Usage

This profile is used to represent a planned course of radiotherapy as elaborated in a radiotherapy treatment planning system. An overview of radiotherapy courses, phases, and treatment plans is shown here. In FHIR, treatment plans and the summaries of treatment plans for a phase or a course are represented as filler orders, and the corresponding prescriptions are represented as original orders. The relationships between the various radiotherapy profiles are shown here.

Conformance

ServiceRequest resource instances whose code is SNOMEDCT 1217123003 (Radiotherapy course of treatment (regime/therapy)) and whose intent is http://hl7.org/fhir/request-intent#filler-order "Filler Order" MUST conform to this profile. Any resource intended to conform to this profile SHOULD populate meta.profile accordingly.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from USCoreServiceRequestProfile

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	USCoreServiceRequestProfile	A request for a service to be performed codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility.
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
modalityAndTechnique	S	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique
Slices for extension				Content/Rules for all slices
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
radiotherapyDosePlannedToVolume	S	0..*	(Complex)	Planned Dose to a Dose Reference URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume
Slices for extension				Content/Rules for all slices
extension:fractionDose		0..0
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
Slices for identifier	S	2..*	Identifier	Identifiers assigned to this order Slice: Unordered, Open by value:use
identifier:displayName	S	1..1	Identifier	The name that is displayed to the user.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: usual
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
identifier:official	S	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
Slices for basedOn		0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills Slice: Unordered, Open by profile:$this.resolve()
basedOn:course-prescription	S	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that this Radiotherapy Planned Course fulfills.
replaces		0..*	Reference(Radiotherapy Planned Course)	What request replaces
intent		1..1	code	(USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: filler-order
Slices for category		1..*	CodeableConcept	(USCDI) Classification of service Slice: Unordered, Open by pattern:$this
category:radiotherapy		1..1	CodeableConcept	(USCDI) Classification of service Binding: Radiotherapy Category Code Max Value Set (required)
doNotPerform		0..0
code		1..1	CodeableConcept	(USCDI) What is being requested/ordered Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		1..1	string	Representation defined by the system Fixed Value: Radiotherapy course of treatment (regime/therapy)
quantity[x]		0..0
asNeeded[x]		0..0
requester		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile)	(USCDI) Who/what is requesting service
Slices for performer	S	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer Slice: Unordered, Open by profile:$this.resolve()
performer:treatmentOrSeedDevice	S	0..*	Reference(Radiotherapy Treatment Device | Radiotherapy Seed Device)	Radiotherapy Treatment Device or Seed Device used as part of therapy.
locationReference	S	0..*	Reference(US Core Location Profile)	Location where the radiotherapy treatment is requested.
reasonCode	S	0..*	CodeableConcept	(USCDI) Explanation/Justification for procedure or service Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(Condition)	(USCDI) US Core Profile that supports the requested service
specimen		0..0
bodySite	S	0..*	CodeableConcept	Body site that is treated with radiotherapy Binding: Radiotherapy Treatment Location Value Set (extensible)
Slices for extension				Content/Rules for all slices
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ServiceRequest.category:radiotherapy	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
ServiceRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
ServiceRequest.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	ServiceRequest	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	ServiceRequest	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	ServiceRequest	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	USCoreServiceRequestProfile	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required)
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required)
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
imageGuidedRadiotherapyModality	SC	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality IGRTEnergyAllowed: Energy is only allowed for X-Ray, Fluorograph, or CT Modalities.
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
radiotherapyDosePlannedToVolume	S	0..*	(Complex)	Planned Dose to a Dose Reference URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:volume	S	1..1	Extension	Volume targeted by the planned dose
extension		0..0
url		1..1	uri	"volume"
value[x]		1..1	Reference(Radiotherapy Volume)	Value of extension
extension:totalDose	S	0..1	Extension	Total Planned Radiation Dose
extension		0..0
url		1..1	uri	"totalDose"
value[x]		1..1	Quantity	Value of extension Required Pattern: At least the following
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractions	S	0..1	Extension	Number of Planned Fractions
extension		0..0
url		1..1	uri	"fractions"
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
url		1..1	uri	"http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume"
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
