Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-snapshot - STU 2.2 - Public Review United States of America flag

Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-snapshot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

Resource Profile: PAS CommunicationRequest - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 4

Definitions for the profile-communicationrequest resource profile

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

0. CommunicationRequest
Definition

A request to convey information; e.g. the CDS system proposes that an alert be sent to a responsible provider, the CDS system proposes that the public health agency be notified about a reportable condition.

ShortA request for information to be sent to a receiver
Control0..*
Is Modifierfalse
Summaryfalse
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())
IdentifierUnlessVO: CommunicationRequest.identifier is required unless CommunicationRequest.medium is 'VO'. ($this.medium.coding.where(code='VO').count() = 0 implies $this.identifier.count() > 0)
2. CommunicationRequest.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. CommunicationRequest.extension
Definition

An Extension


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.

ShortExtensionAdditional 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 CommunicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. CommunicationRequest.extension:serviceLineNumber
    Slice NameserviceLineNumber
    Definition

    A number that links the content being requested with the claim item number.

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(ServiceLineNumber) (Extension Type: positiveInt)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. CommunicationRequest.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())
    10. CommunicationRequest.identifier
    Definition

    Business identifiers assigned to this communication request by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

    ShortUnique Identifier used in linking the Communication Request to the response (X12's Attachment Control Number).Unique identifier
    Comments

    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.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..1*
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Allows identification of the communication request as it is known by various participating systems and in a way that remains consistent across servers.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. CommunicationRequest.status
    Definition

    The status of the proposal or order.

    Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
    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 the communication request.

    Typecode
    Is Modifiertrue because This element is labelled 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
    Summarytrue
    Fixed Valueactive
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. CommunicationRequest.category
    Definition

    The type of message to be sent such as alert, notification, reminder, instruction, etc.

    ShortMessage category
    Comments

    There may be multiple axes of categorization and one communication request may serve multiple purposes.

    Control0..1*
    BindingThe codes SHALL be taken from For example codes, see https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755http://hl7.org/fhir/ValueSet/communication-category|4.0.1
    (required to https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755)

    Codes indicating the title or contents of a document, report or supporting item. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


    Codes for general categories of communications such as alerts, instruction, etc.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. CommunicationRequest.doNotPerform
    Definition

    If true indicates that the CommunicationRequest is asking for the specified action to not occur.

    ShortTrue if request is prohibiting action
    Comments

    The attributes provided with the request qualify what is not to be done.

    Control0..1
    Typeboolean
    Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a communication, it is a request for the communication to not occur.
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Alternate Namesprohibited
    Meaning if MissingIf do not perform is not specified, 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()))
    18. CommunicationRequest.medium
    Definition

    A channel that was used for this communication (e.g. email, fax).

    ShortA channel of communication
    Control0..1*
    BindingUnless not suitable, these codes SHALL be taken from For example codes, see PASCommunicationRequestMedium (2.2.0-snapshot)http://terminology.hl7.org/ValueSet/v3-ParticipationMode
    (extensible to http://hl7.org/fhir/us/davinci-pas/ValueSet/PASCommunicationRequestMedium|2.2.0-snapshot)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. CommunicationRequest.payload
    Definition

    Text, attachment(s), or resource(s) to be communicated to the recipient.

    ShortMessage payload
    Control0..1*
    TypeBackboneElement
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. CommunicationRequest.payload.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional 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 CommunicationRequest.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 24. CommunicationRequest.payload.extension:communicatedDiagnosis
      Slice NamecommunicatedDiagnosis
      Definition

      A code representing the diagnosis that is the subject of the communication

      ShortExtension
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(CommunicatedDiagnosis) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      26. CommunicationRequest.payload.extension:contentModifier
      Slice NamecontentModifier
      Definition

      A code representing a modifier of the content being requested

      ShortExtension
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(ContentModifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      28. CommunicationRequest.payload.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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 even if unrecognized
      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 element that contains them
      Summarytrue
      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, modifiers
      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())
      30. CommunicationRequest.payload.content[x]
      Definition

      The communicated content (or for multi-part communications, one portion of the communication).

