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Patient Administration ![]() | Maturity Level: 3 | Trial Use | Security Category: Patient | Compartments: Device, Group, Patient, Practitioner, RelatedPerson |
A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s).
Appointment resources are used to provide information about a planned meeting that may be in the future or past. The resource only describes a single meeting, a series of repeating visits would require multiple appointment resources to be created for each instance. Examples include a scheduled surgery, a follow-up for a clinical visit, a scheduled conference call between clinicians to discuss a case (where the patient is a subject, but not a participant), the reservation of a piece of diagnostic equipment for a particular use, etc. The visit scheduled by an appointment may be in person or remote (by phone, video conference, etc.) All that matters is that the time and usage of one or more individuals, locations and/or pieces of equipment is being fully or partially reserved for a designated period of time.
This definition takes the concepts of appointments in a clinical setting and also extends them to be relevant in the community healthcare space, and to ease exposure to other appointment / calendar standards widely used outside of healthcare.
Before an appointment can be made, the address/endpoint details of the resource that we want to schedule an appointment with must be determined. This is often based on the healthcare service type and any formatting information which indicates how to make the request. This is typically handled via the Schedule resource.
This optional step permits the checking of any existing available times (Slot resources associated with a selected Schedule) that can be booked against. Just because a time is indicated as available doesn't guarantee that an appointment can be made. The booking system that is going to process the request may make other qualifying decisions to determine if the appointment can be made, such as permissions, assessments, availability of other resources, etc.
This step is optional, as the creation of the appointment is never a guaranteed action. But by performing this availability check, you can increase the chances of making a successful booking.
When an appointment is required, a requester creates new Appointment resource with the Appointment.status="proposed".
All included participants (optional or mandatory) should have the status="needs-action" to allow filtering and displaying
appointments to user-participants for accepting or rejecting new and updated requests. Based on internal system business rules,
certain statuses may be automatically updated, for example: "reject because the requested participant is on vacation" or
"this type of user is not allowed to request those specific appointments".
The reply process is simply performed by the person/system handling the requests, updating the participant statuses on the appointment as needed. If there are multiple systems involved, then these will create AppointmentResponse entries with the desired statuses.
Once all participants have their participation status created/updated (and the main system marking the appointment participant records with the AppointmentResponse statuses) then the overall status of the Appointment is updated.
The requester (organizer) of the appointment checks for the overall status of the appointment (and appointment responses, where applicable) using FHIR pub-sub techniques.
Where the participant statuses indicate that a re-scheduling is required, then the process may start again, with other systems replying to a new set of times.
This optional step permits creating a waitlisted appointment. This could occur if an appointment needs to be booked into a time that is not ideal for the patient due to lack of available time slots. In this workflow, there would be two appointments, the booked appointment in the time slot that is currently available, and the waitlisted appointment with a requestedPeriod spanning the time that the patient would prefer if new slots become available.
If new time slots become available during the requestedPeriod, the scheduling system, or staff at the scheduling organization, can notify the patient that a new time slot is available. If the patient chooses, the waitlisted appointment would then be booked into that specific slot, and the previously booked appointment would be canceled. The specific business process for notifying patients of new availability is not specified, and is up to the implementing system to determine.
These types of requests are typically handled by selecting a specific time from a list of available slots, then making the request for that timeslot.
Clinical scheduling is often far more complex in its requirements and processing. Often this involves checking multiple availabilities across multiple systems and timing with other internal systems, not just those exposed by the Slot resources.
Consideration should be given to situations where scheduling needs to be handled in more of a queue-like process.
Implementation Note: Note: This type of clinical appointment scheduling has not been specifically covered with this definition of the Appointment resource (and other related resources), however if you would like to contribute to the modification of this resource to cover these use cases, please contact the HL7 Patient Administration work-group.
There are 2 main forms of recurring appointments recognized by FHIR:
The recurring appointment uses the recurrenceTemplate
property to define when all of the occurrences
of the appointment should occur. This value only exists on the original booking for the appointment, for all the
subsequent occurrences the originatingAppointment
refers back to original for the template details.
