Canadian Baseline
1.1.0 - CI Build Canada flag

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions

Resource Profile: ServiceRequestProfile - Detailed Descriptions

Draft as of 2020-10-06

Definitions for the profile-servicerequest resource profile.

Guidance on how to interpret the contents of this table can be found here

0. ServiceRequest
Definition

Service Request Profile is based upon the core FHIR ServiceRequest resource and created to define the minimal set of data required to request for service such as diagnostic investigations, treatments, or operations to be performed.

ShortServiceRequest Profile
2. ServiceRequest.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Must Supporttrue
4. ServiceRequest.basedOn
TypeReference(ServiceRequest Profile for Results Reporting, MedicationRequest Profile)
6. ServiceRequest.replaces
TypeReference(ServiceRequest Profile for Results Reporting)
8. ServiceRequest.requisition
Must Supporttrue
10. ServiceRequest.status
Must Supporttrue
12. ServiceRequest.intent
Must Supporttrue
14. ServiceRequest.category
Definition

A code that classifies the service for searching, sorting and display purposes (e.g. Surgical Procedure).

ShortClassification of service
Must Supporttrue
16. ServiceRequest.code
Definition

Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, use of the pan-Canadian LOINC Observation Code Database (pCLOCD) is preferred and can be found in the slice below.

18. ServiceRequest.code.coding
Control0..?
Must Supporttrue
SlicingThis element introduces a set of slices on ServiceRequest.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • 20. ServiceRequest.code.coding:LabOrder
    Slice NameLabOrder
    Definition

    A code that identifies a laboratory procedure that have been requested

    ShortLaboratory procedure code
    Comments

    The binding strength of this element is Preferred, meaning that codes are encouraged to draw from the pCLOCD value set for interoperability purposes but are not required to do so to be considered conformant.

    BindingThe codes SHOULD be taken from https://fhir.infoway-inforoute.ca/ValueSet/pCLOCD
    (preferred to https://fhir.infoway-inforoute.ca/ValueSet/pCLOCD)

    The pan-Canadian LOINC Observation Code Database (pCLOCD) is the Canadian version of the LOINC(tm) database. It was created using the LOINC(tm) records and attributes that were constrained for Canadian use and supplemented to specifically meet Canadian requirements. It contains the core LOINC(tm) attributes as required by Regenstrief copyright rules. The LOINC(tm) Component has been customized to meet Canadian requirements and is displayed as the pan Canadian Component Name. This component name is the basis for the pan Canadian Display Name. Core attributes are include both English and Canadian French.

    TypeCoding
    22. ServiceRequest.code.coding:LabOrder.system
    Control1..1
    24. ServiceRequest.code.coding:LabOrder.code
    Control1..1
    26. ServiceRequest.code.coding:@default
    Slice Name@default
    28. ServiceRequest.code.coding:@default.system
    Control1..1
    30. ServiceRequest.code.coding:@default.code
    Control1..1
    32. ServiceRequest.subject
    TypeReference(Patient Profile, Location Profile, Device Profile (Implantable))
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    34. ServiceRequest.encounter
    TypeReference(Encounter Profile)
    36. ServiceRequest.authoredOn
    Control0..1
    Must Supporttrue
    38. ServiceRequest.requester
    Control1..1
    TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable))
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    40. ServiceRequest.performer
    TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable))
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    42. ServiceRequest.locationReference
    TypeReference(Location Profile)
    44. ServiceRequest.reasonCode
    46. ServiceRequest.reasonReference
    TypeReference(Condition Profile, Observation Profile (General Use), DiagnosticReport Profile for Results Reporting, DocumentReference Profile for metadata about the document)

    Guidance on how to interpret the contents of this table can be found here

    0. ServiceRequest
    Definition

    Service Request Profile is based upon the core FHIR ServiceRequest resource and created to define the minimal set of data required to request for service such as diagnostic investigations, treatments, or operations to be performed.


    A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.

    ShortServiceRequest ProfileA request for a service to be performed
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Alternate Namesdiagnostic request, referral, referral request, transfer of care request
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    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 (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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    prr-1: orderDetail SHALL only be present if code is present (orderDetail.empty() or code.exists())
    prr-1: orderDetail SHALL only be present if code is present (orderDetail.empty() or code.exists())
    2. ServiceRequest.implicitRules
    Definition

    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. ServiceRequest.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    6. ServiceRequest.identifier
    Definition

    Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.

