CA Baseline Encounter Profile

This profile sets minimum expectations for the Encounter resource to represent various observations if no other, more specific profile is applicable.

This Encounter profile represents an interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient, or to communicate information on a visit-specific basis.

This profile defines localization concepts for use in the Canadian context.

Mandatory Data Elements

All elements or attributes within the FHIR specification have cardinality as part of their definition - a minimum number of required appearances and a maximum number of allowable appearances.

Most elements in the FHIR specification have a minimum cardinality of 0, so most elements are not required and subsequently they may be missing from a resource when it is exchanged between systems.

Required elements in the Encounter profile:

• state of the encounter (Encounter.status)
• classification of the encounter (Encounter.class)
• subject of the encounter (Encounter.subject)

Must Support Data Elements

Some elements are marked as Must Support. This means that implementations generating, receiving, or otherwise using resources with Must Support elements SHALL provide support for those elements in some meaningful way (see Must Support definition).

The following elements are marked as Must Support in the Encounter profile:

Must Support elements:

• identifier
• state of the encounter (Encounter.status)
• classification of the encounter (Encounter.class)
• reference to a subject (Encounter.subject)
• responsible providers (Encounter.participant)
• reasons (Encounter.reasonCode)
• diagnosis relevant to the encounter (Encounter.diagnosis)
• diagnosis rank
• admission details (Encounter.hospitalization)

Usage Note

It is anticipated that many systems only need the current information of the encounter and therefore the Encounter resource represents the most recent information.

Systems that need to track historical information about the encounter should be able to do that by increasing complexity of the Encounter resource instance.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	Encounter Profile
identifier	S	0..*	Identifier	Identifier(s) by which this encounter is known
status	S	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled +
class	S	1..1	Coding	Classification of patient encounter
type	S	0..*	CodeableConcept	Specific type of encounter Binding: Encounter Type (preferred): Valueset to describe the Encounter Type
subject	S	1..1	Reference(Patient Profile)	The patient present at the encounter
participant	S	0..*	BackboneElement	A list of Practitioners participating in the encounter
individual		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General))	Persons involved in the encounter other than the patient
reasonCode	S	0..*	CodeableConcept	Coded reason the encounter takes place
reasonReference		0..*	Reference(Condition Profile | Procedure Profile | Observation Profile (General Use) | ImmunizationRecommendation Profile)	Reason the encounter takes place (reference)
diagnosis	S	0..*	BackboneElement	The list of diagnosis relevant to this encounter
condition		1..1	Reference(Condition Profile | Procedure Profile)	The diagnosis or procedure relevant to the encounter
rank	S	0..1	positiveInt	Ranking of the diagnosis (for each role type)
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service
origin		0..1	Reference(Location Profile | Organization Profile)	The location/organization from which the patient came before admission
destination		0..1	Reference(Location Profile | Organization Profile)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: EncounterDischargeDisposition (preferred): Discharge Disposition.
location
location		1..1	Reference(Location Profile)	Location the encounter takes place
serviceProvider		0..1	Reference(Organization Profile)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter Profile)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Encounter.type	preferred	EncounterType https://fhir.infoway-inforoute.ca/ValueSet/encountertype from this IG
Encounter.hospitalization.dischargeDisposition	preferred	EncounterDischargeDisposition https://fhir.infoway-inforoute.ca/ValueSet/encounterdischargedisposition from https://terminologystandardsservice.ca/tx/fhir