intrafractionVerification	SC	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification IntrafractionVerificationQualifierAllowed: Qualifier is only allowed for X-Ray procedure.
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Identifiers assigned to this order Slice: Unordered, Open by value:use
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user.
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: usual
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
Slices for basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills Slice: Unordered, Open by profile:$this.resolve()
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that this Radiotherapy Planned Course fulfills.
replaces	Σ	0..*	Reference(Radiotherapy Planned Course)	What request replaces
status	?!SΣ	1..1	code	(USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent	?!SΣ	1..1	code	(USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: filler-order
Slices for category	SΣ	1..*	CodeableConcept	(USCDI) Classification of service Slice: Unordered, Open by pattern:$this Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
category:us-core	SΣ	0..*	CodeableConcept	(USCDI) Classification of service Binding: US Core ServiceRequest Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:radiotherapy	SΣ	1..1	CodeableConcept	(USCDI) Classification of service Binding: Radiotherapy Category Code Max Value Set (required)
code	SΣ	1..1	CodeableConcept	(USCDI) What is being requested/ordered Binding: US Core Procedure Codes (extensible) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		1..1	string	Representation defined by the system Fixed Value: Radiotherapy course of treatment (regime/therapy)
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Individual or Entity the service is ordered for
occurrence[x]	SΣ	0..1		(USCDI) When service should occur
occurrencePeriod			Period
authoredOn	SΣ	0..1	dateTime	(USCDI) Date request signed
requester	SΣ	0..1	Reference(US Core Practitioner Profile)	(USCDI) Who/what is requesting service
Slices for performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer Slice: Unordered, Open by profile:$this.resolve()
performer:treatmentOrSeedDevice	SΣ	0..*	Reference(Radiotherapy Treatment Device | Radiotherapy Seed Device)	Radiotherapy Treatment Device or Seed Device used as part of therapy.
locationReference	SΣ	0..*	Reference(US Core Location Profile)	Location where the radiotherapy treatment is requested.
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Explanation/Justification for procedure or service Binding: Cancer Disorder Value Set (extensible)
reasonReference	SΣ	0..*	Reference(Condition)	(USCDI) US Core Profile that supports the requested service
bodySite	SΣ	0..*	CodeableConcept	Body site that is treated with radiotherapy Binding: Radiotherapy Treatment Location Value Set (extensible)
Slices for extension				Content/Rules for all slices
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
ServiceRequest.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
ServiceRequest.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: filler-order http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.category	example	ServiceRequestCategoryCodes http://hl7.org/fhir/ValueSet/servicerequest-category from the FHIR Standard
ServiceRequest.category:us-core	required	USCoreServiceRequestCategoryCodes http://hl7.org/fhir/us/core/ValueSet/us-core-servicerequest-category
ServiceRequest.category:radiotherapy	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
ServiceRequest.code	extensible	Pattern: SNOMED-CT Code 1217123003("Radiotherapy course of treatment (regime/therapy)") http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
ServiceRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
ServiceRequest.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	ServiceRequest	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	ServiceRequest	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	ServiceRequest	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	USCoreServiceRequestProfile	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility.
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 Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required)
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required)
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
imageGuidedRadiotherapyModality	SC	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality IGRTEnergyAllowed: Energy is only allowed for X-Ray, Fluorograph, or CT Modalities.
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
radiotherapyDosePlannedToVolume	S	0..*	(Complex)	Planned Dose to a Dose Reference URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:volume	S	1..1	Extension	Volume targeted by the planned dose
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"volume"
value[x]		1..1	Reference(Radiotherapy Volume)	Value of extension
extension:totalDose	S	0..1	Extension	Total Planned Radiation Dose
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"totalDose"
value[x]		1..1	Quantity	Value of extension Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
value		0..1	decimal	Numerical value (with implicit precision)
comparator		0..1	code	< | <= | >= | > - how to understand the value
unit		0..1	string	Unit representation
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractions	S	0..1	Extension	Number of Planned Fractions
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"fractions"
value[x]		0..1	positiveInt	Value of extension
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
url		1..1	uri	"http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume"
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
