Logical model for the national implementation guide of K-order (referral form) in the Czech Republic. The model represents structured data for requesting medical services or consultation requests, aligned with CZ Core FHIR profiles and national code systems.

Record of a medical referral or request for healthcare service, used for communication between hospital, or outpatient systems within the Czech eHealth ecosystem.

System-generated unique identifier (UUID) for the referral form.

Date and time when the referral was created and authorized (ISO 8601 format).

Current status of the referral in its lifecycle (draft, active, completed, cancelled).

Type of referral according to the national code list (e.g., Poukaz K).

Level of urgency (routine, urgent, statim).

Information about the patient for whom the referral is issued.

Patient's given name(s).

Patient's family name.

Patient's date of birth (YYYY-MM-DD).

RID, RCIS, or another national/international identifier.

Patient’s citizenship (ISO 3166-1 alpha-2).

Patient's administrative gender (HL7 administrativeGender).

Preferred patient language (ISO 639-1).

Address, email and telephone contacts of the patient.

Permanent or correspondence address.

Patient’s contact email.

Patient’s contact phone number.

Persons authorized to act on behalf of or contact the patient.

Type of contact (guardian, emergency contact, other).

Relationship between the contact person and patient (e.g., father, mother, guardian).

Unique identifier of the contact person.

Contact person’s given name.

Contact person’s family name.

Contact person’s address.

Email, phone or other telecom contact.

Information about the patient's insurance and payment.

Code of the health insurance company (VZP list, OID 1.2.203.7898.1.1).

Name of the health insurance company.

Patient’s insurance number (usually national ID without slash).

Type of payment or reimbursement (VZP Reimbursement list).

Information about the healthcare provider issuing the referral.

Identifier of the requesting facility (OID 1.2.203.7898.1.3).

Identifier of the healthcare provider (ICO).

Official name of the requesting facility.

Specialty code according to national list (OID 1.2.203.7898.1.4).

Practitioner identifier according to payer registry.

Full name of the requesting practitioner.

Target facility or laboratory receiving the referral.

Identifier of the performer facility.

ICO of the recipient healthcare organization.

Name of the performer organization.

Specialty of the target facility or department.

Clinical diagnoses justifying the referral request.

Main diagnosis coded in ICD-10-CZ.

Additional diagnoses coded in ICD-10-CZ.

Reimbursement code according to the VZP code list.

Clinical reasoning for the request (anamnesis, objective findings).

List of requested medical procedures or examinations.

Verbal description of the requested examination or service.

Procedure code according to VZP performance list.

Additional recommendation or comment (e.g., hospitalization).

Structured clinical notes supplementing the request. Used to convey relevant clinical context that is not expressed by a diagnosis or a procedure code.

Relevant anamnesis data important for the assessment of the request.

Summary of available results of examinations already performed.

Clinical consideration of possible diagnoses.

Current treatment and medication including dosage.

Supplementary documentation attached to the referral.

Electronic signature or seal of the referral document.

Person or system that signed the referral electronically.

Date and time of the electronic signature.

Logical model for the national implementation guide of K-order (referral form) in the Czech Republic. The model represents structured data for requesting medical services or consultation requests, aligned with CZ Core FHIR profiles and national code systems.

Record of a medical referral or request for healthcare service, used for communication between hospital, or outpatient systems within the Czech eHealth ecosystem.

System-generated unique identifier (UUID) for the referral form.

Date and time when the referral was created and authorized (ISO 8601 format).

Current status of the referral in its lifecycle (draft, active, completed, cancelled).

Type of referral according to the national code list (e.g., Poukaz K).

Level of urgency (routine, urgent, statim).

Information about the patient for whom the referral is issued.

Patient's given name(s).

Patient's family name.

Patient's date of birth (YYYY-MM-DD).

RID, RCIS, or another national/international identifier.

Patient’s citizenship (ISO 3166-1 alpha-2).

Patient's administrative gender (HL7 administrativeGender).

Preferred patient language (ISO 639-1).

Address, email and telephone contacts of the patient.

Permanent or correspondence address.

Patient’s contact email.

Patient’s contact phone number.

Persons authorized to act on behalf of or contact the patient.

Type of contact (guardian, emergency contact, other).

Relationship between the contact person and patient (e.g., father, mother, guardian).

Unique identifier of the contact person.

Contact person’s given name.

Contact person’s family name.

Contact person’s address.

Email, phone or other telecom contact.

Information about the patient's insurance and payment.

Code of the health insurance company (VZP list, OID 1.2.203.7898.1.1).

