment : Reference [0..1] « Appointment » « This element has or is affected by some invariantsC »Date/Time that the appointment is to take placestart : instant [0..1] « This element has or is affected by some invariantsC »Date/Time that the appointment is to concludeend : instant [0..1] « This element has or is affected by some invariantsC »Number of minutes that the appointment is to take. This can be less than the duration between the start and end times. For example, where the actual time of appointment is only an estimate or if a 30 minute appointment is being requested, but any time would work. Also, if there is, for example, a planned 15 minute break in the middle of a long appointment, the duration may be 15 minutes less than the difference between the start and endminutesDuration : positiveInt [0..1]A set of date ranges (potentially including times) that the appointment is preferred to be scheduled within. The duration (usually in minutes) could also be provided to indicate the length of the appointment to fill and populate the start/end times for the actual allocated time. However, in other situations the duration may be calculated by the scheduling systemrequestedPeriod : Period [0..*]The slots from the participants' schedules that will be filled by the appointmentslot : Reference [0..*] « Slot »The set of accounts that is expected to be used for billing the activities that result from this Appointmentaccount : Reference [0..*] « Account »The date that this appointment was initially created. This could be different to the meta.lastModified value on the initial entry, as this could have been before the resource was created on the FHIR server, and should remain unchanged over the lifespan of the appointmentcreated : dateTime [0..1]The date/time describing when the appointment was cancelledcancellationDate : dateTime [0..1] « This element has or is affected by some invariantsC »Additional notes/comments about the appointmentnote : Annotation [0..*]While Appointment.note contains information for internal use, Appointment.patientInstructions is used to capture patient facing information about the Appointment (e.g. please bring your referral or fast from 8pm night before)patientInstruction : CodeableReference [0..*] « DocumentReference| Binary|Communication »The request this appointment is allocated to assess (e.g. incoming referral or procedure request)basedOn : Reference [0..*] « CarePlan|DeviceRequest| MedicationRequest|ServiceRequest|RequestOrchestration| NutritionOrder|VisionPrescription|ImmunizationRecommendation »The patient or group associated with the appointment, if they are to be present (usually) then they should also be included in the participant backbone elementsubject : Reference [0..1] « Patient|Group »The sequence number that identifies a specific appointment in a recurring patternrecurrenceId : positiveInt [0..1]This appointment varies from the recurring patternoccurrenceChanged : boolean [0..1]ParticipantRole of participant in the appointmenttype : CodeableConcept [0..*] « null (Strength=Extensible)ParticipantType+ » « This element has or is affected by some invariantsC »Participation period of the actorperiod : Period [0..1]The individual, device, location, or service participating in the appointmentactor : Reference [0..1] « Patient|Group|Practitioner| PractitionerRole|CareTeam|RelatedPerson|Device| HealthcareService|Location » « This element has or is affected by some invariantsC »Whether this participant is required to be present at the meeting. If false, the participant is optionalrequired : boolean [0..1]Participation status of the actorstatus : code [1..1] « null (Strength=Required)ParticipationStatus! »RecurrenceTemplateThe timezone of the recurring appointment occurrencestimezone : CodeableConcept [0..1] « IANA Timezones (BCP 175). (Strength=Required)IANATimezones! »How often the appointment series should recurrecurrenceType : CodeableConcept [1..1] « null (Strength=Preferred)AppointmentRecurrenceType? »Recurring appointments will not occur after this datelastOccurrenceDate : date [0..1]How many appointments are planned in the recurrenceoccurrenceCount : positiveInt [0..1]The list of specific dates that will have appointments generatedoccurrenceDate : date [0..*]Any dates, such as holidays, that should be excluded from the recurrenceexcludingDate : date [0..*]Any dates, such as holidays, that should be excluded from the recurrenceexcludingRecurrenceId : positiveInt [0..*]WeeklyTemplateIndicates that recurring appointments should occur on Mondaysmonday : boolean [0..1]Indicates that recurring appointments should occur on Tuesdaystuesday : boolean [0..1]Indicates that recurring appointments should occur on Wednesdayswednesday : boolean [0..1]Indicates that recurring appointments should occur on Thursdaysthursday : boolean [0..1]Indicates that recurring appointments should occur on Fridaysfriday : boolean [0..1]Indicates that recurring appointments should occur on Saturdayssaturday : boolean [0..1]Indicates that recurring appointments should occur on Sundayssunday : boolean [0..1]The interval defines if the recurrence is every nth week. The default is every week, so it is expected that this value will be 2 or more. e.g. For recurring every second week this interval would be 2, or every third week the interval would be 3weekInterval : positiveInt [0..1]MonthlyTemplateIndicates that appointments in the series of recurring appointments should occur on a specific day of the monthdayOfMonth : positiveInt [0..1]Indicates which week within a month the appointments in the series of recurring appointments should occur onnthWeekOfMonth : Coding [0..1] « null (Strength=Required)WeekOfMonth! »Indicates which day of the week the recurring appointments should occur each nth weekdayOfWeek : Coding [0..1] « null (Strength=Required)DaysOfWeek! »Indicates that recurring appointments should occur every nth monthmonthInterval : positiveInt [1..1]YearlyTemplateAppointment recurs every nth yearyearInterval : positiveInt [1..1]List of participants involved in the appointmentparticipant[1..*]Information about weekly recurring appointmentsweeklyTemplate[0..1]Information about monthly recurring appointmentsmonthlyTemplate[0..1]Information about yearly recurring appointmentsyearlyTemplate[0..1]The details of the recurrence pattern or template that is used to generate recurring appointmentsrecurrenceTemplate[0..*]

