Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for a specific procedure or test request, such as an electrocardiogram (ECG) order or a referral to a support program.
• Query for a specific service offered to a patient, such as a referral to a support program.
• Query for a category of service request (e.g., all cardiology requests)

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Service Request Must Have:

1. a status
2. an intent code indicating whether the request is a proposal, plan, or order.
3. a code defining what is being requested
4. a patient

Each Service Request Must Support:

1. a category
2. the encounter in which the request was created
3. when requested service should happen
4. when the request was made
5. the requester

Additional USCDI Requirements:

This Additional USCDI Requirements element is not Mandatory or Must Support but is required for ONC Health IT certification testing and is included in the formal definition of the profile and the ServiceRequest examples.

1. a reason or indication for referral or consultation*

*see guidance below

Profile Specific Implementation Guidance:

• For more information on exchanging Social Determinants of Health (SDOH) service requests, See the Screening and Assessments guidance page.

• The Must Support ServiceRequest.category is bound, at a minimum, to the US Core ServiceRequest Category Codes, and other category codes can be used. API consumers can query by category when accessing patient information. For the USCDI Laboratory Order, Imaging Order, Clinical Test Order, and Procedure Order Data Elements, implementers SHOULD use the corresponding category codes listed in the table below. For example, laboratory orders would have the category code "108252007" (Laboratory procedure).

  USCDI Order Data Element	Category Codes
  Laboratory Order	108252007 Laboratory procedure (procedure)
  Imaging Order	363679005 Imaging (procedure)
  Clinical Test Order	386053000 Evaluation procedure (procedure), 410606002 Social service procedure (procedure), or 387713003 Surgical procedure (procedure)
  Procedure Order	386053000 Evaluation procedure (procedure), 410606002 Social service procedure (procedure), or 387713003 Surgical procedure (procedure)

• The ServiceRequest.code value set is broad to accommodate a wide variety of use cases and SHOULD be constrained to a subset for a particular use case or domain. These value sets contain concepts that span many use cases and are not bound to any USCDI Data Element. However, the table below identifies additional value set bindings for the USCDI Laboratory Order, Imaging Order and Clinical Test Order Data Elements. Implementers SHOULD conform to the binding strengths listed for each USCDI Order context. For example, laboratory orders are [extensibly] bound to the LOINC Common Laboratory Orders Value Set. Note that the USCDI Class Procedure Order Data Element has no additional binding.

  USCDI Order Data Element	Additional Binding	Binding Strength	Comments
  Laboratory Order	LOINC Common Laboratory Orders Value Set	extensible	The LOINC Common Laboratory Orders Value Set is a ‘starter set’ for mapping commonly used laboratory orders. It does not attempt to include all possible laboratory order codes. For additional information on LOINC Common Laboratory Orders Value Set, refer to www.loinc.org/usage/orders.
  Imaging Order	LOINC Radiology Codes	preferred	The LOINC Radiology Codes include all imaging codes minus concepts that are deprecated or discouraged.
  Clinical Test Order	LOINC Clinical Test Codes	example	LOINC Clinical Test Codes include non-laboratory and non-imaging clinical test codes that represent clinical tests.

• *Servers and Clients SHALL support both US Core ServiceRequest and US Core Procedure Profiles for communicating the reason or justification for a referral as Additional USCDI Requirements. Typically, the reason or justification for a referral or consultation is communicated through Procedure.basedOn linking the Procedure to the US Core ServiceRequest Profile that includes either ServiceRequest.reasonCode or ServiceRequest.reasonReference. When the Procedure does not have an associated ServiceRequest, it is communicated through the US Core Procedure Profile's Procedure.reasonCode or Procedure.reasonReference. Depending on the procedure being documented, a Server will select the appropriate Profile to use.
  • Although both ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but SHALL support at least one of these elements. The certifying Client application SHALL support both elements.
    • when using ServiceRequest.reasonReference:
      • Servers SHALL support at least one target resource in ServiceRequest.reasonReference. Clients SHALL support all target resources.
      • The referenced resources SHOULD be a US Core Profile as documented in Referencing US Core Profiles.

Changes since version 7.0.0:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• See the Scopes Format section for a description of the SMART scopes syntax.
• See the Search Syntax section for a description of the US Core search syntax.
• See the General Requirements section for additional rules and expectations when a Server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

US Core Scopes

Servers providing access to order and referral data SHALL support these US Core SMART Scopes:

• resource level scopes: <patient|user|system>/ServiceRequest.rs

Servers providing access to order and referral data MAY support these US Core SMART Scopes:

• granular scopes: <patient|user|system>/ServiceRequest.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|sdoh

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching for all servicerequests for a patient using the patient search parameter:

   GET [base]/ServiceRequest?patient={Type/}[id]

   Example:

   1. GET [base]/ServiceRequest?patient=1137192

   Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient (how to search by reference)

2. SHALL support both read ServiceRequest by id AND ServiceRequest search using the _id search parameter:

   GET [base]/ServiceRequest/[id] or GET [base]/ServiceRequest?_id=[id]

   Example:

   1. GET [base]/ServiceRequest/1032702
   2. GET [base]/ServiceRequest?_id=1032702

   Implementation Notes: (how to search by the logical id of the resource)

3. SHALL support searching using the combination of the patient and category search parameters:

   GET [base]/ServiceRequest?patient={Type/}[id]&category={system|}[code]

   Example:

   1. GET [base]/ServiceRequest?patient=f201&category=http://loinc.org|LG41762-2

   Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and a category code (how to search by reference and how to search by token)

4. SHALL support searching using the combination of the patient and code search parameters:
   • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

   GET [base]/ServiceRequest?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/ServiceRequest?patient=1032702&code=http://snomed.info/sct|35637008

   Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and report code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token)

5. SHALL support searching using the combination of the patient and category and authored search parameters:
   • including support for these authored comparators: gt,lt,ge,le
   • including optional support for AND search on authored (e.g.authored=[date]&authored=[date]]&...)

   GET [base]/ServiceRequest?patient={Type/}[id]&category={system|}[code]&authored={gt|lt|ge|le}[date]{&authored={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/ServiceRequest?patient=f201&category=http://loinc.org|LG41762-2&date=ge2010-01-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and date and a category code (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and status search parameters:
   • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

   GET [base]/ServiceRequest?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/ServiceRequest?patient=1137192&status=completed

   Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and status (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the patient and code and authored search parameters:
   • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
   • including support for these authored comparators: gt,lt,ge,le
   • including optional support for AND search on authored (e.g.authored=[date]&authored=[date]]&...)

   GET [base]/ServiceRequest?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&authored={gt|lt|ge|le}[date]{&authored={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/ServiceRequest?patient=f201&code=http://snomed.info/sct|35637008&date=ge2019-01-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all ServiceRequest resources for the specified patient and date and service code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token and how to search by date)