    ShortIdentifiers assigned to this order
    Comments

    The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. ServiceRequest.basedOn
    Definition

    Plan/proposal/order fulfilled by this request.

    ShortWhat request fulfills
    Control0..*
    TypeReference(ServiceRequest Profile for Results Reporting, MedicationRequest Profile, CarePlan, ServiceRequest, MedicationRequest)
    Is Modifierfalse
    Summarytrue
    Alternate Namesfulfills
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. ServiceRequest.replaces
    Definition

    The request takes the place of the referenced completed or terminated request(s).

    ShortWhat request replaces
    Control0..*
    TypeReference(ServiceRequest Profile for Results Reporting, ServiceRequest)
    Is Modifierfalse
    Summarytrue
    Alternate Namessupersedes, prior, renewed order
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. ServiceRequest.requisition
    Definition

    A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.

    ShortComposite Request ID
    Comments

    Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

    Control0..1
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

    Alternate NamesgrouperId, groupIdentifier
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. ServiceRequest.status
    Definition

    The status of the order.

    Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
    Comments

    The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.


    The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

    Control1..1
    BindingThe codes SHALL be taken from RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

    The status of a service order.

    Typecode
    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. ServiceRequest.intent
    Definition

    Whether the request is a proposal, plan, an original order or a reflex order.

    Shortproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
    Comments

    This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

    Control1..1
    BindingThe codes SHALL be taken from RequestIntenthttp://hl7.org/fhir/ValueSet/request-intent|4.0.1
    (required to http://hl7.org/fhir/ValueSet/request-intent|4.0.1)

    The kind of service request.

    Typecode
    Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. ServiceRequest.category
    Definition

    A code that classifies the service for searching, sorting and display purposes (e.g. Surgical Procedure).


    A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").

    ShortClassification of service
    Comments

    There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.

    Control0..*
    BindingThe codes SHOULD be taken from For example codes, see ServiceRequestCategoryCodeshttp://hl7.org/fhir/ValueSet/servicerequest-category
    (preferred to http://hl7.org/fhir/ValueSet/servicerequest-category)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Used for filtering what service request are retrieved and displayed.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. ServiceRequest.doNotPerform
    Definition

    Set this to true if the record is saying that the service/procedure should NOT be performed.

    ShortTrue if service/procedure should not be performed
    Comments

    In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

    Control0..1
    Typeboolean
    Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a procedure, it is a request for the procedure to not occur.
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

    Meaning if MissingIf missing, the request is a positive request e.g. "do perform"
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. ServiceRequest.code
    Definition

    Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, use of the pan-Canadian LOINC Observation Code Database (pCLOCD) is preferred and can be found in the slice below.


    A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.

    ShortWhat is being requested/ordered
    Comments

    Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.

    Control0..1
    BindingFor example codes, see ProcedureCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-code
    (example to http://hl7.org/fhir/ValueSet/procedure-code)

    Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is preferred and a valueset using LOINC Order codes is available here.


    Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available here.

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Alternate Namesservice requested
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. ServiceRequest.code.coding
    Definition

    A reference to a code defined by a terminology system.

    ShortCode defined by a terminology system
    Comments

    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

    Control0..*
    TypeCoding
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Allows for alternative encodings within a code system, and translations to other code systems.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on ServiceRequest.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ system
    • 26. ServiceRequest.code.coding:LabOrder
      Slice NameLabOrder
      Definition

      A code that identifies a laboratory procedure that have been requested


      A reference to a code defined by a terminology system.

      ShortLaboratory procedure codeCode defined by a terminology system
      Comments

      The binding strength of this element is Preferred, meaning that codes are encouraged to draw from the pCLOCD value set for interoperability purposes but are not required to do so to be considered conformant.


      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control0..*
      BindingThe codes SHOULD be taken from For codes, see https://fhir.infoway-inforoute.ca/ValueSet/pCLOCD
      (preferred to https://fhir.infoway-inforoute.ca/ValueSet/pCLOCD)

      The pan-Canadian LOINC Observation Code Database (pCLOCD) is the Canadian version of the LOINC(tm) database. It was created using the LOINC(tm) records and attributes that were constrained for Canadian use and supplemented to specifically meet Canadian requirements. It contains the core LOINC(tm) attributes as required by Regenstrief copyright rules. The LOINC(tm) Component has been customized to meet Canadian requirements and is displayed as the pan Canadian Component Name. This component name is the basis for the pan Canadian Display Name. Core attributes are include both English and Canadian French.