XML Template

<Appointment xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this item --></identifier>
 <status value="[code]"/><!-- I 1..1 proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist -->
 <cancellationReason><!-- I 0..1 CodeableConcept The coded reason for the appointment being cancelled --></cancellationReason>
 <class><!-- 0..* CodeableConcept Classification when becoming an encounter icon --></class>
 <serviceCategory><!-- 0..* CodeableConcept A broad categorization of the service that is to be performed during this appointment --></serviceCategory>
 <serviceType><!-- 0..* CodeableReference(HealthcareService) The specific service that is to be performed during this appointment --></serviceType>
 <specialty><!-- 0..* CodeableConcept The specialty of a practitioner that would be required to perform the service requested in this appointment --></specialty>
 <appointmentType><!-- 0..1 CodeableConcept The style of appointment or patient that has been booked in the slot (not service type) icon --></appointmentType>
 <reason><!-- 0..* CodeableReference(Condition|ImmunizationRecommendation|
   Observation|Procedure) Reason this appointment is scheduled --></reason>
 <priority><!-- 0..1 CodeableConcept Used to make informed decisions if needing to re-prioritize icon --></priority>
 <description value="[string]"/><!-- 0..1 Shown on a subject line in a meeting request, or appointment list -->
 <replaces><!-- 0..* Reference(Appointment) Appointment replaced by this Appointment --></replaces>
 <virtualService><!-- 0..* VirtualServiceDetail Connection details of a virtual service (e.g. conference call) --></virtualService>
 <supportingInformation><!-- 0..* Reference(Any) Additional information to support the appointment --></supportingInformation>
 <previousAppointment><!-- 0..1 Reference(Appointment) The previous appointment in a series --></previousAppointment>
 <originatingAppointment><!-- I 0..1 Reference(Appointment) The originating appointment in a recurring set of appointments --></originatingAppointment>
 <start value="[instant]"/><!-- I 0..1 When appointment is to take place -->
 <end value="[instant]"/><!-- I 0..1 When appointment is to conclude -->
 <minutesDuration value="[positiveInt]"/><!-- 0..1 Can be less than start/end (e.g. estimate) -->
 <requestedPeriod><!-- 0..* Period Potential date/time interval(s) requested to allocate the appointment within --></requestedPeriod>
 <slot><!-- 0..* Reference(Slot) The slots that this appointment is filling --></slot>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this Appointment --></account>
 <created value="[dateTime]"/><!-- 0..1 The date that this appointment was initially created -->
 <cancellationDate value="[dateTime]"/><!-- I 0..1 When the appointment was cancelled -->
 <note><!-- 0..* Annotation Additional comments --></note>
 <patientInstruction><!-- 0..* CodeableReference(Binary|Communication|
   DocumentReference) Detailed information and instructions for the patient --></patientInstruction>
 <basedOn><!-- 0..* Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|
   MedicationRequest|NutritionOrder|RequestOrchestration|ServiceRequest|