Name of the health insurance company.

Patient’s insurance number (usually national ID without slash).

Type of payment or reimbursement (VZP Reimbursement list).

Information about the healthcare provider issuing the referral.

Identifier of the requesting facility (OID 1.2.203.7898.1.3).

Identifier of the healthcare provider (ICO).

Official name of the requesting facility.

Specialty code according to national list (OID 1.2.203.7898.1.4).

Practitioner identifier according to payer registry.

Full name of the requesting practitioner.

Target facility or laboratory receiving the referral.

Identifier of the performer facility.

ICO of the recipient healthcare organization.

Name of the performer organization.

Specialty of the target facility or department.

Clinical diagnoses justifying the referral request.

Main diagnosis coded in ICD-10-CZ.

Additional diagnoses coded in ICD-10-CZ.

Reimbursement code according to the VZP code list.

Clinical reasoning for the request (anamnesis, objective findings).

List of requested medical procedures or examinations.

Verbal description of the requested examination or service.

Procedure code according to VZP performance list.

Additional recommendation or comment (e.g., hospitalization).

Structured clinical notes supplementing the request. Used to convey relevant clinical context that is not expressed by a diagnosis or a procedure code.

Relevant anamnesis data important for the assessment of the request.

Summary of available results of examinations already performed.

Clinical consideration of possible diagnoses.

Current treatment and medication including dosage.

Supplementary documentation attached to the referral.

Electronic signature or seal of the referral document.

Person or system that signed the referral electronically.

Date and time of the electronic signature.

Logical model for the national implementation guide of K-order (referral form) in the Czech Republic. The model represents structured data for requesting medical services or consultation requests, aligned with CZ Core FHIR profiles and national code systems.

Record of a medical referral or request for healthcare service, used for communication between hospital, or outpatient systems within the Czech eHealth ecosystem.

System-generated unique identifier (UUID) for the referral form.

Date and time when the referral was created and authorized (ISO 8601 format).

Current status of the referral in its lifecycle (draft, active, completed, cancelled).

Type of referral according to the national code list (e.g., Poukaz K).

Level of urgency (routine, urgent, statim).

Information about the patient for whom the referral is issued.

Patient's given name(s).

Patient's family name.

Patient's date of birth (YYYY-MM-DD).

RID, RCIS, or another national/international identifier.

Patient’s citizenship (ISO 3166-1 alpha-2).

Patient's administrative gender (HL7 administrativeGender).

Preferred patient language (ISO 639-1).

Address, email and telephone contacts of the patient.

Permanent or correspondence address.

Patient’s contact email.

Patient’s contact phone number.

Persons authorized to act on behalf of or contact the patient.

Type of contact (guardian, emergency contact, other).

Relationship between the contact person and patient (e.g., father, mother, guardian).

Unique identifier of the contact person.

Contact person’s given name.

Contact person’s family name.

Contact person’s address.

Email, phone or other telecom contact.

Information about the patient's insurance and payment.

Code of the health insurance company (VZP list, OID 1.2.203.7898.1.1).

Name of the health insurance company.

Patient’s insurance number (usually national ID without slash).

Type of payment or reimbursement (VZP Reimbursement list).

Information about the healthcare provider issuing the referral.

Identifier of the requesting facility (OID 1.2.203.7898.1.3).

Identifier of the healthcare provider (ICO).

Official name of the requesting facility.

Specialty code according to national list (OID 1.2.203.7898.1.4).

Practitioner identifier according to payer registry.

Full name of the requesting practitioner.

Target facility or laboratory receiving the referral.

Identifier of the performer facility.

ICO of the recipient healthcare organization.

Name of the performer organization.

Specialty of the target facility or department.

Clinical diagnoses justifying the referral request.

Main diagnosis coded in ICD-10-CZ.

Additional diagnoses coded in ICD-10-CZ.

Reimbursement code according to the VZP code list.

Clinical reasoning for the request (anamnesis, objective findings).

List of requested medical procedures or examinations.

Verbal description of the requested examination or service.

Procedure code according to VZP performance list.

Additional recommendation or comment (e.g., hospitalization).

Structured clinical notes supplementing the request. Used to convey relevant clinical context that is not expressed by a diagnosis or a procedure code.

Relevant anamnesis data important for the assessment of the request.

Summary of available results of examinations already performed.

Clinical consideration of possible diagnoses.

Current treatment and medication including dosage.

Supplementary documentation attached to the referral.

Electronic signature or seal of the referral document.

Person or system that signed the referral electronically.

Date and time of the electronic signature.