intrafractionVerification	SC	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification IntrafractionVerificationQualifierAllowed: Qualifier is only allowed for X-Ray procedure.
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Identifiers assigned to this order Slice: Unordered, Open by value:use
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: usual
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
instantiatesCanonical	Σ	0..*	canonical(ActivityDefinition | PlanDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
Slices for basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills Slice: Unordered, Open by profile:$this.resolve()
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that this Radiotherapy Planned Course fulfills.
replaces	Σ	0..*	Reference(Radiotherapy Planned Course)	What request replaces
requisition	Σ	0..1	Identifier	Composite Request ID
status	?!SΣ	1..1	code	(USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent	?!SΣ	1..1	code	(USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: filler-order
Slices for category	SΣ	1..*	CodeableConcept	(USCDI) Classification of service Slice: Unordered, Open by pattern:$this Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
category:us-core	SΣ	0..*	CodeableConcept	(USCDI) Classification of service Binding: US Core ServiceRequest Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:radiotherapy	SΣ	1..1	CodeableConcept	(USCDI) Classification of service Binding: Radiotherapy Category Code Max Value Set (required)
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	(USCDI) What is being requested/ordered Binding: US Core Procedure Codes (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		1..1	string	Representation defined by the system Fixed Value: Radiotherapy course of treatment (regime/therapy)
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
orderDetail	ΣC	0..*	CodeableConcept	Additional order information Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Individual or Entity the service is ordered for
encounter	Σ	0..1	Reference(Encounter)	Encounter in which the request was created
occurrence[x]	SΣ	0..1		(USCDI) When service should occur
occurrencePeriod			Period S
occurrenceDateTime			dateTime
occurrenceTiming			Timing
authoredOn	SΣ	0..1	dateTime	(USCDI) Date request signed
requester	SΣ	0..1	Reference(US Core Practitioner Profile S | US Core PractitionerRole Profile | US Core Organization Profile)	(USCDI) 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.
Slices for performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer Slice: Unordered, Open by profile:$this.resolve()
performer:treatmentOrSeedDevice	SΣ	0..*	Reference(Radiotherapy Treatment Device | Radiotherapy Seed Device)	Radiotherapy Treatment Device or Seed Device used as part of therapy.
locationCode	Σ	0..*	CodeableConcept	Requested location Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.
locationReference	SΣ	0..*	Reference(US Core Location Profile)	Location where the radiotherapy treatment is requested.
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Explanation/Justification for procedure or service Binding: Cancer Disorder Value Set (extensible)
reasonReference	SΣ	0..*	Reference(Condition)	(USCDI) US Core Profile that supports the requested service
insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
supportingInfo		0..*	Reference(Resource)	Additional clinical information
bodySite	SΣ	0..*	CodeableConcept	Body site that is treated with radiotherapy Binding: Radiotherapy Treatment Location Value Set (extensible)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
note		0..*	Annotation	Comments
patientInstruction	Σ	0..1	string	Patient or consumer-oriented instructions
relevantHistory		0..*	Reference(Provenance)	Request provenance
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ServiceRequest.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
ServiceRequest.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
ServiceRequest.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.identifier:displayName.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
ServiceRequest.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.identifier:official.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
ServiceRequest.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: filler-order http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.category	example	ServiceRequestCategoryCodes http://hl7.org/fhir/ValueSet/servicerequest-category from the FHIR Standard
ServiceRequest.category:us-core	required	USCoreServiceRequestCategoryCodes http://hl7.org/fhir/us/core/ValueSet/us-core-servicerequest-category
ServiceRequest.category:radiotherapy	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
ServiceRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
ServiceRequest.code	extensible	Pattern: SNOMED-CT Code 1217123003("Radiotherapy course of treatment (regime/therapy)") http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
ServiceRequest.orderDetail	example	ServiceRequestOrderDetailsCodes http://hl7.org/fhir/ValueSet/servicerequest-orderdetail from the FHIR Standard
ServiceRequest.performerType	example	ParticipantRoles http://hl7.org/fhir/ValueSet/participant-role from the FHIR Standard
ServiceRequest.locationCode	example	ServiceDeliveryLocationRoleType http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
ServiceRequest.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	ServiceRequest	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	ServiceRequest	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	ServiceRequest	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1