      TypeCoding
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. ServiceRequest.code.coding:LabOrder.system
      Definition

      The identification of the code system that defines the meaning of the symbol in the code.

      ShortIdentity of the terminology system
      Comments

      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to be unambiguous about the source of the definition of the symbol.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. ServiceRequest.code.coding:LabOrder.code
      Definition

      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

      ShortSymbol in syntax defined by the system
      Control10..1
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to refer to a particular code in the system.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. ServiceRequest.code.coding:@default
      Slice Name@default
      Definition

      A reference to a code defined by a terminology system.

      ShortCode defined by a terminology system
      Comments

      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control0..*
      TypeCoding
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. ServiceRequest.code.coding:@default.system
      Definition

      The identification of the code system that defines the meaning of the symbol in the code.

      ShortIdentity of the terminology system
      Comments

      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to be unambiguous about the source of the definition of the symbol.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. ServiceRequest.code.coding:@default.code
      Definition

      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

      ShortSymbol in syntax defined by the system
      Control10..1
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to refer to a particular code in the system.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. ServiceRequest.subject
      Definition

      On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).

      ShortIndividual or Entity the service is ordered for
      Control1..1
      TypeReference(Patient Profile, Location Profile, Device Profile (Implantable), Patient, Group, Location, Device)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. ServiceRequest.encounter
      Definition

      An encounter that provides additional information about the healthcare context in which this request is made.

      ShortEncounter in which the request was created
      Control0..1
      TypeReference(Encounter Profile, Encounter)
      Is Modifierfalse
      Summarytrue
      Alternate Namescontext
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. ServiceRequest.authoredOn
      Definition

      When the request transitioned to being actionable.

      ShortDate request signed
      Control0..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Alternate NamesorderedOn
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. ServiceRequest.requester
      Definition

      The individual who initiated the request and has responsibility for its activation.

      ShortWho/what is requesting service
      Comments

      This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.

      Control10..1
      TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable), Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Alternate Namesauthor, orderer
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. ServiceRequest.performer
      Definition

      The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.

      ShortRequested performer
      Comments

      If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).

      Control0..*
      TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable), Practitioner, PractitionerRole, Organization, CareTeam, HealthcareService, Patient, Device, RelatedPerson)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Alternate Namesrequest recipient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. ServiceRequest.locationReference
      Definition

      A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.

      ShortRequested location
      Control0..*
      TypeReference(Location Profile, Location)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. ServiceRequest.reasonCode
      Definition

      An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

      ShortExplanation/Justification for procedure or service
      Comments

      This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.


      This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

      Control0..*
      BindingThe codes SHOULD be taken from For example codes, see ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reason
      (preferred to http://hl7.org/fhir/ValueSet/procedure-reason)
      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. ServiceRequest.reasonReference
      Definition

      Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.

      ShortExplanation/Justification for service or service
      Comments

      This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.


      This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

      Control0..*
      TypeReference(Condition Profile, Observation Profile (General Use), DiagnosticReport Profile for Results Reporting, DocumentReference Profile for metadata about the document, Condition, Observation, DiagnosticReport, DocumentReference)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. ServiceRequest
      Definition

      Service Request Profile is based upon the core FHIR ServiceRequest resource and created to define the minimal set of data required to request for service such as diagnostic investigations, treatments, or operations to be performed.

      ShortServiceRequest Profile
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Alternate Namesdiagnostic request, referral, referral request, transfer of care request
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      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 (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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      prr-1: orderDetail SHALL only be present if code is present (orderDetail.empty() or code.exists())
      2. ServiceRequest.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      4. ServiceRequest.meta
      Definition

      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. ServiceRequest.implicitRules
      Definition

      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

      ShortA set of rules under which this content was created
      Comments

      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. ServiceRequest.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. ServiceRequest.text
      Definition

      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

      ShortText summary of the resource, for human interpretation
      Comments

      Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. ServiceRequest.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

      ShortContained, inline Resources
      Comments

      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

      Control0..*
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. ServiceRequest.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. ServiceRequest.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. ServiceRequest.identifier
      Definition

      Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.