   VisionPrescription) The request this appointment is allocated to assess --></basedOn>
 <subject><!-- 0..1 Reference(Group|Patient) The patient or group associated with the appointment --></subject>
 <participant>  <!-- 1..* Participants involved in appointment -->
  <type><!-- I 0..* CodeableConcept Role of participant in the appointment --></type>
  <period><!-- 0..1 Period Participation period of the actor --></period>
  <actor><!-- I 0..1 Reference(CareTeam|Device|Group|HealthcareService|Location|
    Patient|Practitioner|PractitionerRole|RelatedPerson) The individual, device, location, or service participating in the appointment --></actor>
  <required value="[boolean]"/><!-- 0..1 The participant is required to attend (optional when false) -->
  <status value="[code]"/><!-- 1..1 accepted | declined | tentative | needs-action -->
 </participant>
 <recurrenceId value="[positiveInt]"/><!-- 0..1 The sequence number in the recurrence -->
 <occurrenceChanged value="[boolean]"/><!-- 0..1 Indicates that this appointment varies from a recurrence pattern -->
 <recurrenceTemplate>  <!-- I 0..* Details of the recurrence pattern/template used to generate occurrences -->
  <timezone><!-- 0..1 CodeableConcept The timezone of the occurrences --></timezone>
  <recurrenceType><!-- 1..1 CodeableConcept The frequency of the recurrence --></recurrenceType>
  <lastOccurrenceDate value="[date]"/><!-- 0..1 The date when the recurrence should end -->
  <occurrenceCount value="[positiveInt]"/><!-- 0..1 The number of planned occurrences -->
  <occurrenceDate value="[date]"/><!-- 0..* Specific dates for a recurring set of appointments (no template) -->
  <weeklyTemplate>  <!-- 0..1 Information about weekly recurring appointments -->
   <monday value="[boolean]"/><!-- 0..1 Recurs on Mondays -->
   <tuesday value="[boolean]"/><!-- 0..1 Recurs on Tuesday -->
   <wednesday value="[boolean]"/><!-- 0..1 Recurs on Wednesday -->
   <thursday value="[boolean]"/><!-- 0..1 Recurs on Thursday -->
   <friday value="[boolean]"/><!-- 0..1 Recurs on Friday -->
   <saturday value="[boolean]"/><!-- 0..1 Recurs on Saturday -->
   <sunday value="[boolean]"/><!-- 0..1 Recurs on Sunday -->
   <weekInterval value="[positiveInt]"/><!-- 0..1 Recurs every nth week -->
  </weeklyTemplate>
  <monthlyTemplate>  <!-- 0..1 Information about monthly recurring appointments -->
   <dayOfMonth value="[positiveInt]"/><!-- 0..1 Recurs on a specific day of the month -->
   <nthWeekOfMonth><!-- 0..1 Coding Indicates which week of the month the appointment should occur --></nthWeekOfMonth>
   <dayOfWeek><!-- 0..1 Coding Indicates which day of the week the appointment should occur --></dayOfWeek>
   <monthInterval value="[positiveInt]"/><!-- 1..1 Recurs every nth month -->
  </monthlyTemplate>
  <yearlyTemplate>  <!-- 0..1 Information about yearly recurring appointments -->
   <yearInterval value="[positiveInt]"/><!-- 1..1 Recurs every nth year -->
  </yearlyTemplate>
  <excludingDate value="[date]"/><!-- 0..* Any dates that should be excluded from the series -->
  <excludingRecurrenceId value="[positiveInt]"/><!-- 0..* Any recurrence IDs that should be excluded from the recurrence -->
 </recurrenceTemplate>
</Appointment>