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	Encounter Profile dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	0..*	Identifier	Identifier(s) by which this encounter is known ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter. ele-1: All FHIR elements must have a @value or children
class	SΣ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter. ele-1: All FHIR elements must have a @value or children
type	SΣ	0..*	CodeableConcept	Specific type of encounter Binding: Encounter Type (preferred): Valueset to describe the Encounter Type ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(Patient Profile)	The patient present at the encounter ele-1: All FHIR elements must have a @value or children
participant	SΣ	0..*	BackboneElement	A list of Practitioners participating in the encounter ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
individual	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General))	Persons involved in the encounter other than the patient ele-1: All FHIR elements must have a @value or children
reasonCode	SΣ	0..*	CodeableConcept	Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place. ele-1: All FHIR elements must have a @value or children
reasonReference	Σ	0..*	Reference(Condition Profile | Procedure Profile | Observation Profile (General Use) | ImmunizationRecommendation Profile)	Reason the encounter takes place (reference) ele-1: All FHIR elements must have a @value or children
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this encounter ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
condition	Σ	1..1	Reference(Condition Profile | Procedure Profile)	The diagnosis or procedure relevant to the encounter ele-1: All FHIR elements must have a @value or children
rank	S	0..1	positiveInt	Ranking of the diagnosis (for each role type) ele-1: All FHIR elements must have a @value or children
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
origin		0..1	Reference(Location Profile | Organization Profile)	The location/organization from which the patient came before admission ele-1: All FHIR elements must have a @value or children
destination		0..1	Reference(Location Profile | Organization Profile)	Location/organization to which the patient is discharged ele-1: All FHIR elements must have a @value or children
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: EncounterDischargeDisposition (preferred): Discharge Disposition. ele-1: All FHIR elements must have a @value or children
serviceProvider		0..1	Reference(Organization Profile)	The organization (facility) responsible for this encounter ele-1: All FHIR elements must have a @value or children
partOf		0..1	Reference(Encounter Profile)	Another Encounter this encounter is part of ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Encounter.status	required	EncounterStatus http://hl7.org/fhir/ValueSet/encounter-status|4.0.1 from the FHIR Standard
Encounter.class	extensible	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Encounter.type	preferred	EncounterType https://fhir.infoway-inforoute.ca/ValueSet/encountertype from this IG
Encounter.reasonCode	preferred	EncounterReasonCodes http://hl7.org/fhir/ValueSet/encounter-reason from the FHIR Standard
Encounter.hospitalization.dischargeDisposition	preferred	EncounterDischargeDisposition https://fhir.infoway-inforoute.ca/ValueSet/encounterdischargedisposition from https://terminologystandardsservice.ca/tx/fhir