      ShortIdentifiers assigned to this order
      Comments

      The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. ServiceRequest.instantiatesCanonical
      Definition

      The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

      ShortInstantiates FHIR protocol or definition
      Comments

      Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

      Control0..*
      Typecanonical(ActivityDefinition, PlanDefinition)
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. ServiceRequest.instantiatesUri
      Definition

      The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

      ShortInstantiates external protocol or definition
      Comments

      This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

      Control0..*
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. ServiceRequest.basedOn
      Definition

      Plan/proposal/order fulfilled by this request.

      ShortWhat request fulfills
      Control0..*
      TypeReference(ServiceRequest Profile for Results Reporting, MedicationRequest Profile)
      Is Modifierfalse
      Summarytrue
      Alternate Namesfulfills
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. ServiceRequest.replaces
      Definition

      The request takes the place of the referenced completed or terminated request(s).

      ShortWhat request replaces
      Control0..*
      TypeReference(ServiceRequest Profile for Results Reporting)
      Is Modifierfalse
      Summarytrue
      Alternate Namessupersedes, prior, renewed order
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. ServiceRequest.requisition
      Definition

      A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.

      ShortComposite Request ID
      Comments

      Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

      Control0..1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

      Alternate NamesgrouperId, groupIdentifier
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. ServiceRequest.status
      Definition

      The status of the order.

      Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
      Comments

      The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

      Control1..1
      BindingThe codes SHALL be taken from RequestStatus
      (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

      The status of a service order.

      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. ServiceRequest.intent
      Definition

      Whether the request is a proposal, plan, an original order or a reflex order.

      Shortproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
      Comments

      This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

      Control1..1
      BindingThe codes SHALL be taken from RequestIntent
      (required to http://hl7.org/fhir/ValueSet/request-intent|4.0.1)

      The kind of service request.

      Typecode
      Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. ServiceRequest.category
      Definition

      A code that classifies the service for searching, sorting and display purposes (e.g. Surgical Procedure).

      ShortClassification of service
      Comments

      There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.

      Control0..*
      BindingThe codes SHOULD be taken from ServiceRequestCategoryCodes
      (preferred to http://hl7.org/fhir/ValueSet/servicerequest-category)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Used for filtering what service request are retrieved and displayed.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. ServiceRequest.priority
      Definition

      Indicates how quickly the ServiceRequest should be addressed with respect to other requests.

      Shortroutine | urgent | asap | stat
      Control0..1
      BindingThe codes SHALL be taken from RequestPriority
      (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

      Identifies the level of importance to be assigned to actioning the request.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Meaning if MissingIf missing, this task should be performed with normal priority
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. ServiceRequest.doNotPerform
      Definition

      Set this to true if the record is saying that the service/procedure should NOT be performed.

      ShortTrue if service/procedure should not be performed
      Comments

      In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

      Control0..1
      Typeboolean
      Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a procedure, it is a request for the procedure to not occur.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

      Meaning if MissingIf missing, the request is a positive request e.g. "do perform"
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. ServiceRequest.code
      Definition

      Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, use of the pan-Canadian LOINC Observation Code Database (pCLOCD) is preferred and can be found in the slice below.

      ShortWhat is being requested/ordered
      Comments

      Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.

      Control0..1
      BindingFor example codes, see ProcedureCodes(SNOMEDCT)
      (example to http://hl7.org/fhir/ValueSet/procedure-code)

      Codes for tests or services that can be carried out by a designated individual, organization or healthcare service. For laboratory, LOINC is preferred and a valueset using LOINC Order codes is available here.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Alternate Namesservice requested
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. ServiceRequest.code.id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      44. ServiceRequest.code.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on ServiceRequest.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 46. ServiceRequest.code.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control0..*
        TypeCoding
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on ServiceRequest.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ system
        • 48. ServiceRequest.code.coding:LabOrder
          Slice NameLabOrder
          Definition

          A code that identifies a laboratory procedure that have been requested

          ShortLaboratory procedure code
          Comments

          The binding strength of this element is Preferred, meaning that codes are encouraged to draw from the pCLOCD value set for interoperability purposes but are not required to do so to be considered conformant.