JSON Template

{doco
  "resourceType" : "Appointment",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this item
  "status" : "<code>", // I R!  proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist
  "cancellationReason" : { CodeableConcept }, // I The coded reason for the appointment being cancelled
  "class" : [{ CodeableConcept }], // Classification when becoming an encounter icon
  "serviceCategory" : [{ CodeableConcept }], // A broad categorization of the service that is to be performed during this appointment
  "serviceType" : [{ CodeableReference(HealthcareService) }], // The specific service that is to be performed during this appointment
  "specialty" : [{ CodeableConcept }], // The specialty of a practitioner that would be required to perform the service requested in this appointment
  "appointmentType" : { CodeableConcept }, // The style of appointment or patient that has been booked in the slot (not service type) icon
  "reason" : [{ CodeableReference(Condition|ImmunizationRecommendation|
   Observation|Procedure) }], // Reason this appointment is scheduled
  "priority" : { CodeableConcept }, // Used to make informed decisions if needing to re-prioritize icon
  "description" : "<string>", // Shown on a subject line in a meeting request, or appointment list
  "replaces" : [{ Reference(Appointment) }], // Appointment replaced by this Appointment
  "virtualService" : [{ VirtualServiceDetail }], // Connection details of a virtual service (e.g. conference call)
  "supportingInformation" : [{ Reference(Any) }], // Additional information to support the appointment
  "previousAppointment" : { Reference(Appointment) }, // The previous appointment in a series
  "originatingAppointment" : { Reference(Appointment) }, // I The originating appointment in a recurring set of appointments
  "start" : "<instant>", // I When appointment is to take place
  "end" : "<instant>", // I When appointment is to conclude
  "minutesDuration" : "<positiveInt>", // Can be less than start/end (e.g. estimate)
  "requestedPeriod" : [{ Period }], // Potential date/time interval(s) requested to allocate the appointment within
  "slot" : [{ Reference(Slot) }], // The slots that this appointment is filling
  "account" : [{ Reference(Account) }], // The set of accounts that may be used for billing for this Appointment
  "created" : "<dateTime>", // The date that this appointment was initially created
  "cancellationDate" : "<dateTime>", // I When the appointment was cancelled
  "note" : [{ Annotation }], // Additional comments
  "patientInstruction" : [{ CodeableReference(Binary|Communication|
   DocumentReference) }], // Detailed information and instructions for the patient
  "basedOn" : [{ Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|
   MedicationRequest|NutritionOrder|RequestOrchestration|ServiceRequest|
   VisionPrescription) }], // The request this appointment is allocated to assess
  "subject" : { Reference(Group|Patient) }, // The patient or group associated with the appointment
  "participant" : [{ // R!  Participants involved in appointment
    "type" : [{ CodeableConcept }], // I Role of participant in the appointment
    "period" : { Period }, // Participation period of the actor
    "actor" : { Reference(CareTeam|Device|Group|HealthcareService|Location|
    Patient|Practitioner|PractitionerRole|RelatedPerson) }, // I The individual, device, location, or service participating in the appointment
    "required" : <boolean>, // The participant is required to attend (optional when false)
    "status" : "<code>" // R!  accepted | declined | tentative | needs-action
  }],
  "recurrenceId" : "<positiveInt>", // The sequence number in the recurrence
  "occurrenceChanged" : <boolean>, // Indicates that this appointment varies from a recurrence pattern
  "recurrenceTemplate" : [{ // I Details of the recurrence pattern/template used to generate occurrences
    "timezone" : { CodeableConcept }, // The timezone of the occurrences
    "recurrenceType" : { CodeableConcept }, // R!  The frequency of the recurrence
    "lastOccurrenceDate" : "<date>", // The date when the recurrence should end
    "occurrenceCount" : "<positiveInt>", // The number of planned occurrences
    "occurrenceDate" : ["<date>"], // Specific dates for a recurring set of appointments (no template)
    "weeklyTemplate" : { // Information about weekly recurring appointments
      "monday" : <boolean>, // Recurs on Mondays
      "tuesday" : <boolean>, // Recurs on Tuesday
      "wednesday" : <boolean>, // Recurs on Wednesday
      "thursday" : <boolean>, // Recurs on Thursday
      "friday" : <boolean>, // Recurs on Friday
      "saturday" : <boolean>, // Recurs on Saturday
      "sunday" : <boolean>, // Recurs on Sunday
      "weekInterval" : "<positiveInt>" // Recurs every nth week
    },
    "monthlyTemplate" : { // Information about monthly recurring appointments
      "dayOfMonth" : "<positiveInt>", // Recurs on a specific day of the month
      "nthWeekOfMonth" : { Coding }, // Indicates which week of the month the appointment should occur
      "dayOfWeek" : { Coding }, // Indicates which day of the week the appointment should occur
      "monthInterval" : "<positiveInt>" // R!  Recurs every nth month
    },
    "yearlyTemplate" : { // Information about yearly recurring appointments
      "yearInterval" : "<positiveInt>" // R!  Recurs every nth year
    },
    "excludingDate" : ["<date>"], // Any dates that should be excluded from the series
    "excludingRecurrenceId" : ["<positiveInt>"] // Any recurrence IDs that should be excluded from the recurrence
  }]
}