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	Encounter Profile
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!SΣ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory		0..*	BackboneElement	List of past encounter statuses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period		1..1	Period	The time that the episode was in the specified status
class	SΣ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
classHistory		0..*	BackboneElement	List of past encounter classes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
class		1..1	Coding	inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period		1..1	Period	The time that the episode was in the specified class
type	SΣ	0..*	CodeableConcept	Specific type of encounter Binding: Encounter Type (preferred): Valueset to describe the Encounter Type
serviceType	Σ	0..1	CodeableConcept	Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
priority		0..1	CodeableConcept	Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject	SΣ	1..1	Reference(Patient Profile)	The patient present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	SΣ	0..*	BackboneElement	A list of Practitioners participating in the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..*	CodeableConcept	Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General))	Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	SΣ	0..*	CodeableConcept	Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	Σ	0..*	Reference(Condition Profile | Procedure Profile | Observation Profile (General Use) | ImmunizationRecommendation Profile)	Reason the encounter takes place (reference)
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition Profile | Procedure Profile)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank	S	0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location Profile | Organization Profile)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination		0..1	Reference(Location Profile | Organization Profile)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: EncounterDischargeDisposition (preferred): Discharge Disposition.
location		0..*	BackboneElement	List of locations where the patient has been
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location		1..1	Reference(Location Profile)	Location the encounter takes place
status		0..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization Profile)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter Profile)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Encounter.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Encounter.status	required	EncounterStatus http://hl7.org/fhir/ValueSet/encounter-status|4.0.1 from the FHIR Standard
Encounter.statusHistory.status	required	EncounterStatus http://hl7.org/fhir/ValueSet/encounter-status|4.0.1 from the FHIR Standard
Encounter.class	extensible	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Encounter.type	preferred	EncounterType https://fhir.infoway-inforoute.ca/ValueSet/encountertype from this IG
Encounter.serviceType	example	ServiceType http://hl7.org/fhir/ValueSet/service-type from the FHIR Standard
Encounter.priority	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Encounter.participant.type	extensible	ParticipantType http://hl7.org/fhir/ValueSet/encounter-participant-type from the FHIR Standard
Encounter.reasonCode	preferred	EncounterReasonCodes http://hl7.org/fhir/ValueSet/encounter-reason from the FHIR Standard
Encounter.diagnosis.use	preferred	DiagnosisRole http://hl7.org/fhir/ValueSet/diagnosis-role from the FHIR Standard
Encounter.hospitalization.admitSource	preferred	AdmitSource http://hl7.org/fhir/ValueSet/encounter-admit-source from the FHIR Standard
Encounter.hospitalization.reAdmission	example	Hl7VSReAdmissionIndicator http://terminology.hl7.org/ValueSet/v2-0092
Encounter.hospitalization.dietPreference	example	Diet http://hl7.org/fhir/ValueSet/encounter-diet from the FHIR Standard
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy http://hl7.org/fhir/ValueSet/encounter-special-courtesy from the FHIR Standard
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements http://hl7.org/fhir/ValueSet/encounter-special-arrangements from the FHIR Standard
Encounter.hospitalization.dischargeDisposition	preferred	EncounterDischargeDisposition https://fhir.infoway-inforoute.ca/ValueSet/encounterdischargedisposition from https://terminologystandardsservice.ca/tx/fhir
Encounter.location.status	required	EncounterLocationStatus http://hl7.org/fhir/ValueSet/encounter-location-status|4.0.1 from the FHIR Standard
Encounter.location.physicalType	example	LocationType http://hl7.org/fhir/ValueSet/location-physical-type from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	Encounter Profile
identifier	S	0..*	Identifier	Identifier(s) by which this encounter is known
status	S	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled +
class	S	1..1	Coding	Classification of patient encounter
type	S	0..*	CodeableConcept	Specific type of encounter Binding: Encounter Type (preferred): Valueset to describe the Encounter Type
subject	S	1..1	Reference(Patient Profile)	The patient present at the encounter
participant	S	0..*	BackboneElement	A list of Practitioners participating in the encounter
individual		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General))	Persons involved in the encounter other than the patient
reasonCode	S	0..*	CodeableConcept	Coded reason the encounter takes place
reasonReference		0..*	Reference(Condition Profile | Procedure Profile | Observation Profile (General Use) | ImmunizationRecommendation Profile)	Reason the encounter takes place (reference)
diagnosis	S	0..*	BackboneElement	The list of diagnosis relevant to this encounter
condition		1..1	Reference(Condition Profile | Procedure Profile)	The diagnosis or procedure relevant to the encounter
rank	S	0..1	positiveInt	Ranking of the diagnosis (for each role type)
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service
origin		0..1	Reference(Location Profile | Organization Profile)	The location/organization from which the patient came before admission
destination		0..1	Reference(Location Profile | Organization Profile)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: EncounterDischargeDisposition (preferred): Discharge Disposition.
location
location		1..1	Reference(Location Profile)	Location the encounter takes place
serviceProvider		0..1	Reference(Organization Profile)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter Profile)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Encounter.type	preferred	EncounterType https://fhir.infoway-inforoute.ca/ValueSet/encountertype from this IG
Encounter.hospitalization.dischargeDisposition	preferred	EncounterDischargeDisposition https://fhir.infoway-inforoute.ca/ValueSet/encounterdischargedisposition from https://terminologystandardsservice.ca/tx/fhir