      ShortMessage part content
      Control1..1
      BindingThe codes SHALL be taken from For codes, see LOINC valid-hl7-attachment-requests
      (required to http://loinc.org/vs/valid-hl7-attachment-requests)
      Typestring, Reference(Resource), Attachment
      [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
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. CommunicationRequest.requester
      Definition

      The device, individual, or organization who initiated the request and has responsibility for its activation.

      ShortWho/what is requesting service
      Control0..1
      TypeReference(PAS Insurer Organization, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate Namesauthor
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. CommunicationRequest.recipient
      Definition

      The entity (e.g. person, organization, clinical information system, device, group, or care team) which is the intended target of the communication.

      ShortMessage recipient
      Control0..*
      TypeReference(PAS Practitioner, PAS Organization Base Profile, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, Group, CareTeam, HealthcareService)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. CommunicationRequest.sender
      Definition

      The entity (e.g. person, organization, clinical information system, or device) which is to be the source of the communication.

      ShortMessage sender
      Control0..1
      TypeReference(PAS Requestor Organization, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, HealthcareService)
      Is Modifierfalse
      Must Supporttrue
      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 foundhere

      0. CommunicationRequest
      InvariantsIdentifierUnlessVO: CommunicationRequest.identifier is required unless CommunicationRequest.medium is 'VO'. ($this.medium.coding.where(code='VO').count() = 0 implies $this.identifier.count() > 0)
      2. CommunicationRequest.extension
      SlicingThis element introduces a set of slices on CommunicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 4. CommunicationRequest.extension:serviceLineNumber
        Slice NameserviceLineNumber
        Control0..1
        TypeExtension(ServiceLineNumber) (Extension Type: positiveInt)
        Must Supporttrue
        6. CommunicationRequest.identifier
        ShortUnique Identifier used in linking the Communication Request to the response (X12's Attachment Control Number).
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..1
        Must Supporttrue
        8. CommunicationRequest.status
        Fixed Valueactive
        10. CommunicationRequest.category
        Control0..1
        BindingThe codes SHALL be taken from https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755
        (required to https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755)

        Codes indicating the title or contents of a document, report or supporting item. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

        Must Supporttrue
        12. CommunicationRequest.medium
        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from PASCommunicationRequestMedium (2.2.0-snapshot)
        (extensible to http://hl7.org/fhir/us/davinci-pas/ValueSet/PASCommunicationRequestMedium|2.2.0-snapshot)
        Must Supporttrue
        14. CommunicationRequest.payload
        Control0..1
        Must Supporttrue
        16. CommunicationRequest.payload.extension
        SlicingThis element introduces a set of slices on CommunicationRequest.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 18. CommunicationRequest.payload.extension:communicatedDiagnosis
          Slice NamecommunicatedDiagnosis
          Control0..*
          TypeExtension(CommunicatedDiagnosis) (Extension Type: CodeableConcept)
          Must Supporttrue
          20. CommunicationRequest.payload.extension:contentModifier
          Slice NamecontentModifier
          Control0..*
          TypeExtension(ContentModifier) (Extension Type: CodeableConcept)
          Must Supporttrue
          22. CommunicationRequest.payload.content[x]
          BindingThe codes SHALL be taken from LOINC valid-hl7-attachment-requests
          (required to http://loinc.org/vs/valid-hl7-attachment-requests)
          Typestring, Reference(Resource), Attachment
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          24. CommunicationRequest.requester
          TypeReference(PAS Insurer Organization)
          Must Supporttrue
          26. CommunicationRequest.recipient
          TypeReference(PAS Practitioner, PAS Organization Base Profile)
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          28. CommunicationRequest.sender
          TypeReference(PAS Requestor Organization)
          Must Supporttrue

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

          0. CommunicationRequest
          Definition

          A request to convey information; e.g. the CDS system proposes that an alert be sent to a responsible provider, the CDS system proposes that the public health agency be notified about a reportable condition.