          Control0..*
          BindingThe codes SHOULD be taken from https://fhir.infoway-inforoute.ca/ValueSet/pCLOCD
          (preferred to https://fhir.infoway-inforoute.ca/ValueSet/pCLOCD)

          The pan-Canadian LOINC Observation Code Database (pCLOCD) is the Canadian version of the LOINC(tm) database. It was created using the LOINC(tm) records and attributes that were constrained for Canadian use and supplemented to specifically meet Canadian requirements. It contains the core LOINC(tm) attributes as required by Regenstrief copyright rules. The LOINC(tm) Component has been customized to meet Canadian requirements and is displayed as the pan Canadian Component Name. This component name is the basis for the pan Canadian Display Name. Core attributes are include both English and Canadian French.

          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. ServiceRequest.code.coding:LabOrder.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          52. ServiceRequest.code.coding:LabOrder.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on ServiceRequest.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 54. ServiceRequest.code.coding:LabOrder.system
            Definition

            The identification of the code system that defines the meaning of the symbol in the code.

            ShortIdentity of the terminology system
            Comments

            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

            Control1..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to be unambiguous about the source of the definition of the symbol.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. ServiceRequest.code.coding:LabOrder.version
            Definition

            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

            ShortVersion of the system - if relevant
            Comments

            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

            NoteThis is a business version Id, not a resource version Id (see discussion)
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. ServiceRequest.code.coding:LabOrder.code
            Definition

            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

            ShortSymbol in syntax defined by the system
            Control1..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. ServiceRequest.code.coding:LabOrder.display
            Definition

            A representation of the meaning of the code in the system, following the rules of the system.

            ShortRepresentation defined by the system
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. ServiceRequest.code.coding:LabOrder.userSelected
            Definition

            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

            ShortIf this coding was chosen directly by the user
            Comments

            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

            Control0..1
            Typeboolean
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            64. ServiceRequest.code.coding:@default
            Slice Name@default
            Definition

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

            Control0..*
            TypeCoding
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows for alternative encodings within a code system, and translations to other code systems.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. ServiceRequest.code.coding:@default.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            68. ServiceRequest.code.coding:@default.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on ServiceRequest.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 70. ServiceRequest.code.coding:@default.system
              Definition

              The identification of the code system that defines the meaning of the symbol in the code.

              ShortIdentity of the terminology system
              Comments

              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

              Control1..1
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to be unambiguous about the source of the definition of the symbol.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. ServiceRequest.code.coding:@default.version
              Definition

              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

              ShortVersion of the system - if relevant
              Comments

              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

              NoteThis is a business version Id, not a resource version Id (see discussion)
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. ServiceRequest.code.coding:@default.code
              Definition

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

              ShortSymbol in syntax defined by the system
              Control1..1
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to refer to a particular code in the system.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. ServiceRequest.code.coding:@default.display
              Definition

              A representation of the meaning of the code in the system, following the rules of the system.

              ShortRepresentation defined by the system
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              78. ServiceRequest.code.coding:@default.userSelected
              Definition

              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

              ShortIf this coding was chosen directly by the user
              Comments

              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

              Control0..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              80. ServiceRequest.code.text
              Definition

              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

              ShortPlain text representation of the concept
              Comments

              Very often the text is the same as a displayName of one of the codings.

              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              82. ServiceRequest.orderDetail
              Definition

              Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.

              ShortAdditional order information
              Comments

              For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

              Control0..*
              This element is affected by the following invariants: prr-1
              BindingFor example codes, see ServiceRequestOrderDetailsCodes
              (example to http://hl7.org/fhir/ValueSet/servicerequest-orderdetail)

              Codified order entry details which are based on order context.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Alternate Namesdetailed instructions
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              84. ServiceRequest.quantity[x]
              Definition

              An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).

              ShortService amount
              Control0..1
              TypeChoice of: Quantity, Ratio, Range
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summarytrue
              Requirements

              When ordering a service the number of service items may need to be specified separately from the the service item.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              86. ServiceRequest.subject
              Definition

              On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).

              ShortIndividual or Entity the service is ordered for
              Control1..1
              TypeReference(Patient Profile, Location Profile, Device Profile (Implantable))
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              88. ServiceRequest.encounter
              Definition

              An encounter that provides additional information about the healthcare context in which this request is made.

