Patient Cost Transparency Implementation Guide
2.0.0-draft - STU 2 - Draft  flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-draft built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

Resource Profile: PCT GFE ServiceRequest

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-servicerequest Version: 2.0.0-draft
Standards status: Trial-use Maturity Level: 2 Computable Name: PCTServiceRequest
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.23

The PCT ServiceRequest including details about a service for which a GFE is being requested.

Usage:

Changes since version 1.1.0:

  • New Content
  • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    prr-1: orderDetail SHALL only be present if code is present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): The status of a service order.


    ele-1: All FHIR elements must have a @value or children
    Required Pattern: active
    ... intent ?!Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: RequestIntent (required): The kind of service request.


    ele-1: All FHIR elements must have a @value or children
    Required Pattern: proposal
    ... code SΣ 1..1 CodeableConcept What is being requested/ordered
    Binding: Claim Medical Product or Service Value Set (extensible)
    ele-1: All FHIR elements must have a @value or children
    ... quantity[x] SΣ 0..1 Service amount
    ele-1: All FHIR elements must have a @value or children
    .... quantityQuantity Quantity
    .... quantityRatio Ratio
    .... quantityRange Range
    ... subject Σ 1..1 Reference(HRex Patient Demographics) Individual or Entity the service is ordered for
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    ServiceRequest.statusrequiredPattern: active
    http://hl7.org/fhir/ValueSet/request-status|4.0.1
    from the FHIR Standard
    ServiceRequest.intentrequiredPattern: proposal
    http://hl7.org/fhir/ValueSet/request-intent|4.0.1
    from the FHIR Standard
    ServiceRequest.codeextensibleUSClaimMedicalProductOrServiceCodes
    http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
    from this IG

    This structure is derived from ServiceRequest

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. ServiceRequest ServiceRequest
    ... status 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Required Pattern: active
    ... intent 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
    Required Pattern: proposal
    ... doNotPerform 0..0
    ... code S 1..1 CodeableConcept What is being requested/ordered
    Binding: Claim Medical Product or Service Value Set (extensible)
    ... quantity[x] S 0..1 Quantity, Ratio, Range Service amount
    ... subject 1..1 Reference(HRex Patient Demographics) Individual or Entity the service is ordered for

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    ServiceRequest.codeextensibleUSClaimMedicalProductOrServiceCodes
    http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
    from this IG
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
    prr-1: orderDetail SHALL only be present if code is present
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Identifiers assigned to this order
    ... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition
    ... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
    ... basedOn Σ 0..* Reference(CarePlan | ServiceRequest | MedicationRequest) What request fulfills
    ... replaces Σ 0..* Reference(ServiceRequest) What request replaces
    ... requisition Σ 0..1 Identifier Composite Request ID
    ... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): The status of a service order.


    Required Pattern: active
    ... intent ?!Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: RequestIntent (required): The kind of service request.


    Required Pattern: proposal
    ... category Σ 0..* CodeableConcept Classification of service
    Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


    ... priority Σ 0..1 code routine | urgent | asap | stat
    Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

    ... code SΣ 1..1 CodeableConcept What is being requested/ordered
    Binding: Claim Medical Product or Service Value Set (extensible)
    ... orderDetail ΣC 0..* CodeableConcept Additional order information
    Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


    ... quantity[x] SΣ 0..1 Service amount
    .... quantityQuantity Quantity
    .... quantityRatio Ratio
    .... quantityRange Range
    ... subject Σ 1..1 Reference(HRex Patient Demographics) Individual or Entity the service is ordered for
    ... encounter Σ 0..1 Reference(Encounter) Encounter in which the request was created
    ... occurrence[x] Σ 0..1 When service should occur
    .... occurrenceDateTime dateTime
    .... occurrencePeriod Period
    .... occurrenceTiming Timing
    ... asNeeded[x] Σ 0..1 Preconditions for service
    Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

    .... asNeededBoolean boolean
    .... asNeededCodeableConcept CodeableConcept
    ... authoredOn Σ 0..1 dateTime Date request signed
    ... requester Σ 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Who/what is requesting service
    ... performerType Σ 0..1 CodeableConcept Performer role
    Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

    ... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Requested performer
    ... locationCode Σ 0..* CodeableConcept Requested location
    Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


    ... locationReference Σ 0..* Reference(Location) Requested location
    ... reasonCode Σ 0..* CodeableConcept Explanation/Justification for procedure or service
    Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


    ... reasonReference Σ 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Explanation/Justification for service or service
    ... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
    ... supportingInfo 0..* Reference(Resource) Additional clinical information
    ... specimen Σ 0..* Reference(Specimen) Procedure Samples
    ... bodySite Σ 0..* CodeableConcept Location on Body
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


    ... note 0..* Annotation Comments
    ... patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
    ... relevantHistory 0..* Reference(Provenance) Request provenance

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    ServiceRequest.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    ServiceRequest.statusrequiredPattern: active
    http://hl7.org/fhir/ValueSet/request-status|4.0.1
    from the FHIR Standard
    ServiceRequest.intentrequiredPattern: proposal
    http://hl7.org/fhir/ValueSet/request-intent|4.0.1
    from the FHIR Standard
    ServiceRequest.categoryexampleServiceRequestCategoryCodes
    http://hl7.org/fhir/ValueSet/servicerequest-category
    from the FHIR Standard
    ServiceRequest.priorityrequiredRequestPriority
    http://hl7.org/fhir/ValueSet/request-priority|4.0.1
    from the FHIR Standard
    ServiceRequest.codeextensibleUSClaimMedicalProductOrServiceCodes
    http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
    from this IG
    ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
    http://hl7.org/fhir/ValueSet/servicerequest-orderdetail
    from the FHIR Standard
    ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
    http://hl7.org/fhir/ValueSet/medication-as-needed-reason
    from the FHIR Standard
    ServiceRequest.performerTypeexampleParticipantRoles
    http://hl7.org/fhir/ValueSet/participant-role
    from the FHIR Standard
    ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
    http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
    ServiceRequest.reasonCodeexampleProcedureReasonCodes
    http://hl7.org/fhir/ValueSet/procedure-reason
    from the FHIR Standard
    ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard

    This structure is derived from ServiceRequest

    Summary

    Mandatory: 1 element
    Must-Support: 2 elements
    Prohibited: 1 element

    Structures

    This structure refers to these other structures:

    Maturity: 2

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    prr-1: orderDetail SHALL only be present if code is present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): The status of a service order.


    ele-1: All FHIR elements must have a @value or children
    Required Pattern: active
    ... intent ?!Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: RequestIntent (required): The kind of service request.


    ele-1: All FHIR elements must have a @value or children
    Required Pattern: proposal
    ... code SΣ 1..1 CodeableConcept What is being requested/ordered
    Binding: Claim Medical Product or Service Value Set (extensible)
    ele-1: All FHIR elements must have a @value or children
    ... quantity[x] SΣ 0..1 Service amount
    ele-1: All FHIR elements must have a @value or children
    .... quantityQuantity Quantity
    .... quantityRatio Ratio
    .... quantityRange Range
    ... subject Σ 1..1 Reference(HRex Patient Demographics) Individual or Entity the service is ordered for
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    ServiceRequest.statusrequiredPattern: active
    http://hl7.org/fhir/ValueSet/request-status|4.0.1
    from the FHIR Standard
    ServiceRequest.intentrequiredPattern: proposal
    http://hl7.org/fhir/ValueSet/request-intent|4.0.1
    from the FHIR Standard
    ServiceRequest.codeextensibleUSClaimMedicalProductOrServiceCodes
    http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
    from this IG

    Differential View

    This structure is derived from ServiceRequest

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. ServiceRequest ServiceRequest
    ... status 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Required Pattern: active
    ... intent 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
    Required Pattern: proposal
    ... doNotPerform 0..0
    ... code S 1..1 CodeableConcept What is being requested/ordered
    Binding: Claim Medical Product or Service Value Set (extensible)
    ... quantity[x] S 0..1 Quantity, Ratio, Range Service amount
    ... subject 1..1 Reference(HRex Patient Demographics) Individual or Entity the service is ordered for

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    ServiceRequest.codeextensibleUSClaimMedicalProductOrServiceCodes
    http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
    from this IG

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
    prr-1: orderDetail SHALL only be present if code is present
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Identifiers assigned to this order
    ... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition
    ... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
    ... basedOn Σ 0..* Reference(CarePlan | ServiceRequest | MedicationRequest) What request fulfills
    ... replaces Σ 0..* Reference(ServiceRequest) What request replaces
    ... requisition Σ 0..1 Identifier Composite Request ID
    ... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): The status of a service order.