          ShortA request for information to be sent to a receiver
          Control0..*
          Is Modifierfalse
          Summaryfalse
          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())
          IdentifierUnlessVO: CommunicationRequest.identifier is required unless CommunicationRequest.medium is 'VO'. ($this.medium.coding.where(code='VO').count() = 0 implies $this.identifier.count() > 0)
          2. CommunicationRequest.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. CommunicationRequest.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. CommunicationRequest.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. CommunicationRequest.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|4.0.1)

          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. CommunicationRequest.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. CommunicationRequest.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. CommunicationRequest.extension
          Definition

          An Extension

          ShortExtension
          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          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 CommunicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. CommunicationRequest.extension:serviceLineNumber
            Slice NameserviceLineNumber
            Definition

            A number that links the content being requested with the claim item number.

            ShortExtension
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(ServiceLineNumber) (Extension Type: positiveInt)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            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. CommunicationRequest.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())
            20. CommunicationRequest.identifier
            Definition

            Business identifiers assigned to this communication request by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

            ShortUnique Identifier used in linking the Communication Request to the response (X12's Attachment Control Number).
            Comments

            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.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1
            TypeIdentifier
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Allows identification of the communication request as it is known by various participating systems and in a way that remains consistent across servers.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. CommunicationRequest.basedOn
            Definition

            A plan or proposal that is fulfilled in whole or in part by this request.

            ShortFulfills plan or proposal
            Control0..*
            TypeReference(Resource)
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows tracing of authorization for the request and tracking whether proposals/recommendations were acted upon.

            Alternate Namesfulfills
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. CommunicationRequest.replaces
            Definition

            Completed or terminated request(s) whose function is taken by this new request.

            ShortRequest(s) replaced by this request
            Comments

            The replacement could be because the initial request was immediately rejected (due to an issue) or because the previous request was completed, but the need for the action described by the request remains ongoing.

            Control0..*
            TypeReference(CommunicationRequest)
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows tracing the continuation of a therapy or administrative process instantiated through multiple requests.

            Alternate Namessupersedes, prior
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. CommunicationRequest.groupIdentifier
            Definition

            A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition, prescription or similar form.

            ShortComposite request this is part of
            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
            Summarytrue
            Alternate NamesgrouperId
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. CommunicationRequest.status
            Definition

            The status of the proposal or order.

            Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
            Control1..1
            BindingThe codes SHALL be taken from RequestStatus
            (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

            The status of the communication request.

            Typecode
            Is Modifiertrue because This element is labelled 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
            Summarytrue
            Fixed Valueactive
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. CommunicationRequest.statusReason
            Definition

            Captures the reason for the current state of the CommunicationRequest.

            ShortReason for current status
            Comments

            This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the CommunicationRequest was created at all is captured in reasonCode, not here. [distinct reason codes for different statuses can be enforced using invariants if they are universal bindings].

            Control0..1
            Binding

            Codes identifying the reason for the current state of a request.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Alternate NamesSuspended Reason, Cancelled Reason
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. CommunicationRequest.category
            Definition

            The type of message to be sent such as alert, notification, reminder, instruction, etc.

            ShortMessage category
            Comments

            There may be multiple axes of categorization and one communication request may serve multiple purposes.

            Control0..1
            BindingThe codes SHALL be taken from https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755
            (required to https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755)

            Codes indicating the title or contents of a document, report or supporting item. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. CommunicationRequest.priority
            Definition

            Characterizes how quickly the proposed act must be initiated. Includes concepts such as stat, urgent, routine.

            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)

            Codes indicating the relative importance of a communication 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()))
            36. CommunicationRequest.doNotPerform
            Definition

            If true indicates that the CommunicationRequest is asking for the specified action to not occur.

            ShortTrue if request is prohibiting action
            Comments

            The attributes provided with the request qualify what is not to be done.

            Control0..1
            Typeboolean
            Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a communication, it is a request for the communication to not occur.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Alternate Namesprohibited
            Meaning if MissingIf do not perform is not specified, 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()))
            38. CommunicationRequest.medium
            Definition

            A channel that was used for this communication (e.g. email, fax).