              ShortEncounter in which the request was created
              Control0..1
              TypeReference(Encounter Profile)
              Is Modifierfalse
              Summarytrue
              Alternate Namescontext
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              90. ServiceRequest.occurrence[x]
              Definition

              The date/time at which the requested service should occur.

              ShortWhen service should occur
              Control0..1
              TypeChoice of: dateTime, Period, Timing
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Alternate Namesschedule
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              92. ServiceRequest.asNeeded[x]
              Definition

              If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.

              ShortPreconditions for service
              Control0..1
              BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
              (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

              A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

              TypeChoice of: boolean, CodeableConcept
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              94. ServiceRequest.authoredOn
              Definition

              When the request transitioned to being actionable.

              ShortDate request signed
              Control0..1
              TypedateTime
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Alternate NamesorderedOn
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              96. ServiceRequest.requester
              Definition

              The individual who initiated the request and has responsibility for its activation.

              ShortWho/what is requesting service
              Comments

              This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.

              Control1..1
              TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable))
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Alternate Namesauthor, orderer
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              98. ServiceRequest.performerType
              Definition

              Desired type of performer for doing the requested service.

              ShortPerformer role
              Comments

              This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.

              Control0..1
              BindingFor example codes, see ParticipantRoles
              (example to http://hl7.org/fhir/ValueSet/participant-role)

              Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Alternate Namesspecialty
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              100. ServiceRequest.performer
              Definition

              The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.

              ShortRequested performer
              Comments

              If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).

              Control0..*
              TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable))
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Alternate Namesrequest recipient
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              102. ServiceRequest.locationCode
              Definition

              The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.

              ShortRequested location
              Control0..*
              BindingFor example codes, see ServiceDeliveryLocationRoleType
              (example to http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType)

              A location type where services are delivered.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              104. ServiceRequest.locationReference
              Definition

              A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.

              ShortRequested location
              Control0..*
              TypeReference(Location Profile)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              106. ServiceRequest.reasonCode
              Definition

              An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

              ShortExplanation/Justification for procedure or service
              Comments

              This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

              Control0..*
              BindingThe codes SHOULD be taken from ProcedureReasonCodes
              (preferred to http://hl7.org/fhir/ValueSet/procedure-reason)
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              108. ServiceRequest.reasonReference
              Definition

              Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.

              ShortExplanation/Justification for service or service
              Comments

              This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

              Control0..*
              TypeReference(Condition Profile, Observation Profile (General Use), DiagnosticReport Profile for Results Reporting, DocumentReference Profile for metadata about the document)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              110. ServiceRequest.insurance
              Definition

              Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.

              ShortAssociated insurance coverage
              Control0..*
              TypeReference(Coverage, ClaimResponse)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              112. ServiceRequest.supportingInfo
              Definition

              Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.

              ShortAdditional clinical information
              Comments

              To represent information about how the services are to be delivered use the instructions element.

              Control0..*
              TypeReference(Resource)
              Is Modifierfalse
              Summaryfalse
              Alternate NamesAsk at order entry question, AOE
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              114. ServiceRequest.specimen
              Definition

              One or more specimens that the laboratory procedure will use.

              ShortProcedure Samples
              Comments

              Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.

              Control0..*
              TypeReference(Specimen)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              116. ServiceRequest.bodySite
              Definition

              Anatomic location where the procedure should be performed. This is the target site.

              ShortLocation on Body
              Comments

              Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure.

              Control0..*
              BindingFor example codes, see SNOMEDCTBodyStructures
              (example to http://hl7.org/fhir/ValueSet/body-site)

              Codes describing anatomical locations. May include laterality.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              Knowing where the procedure is performed is important for tracking if multiple sites are possible.

              Alternate Nameslocation
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              118. ServiceRequest.note
              Definition

              Any other notes and comments made about the service request. For example, internal billing notes.

              ShortComments
              Control0..*
              TypeAnnotation
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              120. ServiceRequest.patientInstruction
              Definition

              Instructions in terms that are understood by the patient or consumer.

              ShortPatient or consumer-oriented instructions
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              122. ServiceRequest.relevantHistory
              Definition

              Key events in the history of the request.

              ShortRequest provenance
              Comments

              This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.

              Control0..*
              TypeReference(Provenance)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))