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	Encounter Profile dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	0..*	Identifier	Identifier(s) by which this encounter is known ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter. ele-1: All FHIR elements must have a @value or children
class	SΣ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter. ele-1: All FHIR elements must have a @value or children
type	SΣ	0..*	CodeableConcept	Specific type of encounter Binding: Encounter Type (preferred): Valueset to describe the Encounter Type ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(Patient Profile)	The patient present at the encounter ele-1: All FHIR elements must have a @value or children
participant	SΣ	0..*	BackboneElement	A list of Practitioners participating in the encounter ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
individual	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General))	Persons involved in the encounter other than the patient ele-1: All FHIR elements must have a @value or children
reasonCode	SΣ	0..*	CodeableConcept	Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place. ele-1: All FHIR elements must have a @value or children
reasonReference	Σ	0..*	Reference(Condition Profile | Procedure Profile | Observation Profile (General Use) | ImmunizationRecommendation Profile)	Reason the encounter takes place (reference) ele-1: All FHIR elements must have a @value or children
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this encounter ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
condition	Σ	1..1	Reference(Condition Profile | Procedure Profile)	The diagnosis or procedure relevant to the encounter ele-1: All FHIR elements must have a @value or children
rank	S	0..1	positiveInt	Ranking of the diagnosis (for each role type) ele-1: All FHIR elements must have a @value or children
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
origin		0..1	Reference(Location Profile | Organization Profile)	The location/organization from which the patient came before admission ele-1: All FHIR elements must have a @value or children
destination		0..1	Reference(Location Profile | Organization Profile)	Location/organization to which the patient is discharged ele-1: All FHIR elements must have a @value or children
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: EncounterDischargeDisposition (preferred): Discharge Disposition. ele-1: All FHIR elements must have a @value or children
serviceProvider		0..1	Reference(Organization Profile)	The organization (facility) responsible for this encounter ele-1: All FHIR elements must have a @value or children
partOf		0..1	Reference(Encounter Profile)	Another Encounter this encounter is part of ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Encounter.status	required	EncounterStatus http://hl7.org/fhir/ValueSet/encounter-status|4.0.1 from the FHIR Standard
Encounter.class	extensible	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Encounter.type	preferred	EncounterType https://fhir.infoway-inforoute.ca/ValueSet/encountertype from this IG
Encounter.reasonCode	preferred	EncounterReasonCodes http://hl7.org/fhir/ValueSet/encounter-reason from the FHIR Standard
Encounter.hospitalization.dischargeDisposition	preferred	EncounterDischargeDisposition https://fhir.infoway-inforoute.ca/ValueSet/encounterdischargedisposition from https://terminologystandardsservice.ca/tx/fhir