Turtle Template

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


[ a fhir:Appointment;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* External Ids for this item
  fhir:status [ code ] ; # 1..1 I proposed | pending | booked | arrived | fulfilled | cancelled | noshow | entered-in-error | checked-in | waitlist
  fhir:cancellationReason [ CodeableConcept ] ; # 0..1 I The coded reason for the appointment being cancelled
  fhir:class  ( [ CodeableConcept ] ... ) ; # 0..* Classification when becoming an encounter
  fhir:serviceCategory  ( [ CodeableConcept ] ... ) ; # 0..* A broad categorization of the service that is to be performed during this appointment
  fhir:serviceType  ( [ CodeableReference(HealthcareService) ] ... ) ; # 0..* The specific service that is to be performed during this appointment
  fhir:specialty  ( [ CodeableConcept ] ... ) ; # 0..* The specialty of a practitioner that would be required to perform the service requested in this appointment
  fhir:appointmentType [ CodeableConcept ] ; # 0..1 The style of appointment or patient that has been booked in the slot (not service type)
  fhir:reason  ( [ CodeableReference(Condition|ImmunizationRecommendation|Observation|Procedure) ] ... ) ; # 0..* Reason this appointment is scheduled
  fhir:priority [ CodeableConcept ] ; # 0..1 Used to make informed decisions if needing to re-prioritize
  fhir:description [ string ] ; # 0..1 Shown on a subject line in a meeting request, or appointment list
  fhir:replaces  ( [ Reference(Appointment) ] ... ) ; # 0..* Appointment replaced by this Appointment
  fhir:virtualService  ( [ VirtualServiceDetail ] ... ) ; # 0..* Connection details of a virtual service (e.g. conference call)
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Additional information to support the appointment
  fhir:previousAppointment [ Reference(Appointment) ] ; # 0..1 The previous appointment in a series
  fhir:originatingAppointment [ Reference(Appointment) ] ; # 0..1 I The originating appointment in a recurring set of appointments
  fhir:start [ instant ] ; # 0..1 I When appointment is to take place
  fhir:end [ instant ] ; # 0..1 I When appointment is to conclude
  fhir:minutesDuration [ positiveInt ] ; # 0..1 Can be less than start/end (e.g. estimate)
  fhir:requestedPeriod  ( [ Period ] ... ) ; # 0..* Potential date/time interval(s) requested to allocate the appointment within
  fhir:slot  ( [ Reference(Slot) ] ... ) ; # 0..* The slots that this appointment is filling
  fhir:account  ( [ Reference(Account) ] ... ) ; # 0..* The set of accounts that may be used for billing for this Appointment
  fhir:created [ dateTime ] ; # 0..1 The date that this appointment was initially created
  fhir:cancellationDate [ dateTime ] ; # 0..1 I When the appointment was cancelled
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Additional comments
  fhir:patientInstruction  ( [ CodeableReference(Binary|Communication|DocumentReference) ] ... ) ; # 0..* Detailed information and instructions for the patient
  fhir:basedOn  ( [ Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|MedicationRequest|
  NutritionOrder|RequestOrchestration|ServiceRequest|VisionPrescription) ] ... ) ; # 0..* The request this appointment is allocated to assess
  fhir:subject [ Reference(Group|Patient) ] ; # 0..1 The patient or group associated with the appointment
  fhir:participant ( [ # 1..* Participants involved in appointment
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* I Role of participant in the appointment
    fhir:period [ Period ] ; # 0..1 Participation period of the actor
    fhir:actor [ Reference(CareTeam|Device|Group|HealthcareService|Location|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 I The individual, device, location, or service participating in the appointment
    fhir:required [ boolean ] ; # 0..1 The participant is required to attend (optional when false)
    fhir:status [ code ] ; # 1..1 accepted | declined | tentative | needs-action
  ] ... ) ;
  fhir:recurrenceId [ positiveInt ] ; # 0..1 The sequence number in the recurrence
  fhir:occurrenceChanged [ boolean ] ; # 0..1 Indicates that this appointment varies from a recurrence pattern
  fhir:recurrenceTemplate ( [ # 0..* I Details of the recurrence pattern/template used to generate occurrences
    fhir:timezone [ CodeableConcept ] ; # 0..1 The timezone of the occurrences
    fhir:recurrenceType [ CodeableConcept ] ; # 1..1 The frequency of the recurrence
    fhir:lastOccurrenceDate [ date ] ; # 0..1 The date when the recurrence should end
    fhir:occurrenceCount [ positiveInt ] ; # 0..1 The number of planned occurrences
    fhir:occurrenceDate  ( [ date ] ... ) ; # 0..* Specific dates for a recurring set of appointments (no template)
    fhir:weeklyTemplate [ # 0..1 Information about weekly recurring appointments
      fhir:monday [ boolean ] ; # 0..1 Recurs on Mondays
      fhir:tuesday [ boolean ] ; # 0..1 Recurs on Tuesday
      fhir:wednesday [ boolean ] ; # 0..1 Recurs on Wednesday
      fhir:thursday [ boolean ] ; # 0..1 Recurs on Thursday
      fhir:friday [ boolean ] ; # 0..1 Recurs on Friday
      fhir:saturday [ boolean ] ; # 0..1 Recurs on Saturday
      fhir:sunday [ boolean ] ; # 0..1 Recurs on Sunday
      fhir:weekInterval [ positiveInt ] ; # 0..1 Recurs every nth week
    ] ;
    fhir:monthlyTemplate [ # 0..1 Information about monthly recurring appointments
      fhir:dayOfMonth [ positiveInt ] ; # 0..1 Recurs on a specific day of the month
      fhir:nthWeekOfMonth [ Coding ] ; # 0..1 Indicates which week of the month the appointment should occur
      fhir:dayOfWeek [ Coding ] ; # 0..1 Indicates which day of the week the appointment should occur
      fhir:monthInterval [ positiveInt ] ; # 1..1 Recurs every nth month
    ] ;
    fhir:yearlyTemplate [ # 0..1 Information about yearly recurring appointments
      fhir:yearInterval [ positiveInt ] ; # 1..1 Recurs every nth year
    ] ;
    fhir:excludingDate  ( [ date ] ... ) ; # 0..* Any dates that should be excluded from the series
    fhir:excludingRecurrenceId  ( [ positiveInt ] ... ) ; # 0..* Any recurrence IDs that should be excluded from the recurrence
  ] ... ) ;
]