    Required Pattern: active
    ... intent ?!Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: RequestIntent (required): The kind of service request.


    Required Pattern: proposal
    ... category Σ 0..* CodeableConcept Classification of service
    Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


    ... priority Σ 0..1 code routine | urgent | asap | stat
    Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

    ... code SΣ 1..1 CodeableConcept What is being requested/ordered
    Binding: Claim Medical Product or Service Value Set (extensible)
    ... orderDetail ΣC 0..* CodeableConcept Additional order information
    Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


    ... quantity[x] SΣ 0..1 Service amount
    .... quantityQuantity Quantity
    .... quantityRatio Ratio
    .... quantityRange Range
    ... subject Σ 1..1 Reference(HRex Patient Demographics) Individual or Entity the service is ordered for
    ... encounter Σ 0..1 Reference(Encounter) Encounter in which the request was created
    ... occurrence[x] Σ 0..1 When service should occur
    .... occurrenceDateTime dateTime
    .... occurrencePeriod Period
    .... occurrenceTiming Timing
    ... asNeeded[x] Σ 0..1 Preconditions for service
    Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

    .... asNeededBoolean boolean
    .... asNeededCodeableConcept CodeableConcept
    ... authoredOn Σ 0..1 dateTime Date request signed
    ... requester Σ 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Who/what is requesting service
    ... performerType Σ 0..1 CodeableConcept Performer role
    Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

    ... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Requested performer
    ... locationCode Σ 0..* CodeableConcept Requested location
    Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


    ... locationReference Σ 0..* Reference(Location) Requested location
    ... reasonCode Σ 0..* CodeableConcept Explanation/Justification for procedure or service
    Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


    ... reasonReference Σ 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Explanation/Justification for service or service
    ... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
    ... supportingInfo 0..* Reference(Resource) Additional clinical information
    ... specimen Σ 0..* Reference(Specimen) Procedure Samples
    ... bodySite Σ 0..* CodeableConcept Location on Body
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


    ... note 0..* Annotation Comments
    ... patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
    ... relevantHistory 0..* Reference(Provenance) Request provenance

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    ServiceRequest.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    ServiceRequest.statusrequiredPattern: active
    http://hl7.org/fhir/ValueSet/request-status|4.0.1
    from the FHIR Standard
    ServiceRequest.intentrequiredPattern: proposal
    http://hl7.org/fhir/ValueSet/request-intent|4.0.1
    from the FHIR Standard
    ServiceRequest.categoryexampleServiceRequestCategoryCodes
    http://hl7.org/fhir/ValueSet/servicerequest-category
    from the FHIR Standard
    ServiceRequest.priorityrequiredRequestPriority
    http://hl7.org/fhir/ValueSet/request-priority|4.0.1
    from the FHIR Standard
    ServiceRequest.codeextensibleUSClaimMedicalProductOrServiceCodes
    http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
    from this IG
    ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
    http://hl7.org/fhir/ValueSet/servicerequest-orderdetail
    from the FHIR Standard
    ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
    http://hl7.org/fhir/ValueSet/medication-as-needed-reason
    from the FHIR Standard
    ServiceRequest.performerTypeexampleParticipantRoles
    http://hl7.org/fhir/ValueSet/participant-role
    from the FHIR Standard
    ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
    http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
    ServiceRequest.reasonCodeexampleProcedureReasonCodes
    http://hl7.org/fhir/ValueSet/procedure-reason
    from the FHIR Standard
    ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard

    This structure is derived from ServiceRequest

    Summary

    Mandatory: 1 element
    Must-Support: 2 elements
    Prohibited: 1 element

    Structures

    This structure refers to these other structures:

    Maturity: 2

     

    Other representations of profile: CSV, Excel, Schematron