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	Encounter Profile
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!SΣ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory		0..*	BackboneElement	List of past encounter statuses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period		1..1	Period	The time that the episode was in the specified status
class	SΣ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
classHistory		0..*	BackboneElement	List of past encounter classes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
class		1..1	Coding	inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period		1..1	Period	The time that the episode was in the specified class
type	SΣ	0..*	CodeableConcept	Specific type of encounter Binding: Encounter Type (preferred): Valueset to describe the Encounter Type
serviceType	Σ	0..1	CodeableConcept	Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
priority		0..1	CodeableConcept	Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject	SΣ	1..1	Reference(Patient Profile)	The patient present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	SΣ	0..*	BackboneElement	A list of Practitioners participating in the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..*	CodeableConcept	Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General))	Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	SΣ	0..*	CodeableConcept	Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	Σ	0..*	Reference(Condition Profile | Procedure Profile | Observation Profile (General Use) | ImmunizationRecommendation Profile)	Reason the encounter takes place (reference)
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition Profile | Procedure Profile)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank	S	0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location Profile | Organization Profile)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination		0..1	Reference(Location Profile | Organization Profile)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: EncounterDischargeDisposition (preferred): Discharge Disposition.
location		0..*	BackboneElement	List of locations where the patient has been
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location		1..1	Reference(Location Profile)	Location the encounter takes place
status		0..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization Profile)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter Profile)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Encounter.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Encounter.status	required	EncounterStatus http://hl7.org/fhir/ValueSet/encounter-status|4.0.1 from the FHIR Standard
Encounter.statusHistory.status	required	EncounterStatus http://hl7.org/fhir/ValueSet/encounter-status|4.0.1 from the FHIR Standard
Encounter.class	extensible	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Encounter.type	preferred	EncounterType https://fhir.infoway-inforoute.ca/ValueSet/encountertype from this IG
Encounter.serviceType	example	ServiceType http://hl7.org/fhir/ValueSet/service-type from the FHIR Standard
Encounter.priority	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Encounter.participant.type	extensible	ParticipantType http://hl7.org/fhir/ValueSet/encounter-participant-type from the FHIR Standard
Encounter.reasonCode	preferred	EncounterReasonCodes http://hl7.org/fhir/ValueSet/encounter-reason from the FHIR Standard
Encounter.diagnosis.use	preferred	DiagnosisRole http://hl7.org/fhir/ValueSet/diagnosis-role from the FHIR Standard
Encounter.hospitalization.admitSource	preferred	AdmitSource http://hl7.org/fhir/ValueSet/encounter-admit-source from the FHIR Standard
Encounter.hospitalization.reAdmission	example	Hl7VSReAdmissionIndicator http://terminology.hl7.org/ValueSet/v2-0092
Encounter.hospitalization.dietPreference	example	Diet http://hl7.org/fhir/ValueSet/encounter-diet from the FHIR Standard
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy http://hl7.org/fhir/ValueSet/encounter-special-courtesy from the FHIR Standard
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements http://hl7.org/fhir/ValueSet/encounter-special-arrangements from the FHIR Standard
Encounter.hospitalization.dischargeDisposition	preferred	EncounterDischargeDisposition https://fhir.infoway-inforoute.ca/ValueSet/encounterdischargedisposition from https://terminologystandardsservice.ca/tx/fhir
Encounter.location.status	required	EncounterLocationStatus http://hl7.org/fhir/ValueSet/encounter-location-status|4.0.1 from the FHIR Standard
Encounter.location.physicalType	example	LocationType http://hl7.org/fhir/ValueSet/location-physical-type from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Encounter

Summary

Mandatory: 1 element
Must-Support: 10 elements

Structures

This structure refers to these other structures:

• Patient Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient)
• Practitioner Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner)
• PractitionerRole Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole)
• Condition Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-condition)
• Procedure Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-procedure)
• Observation Profile (General Use) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-observation)
• ImmunizationRecommendation Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-immunizationrecommendation)
• Location Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-location)
• Organization Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
• Encounter Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter)

Class

The Encounter.class element is to provide the kind of stay that a subject is having. This is different than the Encounter.type that explains what is done to the subject within this encounter.

In other words, the Encounter.class identifies the setting for the encounter (inpatient/outpatient) in which the encounter took place.

Since it is important for interpreting the context of the encounter, for choosing the appropriate business rules to enforce the clinical/management process, this element is required (cardinality 1..1) and marked as Must Support.

The Encounter.class element does NOT identify the priority of the encounter (see Encounter.priority). Therefore Encounter.class = "EMER" (Emergency) refers to an encounter happening at a dedicated healthcare service delivery location (e.g., Emergency Department) rather than the priority of the encounter.

Type

The Encounter.type element is to provide a specific code indicating type of service provided.

This element is bound to EncounterType value set which includes codes from SNOMED CT decending from the 308335008 (Patient encounter procedure (procedure)) concept.

To extract all descendant of the SNOMED CT concept 308335008 use an ECL expression << 308335008.

- ISSUE #143: Need to better define the value set for the Encounter.type and explain the difference between Encounter.type and Encounter.serviceType based on use cases. 
- Possible value sets:
- descendant of the SNOMED CT concept 308335008 | Patient encounter procedure (procedure);
- descendant of the SNOMED CT concept 308467007 | Seen in establishment (finding)
- descendant of the SNOMED CT concept 308930007 | Seen by health professional (finding)

Service Type

The Encounter.serviceType element describes the service to be performed during the encounter. This element is connected to other resources such as Appointment (Appointment.serviceType), HealthcareService (HealthcareService.type) or Schedule (Schedule.serviceType)