Changes from both R4 and R4B

Appointment
Appointment.cancellationReason
  • Renamed from cancelationReason to cancellationReason
Appointment.class
  • Added Element
Appointment.serviceType
  • Type changed from CodeableConcept to CodeableReference
Appointment.reason
  • Renamed from reasonCode to reason
  • Type changed from CodeableConcept to CodeableReference
Appointment.priority
  • Type changed from unsignedInt to CodeableConcept
Appointment.replaces
  • Added Element
Appointment.virtualService
  • Added Element
Appointment.previousAppointment
  • Added Element
Appointment.originatingAppointment
  • Added Element
Appointment.account
  • Added Element
Appointment.cancellationDate
  • Added Element
Appointment.note
  • Renamed from comment to note
  • Max Cardinality changed from 1 to *
  • Type changed from string to Annotation
Appointment.patientInstruction
  • Max Cardinality changed from 1 to *
  • Type changed from string to CodeableReference
Appointment.basedOn
  • Type Reference: Added Target Types CarePlan, DeviceRequest, MedicationRequest, RequestOrchestration, NutritionOrder, VisionPrescription, ImmunizationRecommendation
Appointment.subject
  • Added Element
Appointment.participant.actor
  • Type Reference: Added Target Types Group, CareTeam
Appointment.participant.required
  • Type changed from code to boolean
  • Remove Binding `http://hl7.org/fhir/ValueSet/participantrequired|4.0.0` (required)
Appointment.recurrenceId
  • Added Element
Appointment.occurrenceChanged
  • Added Element
Appointment.recurrenceTemplate
  • Added Element
Appointment.recurrenceTemplate.timezone
  • Added Element
Appointment.recurrenceTemplate.recurrenceType
  • Added Mandatory Element
Appointment.recurrenceTemplate.lastOccurrenceDate
  • Added Element
Appointment.recurrenceTemplate.occurrenceCount
  • Added Element
Appointment.recurrenceTemplate.occurrenceDate
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.monday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.tuesday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.wednesday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.thursday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.friday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.saturday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.sunday
  • Added Element
Appointment.recurrenceTemplate.weeklyTemplate.weekInterval
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.dayOfMonth
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.nthWeekOfMonth
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.dayOfWeek
  • Added Element
Appointment.recurrenceTemplate.monthlyTemplate.monthInterval
  • Added Mandatory Element
Appointment.recurrenceTemplate.yearlyTemplate
  • Added Element
Appointment.recurrenceTemplate.yearlyTemplate.yearInterval
  • Added Mandatory Element
Appointment.recurrenceTemplate.excludingDate
  • Added Element
Appointment.recurrenceTemplate.excludingRecurrenceId
  • Added Element
Appointment.reasonReference
  • Deleted (->Appointment.reason.reference)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

12.14.4.1 Terminology Bindings

Path ValueSet Type Documentation
Appointment.status AppointmentStatus Required

The free/busy status of an appointment.
Appointment.cancellationReason AppointmentCancellationReason Example

This example value set defines a set of reasons for the cancellation of an appointment.
Appointment.class http://terminology.hl7.org/ValueSet/EncounterClass icon Preferred
Appointment.serviceCategory ServiceCategory Example

This value set defines an example set of codes that can be used to classify groupings of service-types/specialties.
Appointment.serviceType ServiceType Example

This value set defines an example set of codes of service-types.
Appointment.specialty PracticeSettingCodeValueSet Preferred

This is the code representing the clinical specialty of the clinician or provider who interacted with, treated, or provided a service to/for the patient. The value set used for clinical specialty has been limited by HITSP to the value set reproduced from HITSP C80 Table 2-149 Clinical Specialty Value Set Definition.
Appointment.appointmentType Hl7VSAppointmentReasonCodes icon (a valid code from appointmentReason icon) Preferred

Value Set of codes that describe the kind of appointment or the reason why an appointment has been scheduled.
Appointment.reason EncounterReasonCodes Preferred

This examples value set defines the set of codes that can be used to indicate reasons for an encounter.
Appointment.priority ActPriority icon Example

A code or set of codes (e.g., for routine, emergency,) specifying the urgency under which the Act happened, can happen, is happening, is intended to happen, or is requested/demanded to happen.

Discussion: This attribute is used in orders to indicate the ordered priority, and in event documentation it indicates the actual priority used to perform the act. In definition mood it indicates the available priorities.
Appointment.participant.type ParticipantType Extensible

This value set defines a set of codes that can be used to indicate how an individual participates in an encounter.
Appointment.participant.status ParticipationStatus Required

The Participation status of an appointment.
Appointment.recurrenceTemplate.timezone IANATimezones (a valid code from IANA Time Zone Database icon) Required

An IANA timezone code for the timezone offset per BCP 175 icon. The offset is specified as part of a dateTime/instant (or using the tzOffset extension on a date if necessary). The timezone code may also be provided to allow for human display of the location associated with the offset. These are codes like 'America/New_York' or 'America/Los_Angeles'. See IANA Timezones icon for the official source, and Wikipedia icon for information
Appointment.recurrenceTemplate.recurrenceType AppointmentRecurrenceType Preferred

The recurrence type of a recurring appointment.
Appointment.recurrenceTemplate.monthlyTemplate.nthWeekOfMonth WeekOfMonth Required

The set of weeks in a month.
Appointment.recurrenceTemplate.monthlyTemplate.dayOfWeek DaysOfWeek Required

The days of the week.