            ShortA channel of communication
            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from PASCommunicationRequestMedium (2.2.0-snapshot)
            (extensible to http://hl7.org/fhir/us/davinci-pas/ValueSet/PASCommunicationRequestMedium|2.2.0-snapshot)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. CommunicationRequest.subject
            Definition

            The patient or group that is the focus of this communication request.

            ShortFocus of message
            Control0..1
            TypeReference(Patient, Group)
            Is Modifierfalse
            Summaryfalse
            Alternate Namespatient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. CommunicationRequest.about
            Definition

            Other resources that pertain to this communication request and to which this communication request should be associated.

            ShortResources that pertain to this communication request
            Comments

            Don't use CommunicationRequest.about element when a more specific element exists, such as basedOn, reasonReference, or replaces.

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

            The Encounter during which this CommunicationRequest was created or to which the creation of this record is tightly associated.

            ShortEncounter created as part of
            Comments

            This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

            Control0..1
            TypeReference(Encounter)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. CommunicationRequest.payload
            Definition

            Text, attachment(s), or resource(s) to be communicated to the recipient.

            ShortMessage payload
            Control0..1
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. CommunicationRequest.payload.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
            50. CommunicationRequest.payload.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            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 CommunicationRequest.payload.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 52. CommunicationRequest.payload.extension:communicatedDiagnosis
              Slice NamecommunicatedDiagnosis
              Definition

              A code representing the diagnosis that is the subject of the communication

              ShortExtension
              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(CommunicatedDiagnosis) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              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())
              54. CommunicationRequest.payload.extension:contentModifier
              Slice NamecontentModifier
              Definition

              A code representing a modifier of the content being requested

              ShortExtension
              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(ContentModifier) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              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())
              56. CommunicationRequest.payload.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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 even if unrecognized
              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 element that contains them
              Summarytrue
              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, modifiers
              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())
              58. CommunicationRequest.payload.content[x]
              Definition

              The communicated content (or for multi-part communications, one portion of the communication).

              ShortMessage part content
              Control1..1
              BindingThe codes SHALL be taken from LOINC valid-hl7-attachment-requests
              (required to http://loinc.org/vs/valid-hl7-attachment-requests)
              Typestring
              [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
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              60. CommunicationRequest.occurrence[x]
              Definition

              The time when this communication is to occur.

              ShortWhen scheduled
              Control0..1
              TypeChoice of: dateTime, Period
              [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 Namestiming
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              62. CommunicationRequest.authoredOn
              Definition

              For draft requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation.

              ShortWhen request transitioned to being actionable
              Control0..1
              TypedateTime
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Alternate NamescreatedOn
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. CommunicationRequest.requester
              Definition

              The device, individual, or organization who initiated the request and has responsibility for its activation.

              ShortWho/what is requesting service
              Control0..1
              TypeReference(PAS Insurer Organization)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Alternate Namesauthor
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. CommunicationRequest.recipient
              Definition

              The entity (e.g. person, organization, clinical information system, device, group, or care team) which is the intended target of the communication.

              ShortMessage recipient
              Control0..*
              TypeReference(PAS Practitioner, PAS Organization Base Profile)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. CommunicationRequest.sender
              Definition

              The entity (e.g. person, organization, clinical information system, or device) which is to be the source of the communication.

              ShortMessage sender
              Control0..1
              TypeReference(PAS Requestor Organization)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              70. CommunicationRequest.reasonCode
              Definition

              Describes why the request is being made in coded or textual form.

              ShortWhy is communication needed?
              Comments

              Textual reasons can be captured using reasonCode.text.

              Control0..*
              BindingFor example codes, see ActReason (3.0.0)
              (example to http://terminology.hl7.org/ValueSet/v3-ActReason|3.0.0)

              Codes for describing reasons for the occurrence of a communication.

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

              Indicates another resource whose existence justifies this request.

              ShortWhy is communication needed?
              Control0..*
              TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. CommunicationRequest.note
              Definition

              Comments made about the request by the requester, sender, recipient, subject or other participants.

              ShortComments made about communication request
              Control0..*
              TypeAnnotation
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))