Accepting a recurring appointment can be done either as accepting the entire series
(using AppointmentResponse.recurring=true
) or can accept each occurrence individually
(using AppointmentResponse.recurring=false
along with AppointmentResponse.occurrenceDate
or AppointmentResponse.recurrenceId
to indicate which repetition specifically)
Note that in the template the timezone
property defines which timezone the start/end times
apply. This is required as the time
properties only have the offset (+10), and not the zone (Australia/Melbourne), which means
that they cannot be used by the template to generate 9am every Wednesday all year (as Melbourne changes to +11 during daylight saving time).
A series appointment has no template information, and thus don't use the
recurrenceTemplate
property. Often when first booked it is likely not known
that it will become a series of bookings, and only on conclusion of the encounter it is decided to follow-up
and then book a new appointment (or even book it later on) and relate the new booking to the previous in the series
through the previousAppointment
property.
This style of recurring appointment likely won't use the originatingAppointment
property either.
As each appointment in a series is a separate appointment and booked as needed, the acceptance of requests here is just as it would be normally if they didn't have a sequence.
As each occurrence is booked independently there are no specific issues with timezones, as each instance exactly defines when it occurs (there is no template).
Note to Implementers: We are seeking input from the implementer community on the recurring appointment functionality and specifically if there is a need for a "recur forever" or similar flag.
Feedback here
.
When using a request-response style of appointment this is done using Appointment
and AppointmentResponse resources.
The request is made in the form of an Appointment with a proposed or pending status,
and the list of actors with a participation status of "needs-action".
Participants in the appointment respond with their acceptance (or not) to the appointment
by creating AppointmentResponse resources.
Once all the participants have replied, then the Appointment resource is able to be
updated with an overall status which collates the results of all the participants
and presents the approved details of the appointment.
The participant type property can be used to represent a specific role that a practitioner
is required to perform for the appointment. This could be specified without an actor when the actual
practitioner is not known, and will be filled in closer to the scheduled time.
This property must be the same between the Appointment-participant and the AppointmentResponse
so that the appropriate values can be allocated.
If you need multiple actors of a specific type, then multiple participants with that type value
are included on the appointment.
The Appointment resource represents an intention to perform a service. An Appointment does NOT represent an authorization. Authorization is typically provided via a ServiceRequest when required. Details about the fulfillment of the appointment are handled by the Encounter resource.
Appointments can be considered as Administrative only, and the Encounter is expected to have clinical implications. Both resources align with the Clinical Workflow Process Life Cycle pattern.
In general, it is expected that appointments will result in the creation of an Encounter. The encounter is typically created when the service starts, not when the patient arrives. When the patient arrives, an appointment can be marked with a status of Arrived.
In an Emergency Room context, the appointment Resource is probably not appropriate to be used. In these cases, an Encounter should be created.
The Appointment request pattern used is different from the order-response pattern used elsewhere in FHIR.
This is due to the close relationship to the iCal standard. Many non-clinical systems use generic
non-health appointment systems which implement this standard, and the desire to integrate
with the consumer who has no access to health based software is highly desirable.
The mappings to the iCal standard have been provided to guide implementation of gateways between
FHIR servers and iCal systems.
The location of the appointment is to be defined by using a participant that references a Location
or HealthcareService resource.
This permits the location to also have its availability checked via a schedule and any
conflicts more easily managed.
Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis
Path | ValueSet | Type | Documentation |
---|---|---|---|
Appointment.status | AppointmentStatus | Required | The free/busy status of an appointment. |
Appointment.cancellationReason | AppointmentCancellationReason | Example | This example value set defines a set of reasons for the cancellation of an appointment. |
Appointment.class | http://terminology.hl7.org/ValueSet/EncounterClass ![]() |
Preferred | |
Appointment.serviceCategory | ServiceCategory | Example | This value set defines an example set of codes that can be used to classify groupings of service-types/specialties. |
Appointment.serviceType | ServiceType | Example | This value set defines an example set of codes of service-types. |
Appointment.specialty | PracticeSettingCodeValueSet | Preferred | This is the code representing the clinical specialty of the clinician or provider who interacted with, treated, or provided a service to/for the patient. The value set used for clinical specialty has been limited by HITSP to the value set reproduced from HITSP C80 Table 2-149 Clinical Specialty Value Set Definition. |
Appointment.appointmentType | Hl7VSAppointmentReasonCodes ![]() ![]() |
Preferred | Value Set of codes that describe the kind of appointment or the reason why an appointment has been scheduled. |
Appointment.reason | EncounterReasonCodes | Preferred | This examples value set defines the set of codes that can be used to indicate reasons for an encounter. |
Appointment.priority | ActPriority ![]() |
Example | A code or set of codes (e.g., for routine, emergency,) specifying the urgency under which the Act happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. Discussion: This attribute is used in orders to indicate the ordered priority, and in event documentation it indicates the actual priority used to perform the act. In definition mood it indicates the available priorities. |
Appointment.participant.type | ParticipantType | Extensible | This value set defines a set of codes that can be used to indicate how an individual participates in an encounter. |
Appointment.participant.status | ParticipationStatus | Required | The Participation status of an appointment. |
Appointment.recurrenceTemplate.timezone | IANATimezones (a valid code from IANA Time Zone Database ![]() |
Required | An IANA timezone code for the timezone offset per BCP 175 |
Appointment.recurrenceTemplate.recurrenceType | AppointmentRecurrenceType | Preferred | The recurrence type of a recurring appointment. |
Appointment.recurrenceTemplate.monthlyTemplate.nthWeekOfMonth | WeekOfMonth | Required | The set of weeks in a month. |
Appointment.recurrenceTemplate.monthlyTemplate.dayOfWeek | DaysOfWeek | Required | The days of the week. |
UniqueKey | Level | Location | Description | Expression |
![]() | Rule | Appointment.participant | Either the type or actor on the participant SHALL be specified | type.exists() or actor.exists() |
![]() | Rule | (base) | Either start and end are specified, or neither | start.exists() = end.exists() |
![]() | Rule | (base) | Only proposed or cancelled appointments can be missing start/end dates | (start.exists() and end.exists()) or (status in ('proposed' | 'cancelled' | 'waitlist')) |
![]() | Rule | (base) | Cancellation reason is only used for appointments that have been cancelled, or noshow | cancellationReason.exists() implies (status='noshow' or status='cancelled') |
![]() | Rule | (base) | The start must be less than or equal to the end | start.exists() implies start <= end |
![]() | Guideline | (base) | An appointment may have an originatingAppointment or recurrenceTemplate, but not both | originatingAppointment.exists().not() or recurrenceTemplate.exists().not() This is (only) a best practice guideline because:
|
![]() | Rule | (base) | Cancellation date is only used for appointments that have been cancelled, or noshow | cancellationDate.exists() implies (status='noshow' or status='cancelled') |
Activity Description | Slot | Appointment | Appointment Response | Encounter |
---|---|---|---|---|
The schedule is created/published (Role: Scheduler) |
freeBusyType = FREE | |||
An appointment request is created after locating an available slot (Role: Requester) |
status = pending participant.status = needs-action |
|||
The appointment request is processed and the slot status updated (Role: Scheduler) |
freeBusyType = BUSY-TENTATIVE | |||
The appointment is accepted as described - by all participants (Role: Participant(s)) |
participantStatus = accepted | |||