12.14.4.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img app-1Rule Appointment.participantEither the type or actor on the participant SHALL be specifiedtype.exists() or actor.exists()
img app-2Rule (base)Either start and end are specified, or neitherstart.exists() = end.exists()
img app-3Rule (base)Only proposed or cancelled appointments can be missing start/end dates(start.exists() and end.exists()) or (status in ('proposed' | 'cancelled' | 'waitlist'))
img app-4Rule (base)Cancellation reason is only used for appointments that have been cancelled, or noshowcancellationReason.exists() implies (status='noshow' or status='cancelled')
img app-5Rule (base)The start must be less than or equal to the endstart.exists() implies start <= end
img app-6Guideline (base)An appointment may have an originatingAppointment or recurrenceTemplate, but not bothoriginatingAppointment.exists().not() or recurrenceTemplate.exists().not()
This is (only) a best practice guideline because:

For a recurring series of appointments, the originating appointment should have the recurrenceTemplate defining the details of the overall recurrence. Each occurence should refer back to the originatingAppointment as the single source of truth for the details of the recurrence.

img app-7Rule (base)Cancellation date is only used for appointments that have been cancelled, or noshowcancellationDate.exists() implies (status='noshow' or status='cancelled')

12.14.5 Typical Status Transition Examples:

12.14.5.1 Typical flow of statuses for an appointment:

Activity Description Slot Appointment Appointment Response Encounter
The schedule is created/published
(Role: Scheduler) 		freeBusyType = FREE
An appointment request is created after locating an available slot
(Role: Requester) 		status = pending
participant.status = needs-action
The appointment request is processed and the slot status updated
(Role: Scheduler) 		freeBusyType = BUSY-TENTATIVE
The appointment is accepted as described - by all participants
(Role: Participant(s)) 		participantStatus = accepted
The appointment is confirmed as accepted by all participants
(Role: Scheduler) 		freeBusyType = BUSY status = booked
participant.status = accepted
Optional: Preparation for the appointment begins - could be preparing a room for the appointment, etc.
(Role: Participants/Admin) 		status = planned (optional)
location.status = planned
The patient arrives for the appointment, often sitting in a waiting room
(Role: Admin) 		status = arrived status = in-progress
subjectStatus = arrived
location.status = active
The practitioner and the patient meet and the provision of the service begins/occurs
(Role: Participant(s)/Admin) 		status = fulfilled status = in-progress
subjectStatus = receiving-care
The care provision concludes and the patient leaves, some administrative and/or cleanup actions take place
(Role: Practitioner(s)/Admin/Billing - excluding patient) 		status = discharged
subjectStatus = departed
The encounter concludes, all paperwork has been completed and the encounter can be closed off
(Role: Practitioner(s)/Admin) 		status = finished
location.status = completed

12.14.5.2 Flow for the rejection/cancellation of an appointment

Activity Description Slot Appointment Appointment Response
The schedule is created/published
(Role: Scheduler) 		freeBusyType = FREE
An appointment request is created
(Role: Requester) 		status = pending
participant.status = needs-action
The appointment request is processed and the slot status updated
(Role: Scheduler) 		freeBusyType = BUSY-TENTATIVE
Participant declines the Appointment
(Role: Participant) 		participantStatus = declined
The appointment is cancelled (typically the cancellationDate will be populated, along with a cancellation reason if applicable, this is often selected by the scheduler as could be used by the billing engine)
(Role: Scheduler) 		freeBusyType = FREE status = cancelled
cancellationDate = (date of cancellation)
cancellationReason = (cancellation reason if applicable)
participant.status = declined

12.14.5.3 Flow for re-negotiation:

Activity Description Slot Appointment Appointment Response
The schedule is created/published
(Role: Scheduler) 		freeBusyType = FREE
An appointment is requested (e.g. with Brian and Peter)
(Role: Requester) 		status = proposed
participant(Brian).status = needs-action
participant(Peter).status = needs-action
The schedule is updated to inform others of interest in the slot
(Role: Scheduler) 		freeBusyType = BUSY-TENTATIVE
Brian accepts the appointment
(Role: Participant-Brian) 		(Brian).participantStatus = accepted
Appointment is updated with Brian's status
(Role: Scheduler) 		status = pending
participant(Brian).status = accepted
Peter suggests a new time
(Role: Participant-Peter) 		(Peter).participantStatus = tentative
(with new time)
Appointment is updated with new time, and indicates that action is needed by both participants
(Role: Scheduler) 		(new time details updated)
participant(Brian).status = needs-action
participant(Peter).status = needs-action
Brian accepts the appointment
(Role: Participant-Brian) 		(Brian).participantStatus = accepted
Appointment updated
(Role: Scheduler) 		participant(Brian).status = accepted

(Role: Participant-Peter) 		(Peter).participantStatus = accepted
Appointment updated
(Role: Scheduler) 		freeBusyType = BUSY status = booked
participant(Peter).status = accepted

12.14.5.4 Flow for a patient no-show:

Activity Description Slot Appointment Appointment Response Encounter
(from typical status flow) freeBusyType = BUSY status = booked
participant.status = accepted
Appointment is updated as a noshow
(Role: Scheduler/Admin) 		status = noshow (no encounter created)

12.14.5.5 Flow for a patient waitlist:

Activity Description Appointment (inconvenient) Appointment (preferred)
An appointment is booked for an inconvenient time using a typical status flow status = booked
participant.status = accepted
Waitlist appointment created status = booked
participant.status = accepted 		status = waitlist
requestedPeriod = (more convenient time period)
Patient notified of availability of a better slot status = booked status = proposed
participant.status = needs-action
Patient accepts better slot status = cancelled status = booked
participant.status = accepted

12.14.6 Notes:

  • Placer/Filler (HL7 V2 icon)
    The appointment information is effectively the same between the filler and placer, and given the nature of the FHIR resource, there is only a single resource for both purposes. The placer is the actor that performs the PUT or POST operation on the resource, and the filler is the actor that receives these resource messages and processes the information and makes a decision if the appointment can be used.
  • Terminology - ServiceCategory, ServiceType and Specialty
    The 3 core clinical terminologies associated with the appointment may have relationships with each other through the terminology server, but not these might not be visible in the actual appointment resource or profile.
  • Interaction with other Standards
    The strong desire is that implementers of this resource should consider providing this resource in the iCalendar format as an alternative representation. Many 3rd party applications and component providers have parsers and user interface controls to display this information. This may lower the entry point to integrate outside the health-care specific applications, and into the consumer space. This would permit the easier creation of a mobile application that creates appointments in the devices native calendar.
    The iCalendar specification can be found at http://www.ietf.org/rfc/rfc2445.txt icon.

12.14.6.1 Insurance for Appointments

When appointments are scheduled, often insurance information is collected. This may be a single coverage, or multiple coverages. To document this preliminary coverage information, Appointment.account may be used to reference an Account which would contain the ordered list of Coverages that are expected to apply to the Appointment.

12.14.6.2 Payment Authorization for Appointments

Prior authorization for an Appointment would involve a Claim (to submit the prior authorization request) and a ClaimResponse (to receive the prior authorization approval). In this case, the Claim and ClaimResponse associated with the prior auth would reference the planned Appointment that was authorized. How the association between the prior authorization and the authorized services is described may vary by jurisdiction (e.g., Da Vinci PAS in the US).

Note to Implementers: Implementer feedback is sought on the values for Appointment.priority and how interoperable they are. Using an extension to record a CodeableConcept for named values may be tested at a future Connectathon.
Implementer feedback is also sought to clarify desired relationship linkages between ServiceCategory, ServiceType and Specialty, along with how they have approached the definition.

Feedback here icon.

12.14.7 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
actor reference Any one of the individuals participating in the appointment Appointment.participant.actor
(Practitioner, Group, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson, Location)
appointment-type token The style of appointment or patient that has been booked in the slot (not service type) Appointment.appointmentType
based-on reference The service request this appointment is allocated to assess Appointment.basedOn
(CarePlan, MedicationRequest, RequestOrchestration, NutritionOrder, VisionPrescription, DeviceRequest, ServiceRequest, ImmunizationRecommendation)
date date Appointment date/time. (start | requestedPeriod.start).first() 26 Resources
group reference One of the individuals of the appointment is this patient Appointment.participant.actor.where(resolve() is Group) | Appointment.subject.where(resolve() is Group)
(Group)
has-recurrence-template token This Appointment contains a recurrence template Appointment.recurrenceTemplate.exists()
identifier token An Identifier of the Appointment Appointment.identifier 65 Resources
is-recurring token This Appointment is a part of a recurring series of appointments (has a template or an originating appointment) Appointment.recurrenceTemplate.exists() | Appointment.originatingAppointment.exists()
location reference This location is listed in the participants of the appointment Appointment.participant.actor.where(resolve() is Location)
(Location)
occurrence-changed token This Appointment has been changed from the recurrence template Appointment.occurrenceChanged
originating-appointment reference Reference to the Appointment that contains the recurrence template Appointment.originatingAppointment
(Appointment)
part-status token The Participation status of the subject, or other participant on the appointment. Can be used to locate participants that have not responded to meeting requests. Appointment.participant.status
patient reference One of the individuals of the appointment is this patient Appointment.participant.actor.where(resolve() is Patient) | Appointment.subject.where(resolve() is Patient)
(Patient)		 65 Resources
practitioner reference One of the individuals of the appointment is this practitioner Appointment.participant.actor.where(resolve() is Practitioner)
(Practitioner)
previous-appointment reference Reference to the Appointment that preceded this appointment in a series Appointment.previousAppointment
(Appointment)
reason-code token Reference to a concept (by class) Appointment.reason.concept
reason-reference reference Reference to a resource (by instance) Appointment.reason.reference
requested-period date During what period was the Appointment requested to take place requestedPeriod
service-category token A broad categorization of the service that is to be performed during this appointment Appointment.serviceCategory
service-type token The specific service (by coding) that is to be performed during this appointment Appointment.serviceType.concept
service-type-reference reference The specific service (by HealthcareService) that is to be performed during this appointment Appointment.serviceType.reference
slot reference The slots that this appointment is filling Appointment.slot
(Slot)
specialty token The specialty of a practitioner that would be required to perform the service requested in this appointment Appointment.specialty
status token The overall status of the appointment Appointment.status
subject reference One of the individuals of the appointment is this patient Appointment.subject
(Group, Patient)
supporting-info reference Additional information to support the appointment Appointment.supportingInformation
(Any)