The appointment is confirmed as accepted by all participants (Role: Scheduler) |
freeBusyType = BUSY |
status = booked participant.status = accepted |
||
Optional: Preparation for the appointment begins - could be preparing a room for the appointment, etc. (Role: Participants/Admin) |
status = planned (optional) location.status = planned |
|||
The patient arrives for the appointment, often sitting in a waiting room (Role: Admin) |
status = arrived |
status = in-progress subjectStatus = arrived location.status = active |
||
The practitioner and the patient meet and the provision of the service begins/occurs (Role: Participant(s)/Admin) |
status = fulfilled |
status = in-progress subjectStatus = receiving-care |
||
The care provision concludes and the patient leaves, some administrative and/or cleanup actions take place (Role: Practitioner(s)/Admin/Billing - excluding patient) |
status = discharged subjectStatus = departed |
|||
The encounter concludes, all paperwork has been completed and the encounter can be closed off (Role: Practitioner(s)/Admin) |
status = finished location.status = completed |
Activity Description | Slot | Appointment | Appointment Response |
---|---|---|---|
The schedule is created/published (Role: Scheduler) |
freeBusyType = FREE | ||
An appointment request is created (Role: Requester) |
status = pending participant.status = needs-action |
||
The appointment request is processed and the slot status updated (Role: Scheduler) |
freeBusyType = BUSY-TENTATIVE | ||
Participant declines the Appointment (Role: Participant) |
participantStatus = declined | ||
The appointment is cancelled (typically the cancellationDate will be populated, along with a cancellation reason if applicable, this is often selected by the scheduler as could be used by the billing engine) (Role: Scheduler) |
freeBusyType = FREE |
status = cancelled cancellationDate = (date of cancellation) cancellationReason = (cancellation reason if applicable) participant.status = declined |
Activity Description | Slot | Appointment | Appointment Response |
---|---|---|---|
The schedule is created/published (Role: Scheduler) |
freeBusyType = FREE | ||
An appointment is requested (e.g. with Brian and Peter) (Role: Requester) |
status = proposed participant(Brian).status = needs-action participant(Peter).status = needs-action |
||
The schedule is updated to inform others of interest in the slot (Role: Scheduler) |
freeBusyType = BUSY-TENTATIVE | ||
Brian accepts the appointment (Role: Participant-Brian) |
(Brian).participantStatus = accepted | ||
Appointment is updated with Brian's status (Role: Scheduler) |
status = pending participant(Brian).status = accepted |
||
Peter suggests a new time (Role: Participant-Peter) |
(Peter).participantStatus = tentative (with new time) |
||
Appointment is updated with new time, and indicates that action is needed by both participants (Role: Scheduler) |
(new time details updated) participant(Brian).status = needs-action participant(Peter).status = needs-action |
||
Brian accepts the appointment (Role: Participant-Brian) |
(Brian).participantStatus = accepted | ||
Appointment updated (Role: Scheduler) |
participant(Brian).status = accepted | ||
(Role: Participant-Peter) |
(Peter).participantStatus = accepted | ||
Appointment updated (Role: Scheduler) |
freeBusyType = BUSY |
status = booked participant(Peter).status = accepted |
Activity Description | Slot | Appointment | Appointment Response | Encounter |
---|---|---|---|---|
(from typical status flow) | freeBusyType = BUSY |
status = booked participant.status = accepted |
||
Appointment is updated as a noshow (Role: Scheduler/Admin) |
status = noshow | (no encounter created) |
Activity Description | Appointment (inconvenient) | Appointment (preferred) |
---|---|---|
An appointment is booked for an inconvenient time using a typical status flow |
status = booked participant.status = accepted |
|
Waitlist appointment created |
status = booked participant.status = accepted |
status = waitlist requestedPeriod = (more convenient time period) |
Patient notified of availability of a better slot | status = booked |
status = proposed participant.status = needs-action |
Patient accepts better slot | status = cancelled |
status = booked participant.status = accepted |
When appointments are scheduled, often insurance information is collected. This may be a single coverage, or multiple coverages. To document this preliminary coverage information, Appointment.account may be used to reference an Account which would contain the ordered list of Coverages that are expected to apply to the Appointment.
Prior authorization for an Appointment would involve a Claim (to submit the prior authorization request) and a ClaimResponse (to receive the prior authorization approval). In this case, the Claim and ClaimResponse associated with the prior auth would reference the planned Appointment that was authorized. How the association between the prior authorization and the authorized services is described may vary by jurisdiction (e.g., Da Vinci PAS in the US).
Note to Implementers: Implementer feedback is sought on the values for Appointment.priority and how interoperable they are. Using an extension to record a CodeableConcept for named values may be tested at a future Connectathon.
Implementer feedback is also sought to clarify desired relationship linkages between ServiceCategory, ServiceType and Specialty, along with how they have approached the definition.Feedback here
.
Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
Name | Type | Description | Expression | In Common |
actor | reference | Any one of the individuals participating in the appointment | Appointment.participant.actor (Practitioner, Group, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson, Location) |
|
appointment-type | token | The style of appointment or patient that has been booked in the slot (not service type) | Appointment.appointmentType | |
based-on | reference | The service request this appointment is allocated to assess | Appointment.basedOn (CarePlan, MedicationRequest, RequestOrchestration, NutritionOrder, VisionPrescription, DeviceRequest, ServiceRequest, ImmunizationRecommendation) |
|
date | date | Appointment date/time. | (start | requestedPeriod.start).first() | 26 Resources |
group | reference | One of the individuals of the appointment is this patient | Appointment.participant.actor.where(resolve() is Group) | Appointment.subject.where(resolve() is Group) (Group) |
|
has-recurrence-template | token | This Appointment contains a recurrence template | Appointment.recurrenceTemplate.exists() | |
identifier | token | An Identifier of the Appointment | Appointment.identifier | 65 Resources |
is-recurring | token | This Appointment is a part of a recurring series of appointments (has a template or an originating appointment) | Appointment.recurrenceTemplate.exists() | Appointment.originatingAppointment.exists() | |
location | reference | This location is listed in the participants of the appointment | Appointment.participant.actor.where(resolve() is Location) (Location) |
|
occurrence-changed | token | This Appointment has been changed from the recurrence template | Appointment.occurrenceChanged | |
originating-appointment | reference | Reference to the Appointment that contains the recurrence template | Appointment.originatingAppointment (Appointment) |
|
part-status | token | The Participation status of the subject, or other participant on the appointment. Can be used to locate participants that have not responded to meeting requests. | Appointment.participant.status | |
patient | reference | One of the individuals of the appointment is this patient | Appointment.participant.actor.where(resolve() is Patient) | Appointment.subject.where(resolve() is Patient) (Patient) |
65 Resources |
practitioner | reference | One of the individuals of the appointment is this practitioner | Appointment.participant.actor.where(resolve() is Practitioner) (Practitioner) |
|
previous-appointment | reference | Reference to the Appointment that preceded this appointment in a series | Appointment.previousAppointment (Appointment) |
|
reason-code | token | Reference to a concept (by class) | Appointment.reason.concept | |
reason-reference | reference | Reference to a resource (by instance) | Appointment.reason.reference | |
requested-period | date | During what period was the Appointment requested to take place | requestedPeriod | |
service-category | token | A broad categorization of the service that is to be performed during this appointment | Appointment.serviceCategory | |
service-type | token | The specific service (by coding) that is to be performed during this appointment | Appointment.serviceType.concept | |
service-type-reference | reference | The specific service (by HealthcareService) that is to be performed during this appointment | Appointment.serviceType.reference | |
slot | reference | The slots that this appointment is filling | Appointment.slot (Slot) |
|
specialty | token | The specialty of a practitioner that would be required to perform the service requested in this appointment | Appointment.specialty | |
status | token | The overall status of the appointment | Appointment.status | |
subject | reference | One of the individuals of the appointment is this patient | Appointment.subject (Group, Patient) |
|
supporting-info | reference | Additional information to support the appointment | Appointment.supportingInformation (Any) |