Differential View

This structure is derived from USCoreServiceRequestProfile

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	USCoreServiceRequestProfile	A request for a service to be performed codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility.
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
modalityAndTechnique	S	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique
Slices for extension				Content/Rules for all slices
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
radiotherapyDosePlannedToVolume	S	0..*	(Complex)	Planned Dose to a Dose Reference URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume
Slices for extension				Content/Rules for all slices
extension:fractionDose		0..0
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
Slices for identifier	S	2..*	Identifier	Identifiers assigned to this order Slice: Unordered, Open by value:use
identifier:displayName	S	1..1	Identifier	The name that is displayed to the user.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: usual
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
identifier:official	S	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
Slices for basedOn		0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills Slice: Unordered, Open by profile:$this.resolve()
basedOn:course-prescription	S	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that this Radiotherapy Planned Course fulfills.
replaces		0..*	Reference(Radiotherapy Planned Course)	What request replaces
intent		1..1	code	(USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: filler-order
Slices for category		1..*	CodeableConcept	(USCDI) Classification of service Slice: Unordered, Open by pattern:$this
category:radiotherapy		1..1	CodeableConcept	(USCDI) Classification of service Binding: Radiotherapy Category Code Max Value Set (required)
doNotPerform		0..0
code		1..1	CodeableConcept	(USCDI) What is being requested/ordered Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		1..1	string	Representation defined by the system Fixed Value: Radiotherapy course of treatment (regime/therapy)
quantity[x]		0..0
asNeeded[x]		0..0
requester		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile)	(USCDI) Who/what is requesting service
Slices for performer	S	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer Slice: Unordered, Open by profile:$this.resolve()
performer:treatmentOrSeedDevice	S	0..*	Reference(Radiotherapy Treatment Device | Radiotherapy Seed Device)	Radiotherapy Treatment Device or Seed Device used as part of therapy.
locationReference	S	0..*	Reference(US Core Location Profile)	Location where the radiotherapy treatment is requested.
reasonCode	S	0..*	CodeableConcept	(USCDI) Explanation/Justification for procedure or service Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(Condition)	(USCDI) US Core Profile that supports the requested service
specimen		0..0
bodySite	S	0..*	CodeableConcept	Body site that is treated with radiotherapy Binding: Radiotherapy Treatment Location Value Set (extensible)
Slices for extension				Content/Rules for all slices
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ServiceRequest.category:radiotherapy	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
ServiceRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
ServiceRequest.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	ServiceRequest	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	ServiceRequest	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	ServiceRequest	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	USCoreServiceRequestProfile	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required)
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required)
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
imageGuidedRadiotherapyModality	SC	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality IGRTEnergyAllowed: Energy is only allowed for X-Ray, Fluorograph, or CT Modalities.
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
radiotherapyDosePlannedToVolume	S	0..*	(Complex)	Planned Dose to a Dose Reference URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:volume	S	1..1	Extension	Volume targeted by the planned dose
extension		0..0
url		1..1	uri	"volume"
value[x]		1..1	Reference(Radiotherapy Volume)	Value of extension
extension:totalDose	S	0..1	Extension	Total Planned Radiation Dose
extension		0..0
url		1..1	uri	"totalDose"
value[x]		1..1	Quantity	Value of extension Required Pattern: At least the following
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractions	S	0..1	Extension	Number of Planned Fractions
extension		0..0
url		1..1	uri	"fractions"
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
url		1..1	uri	"http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume"
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
intrafractionVerification	SC	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification IntrafractionVerificationQualifierAllowed: Qualifier is only allowed for X-Ray procedure.
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Identifiers assigned to this order Slice: Unordered, Open by value:use
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user.
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: usual
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
Slices for basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills Slice: Unordered, Open by profile:$this.resolve()
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that this Radiotherapy Planned Course fulfills.
replaces	Σ	0..*	Reference(Radiotherapy Planned Course)	What request replaces
status	?!SΣ	1..1	code	(USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent	?!SΣ	1..1	code	(USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: filler-order
Slices for category	SΣ	1..*	CodeableConcept	(USCDI) Classification of service Slice: Unordered, Open by pattern:$this Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
category:us-core	SΣ	0..*	CodeableConcept	(USCDI) Classification of service Binding: US Core ServiceRequest Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:radiotherapy	SΣ	1..1	CodeableConcept	(USCDI) Classification of service Binding: Radiotherapy Category Code Max Value Set (required)
code	SΣ	1..1	CodeableConcept	(USCDI) What is being requested/ordered Binding: US Core Procedure Codes (extensible) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		1..1	string	Representation defined by the system Fixed Value: Radiotherapy course of treatment (regime/therapy)
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Individual or Entity the service is ordered for
occurrence[x]	SΣ	0..1		(USCDI) When service should occur
occurrencePeriod			Period
authoredOn	SΣ	0..1	dateTime	(USCDI) Date request signed
requester	SΣ	0..1	Reference(US Core Practitioner Profile)	(USCDI) Who/what is requesting service
Slices for performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer Slice: Unordered, Open by profile:$this.resolve()
performer:treatmentOrSeedDevice	SΣ	0..*	Reference(Radiotherapy Treatment Device | Radiotherapy Seed Device)	Radiotherapy Treatment Device or Seed Device used as part of therapy.
locationReference	SΣ	0..*	Reference(US Core Location Profile)	Location where the radiotherapy treatment is requested.
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Explanation/Justification for procedure or service Binding: Cancer Disorder Value Set (extensible)
reasonReference	SΣ	0..*	Reference(Condition)	(USCDI) US Core Profile that supports the requested service
bodySite	SΣ	0..*	CodeableConcept	Body site that is treated with radiotherapy Binding: Radiotherapy Treatment Location Value Set (extensible)
Slices for extension				Content/Rules for all slices
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
ServiceRequest.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
ServiceRequest.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: filler-order http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.category	example	ServiceRequestCategoryCodes http://hl7.org/fhir/ValueSet/servicerequest-category from the FHIR Standard
ServiceRequest.category:us-core	required	USCoreServiceRequestCategoryCodes http://hl7.org/fhir/us/core/ValueSet/us-core-servicerequest-category
ServiceRequest.category:radiotherapy	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
ServiceRequest.code	extensible	Pattern: SNOMED-CT Code 1217123003("Radiotherapy course of treatment (regime/therapy)") http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
ServiceRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
ServiceRequest.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	ServiceRequest	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	ServiceRequest	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	ServiceRequest	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
ServiceRequest	C	0..*	USCoreServiceRequestProfile	A request for a service to be performed prr-1: orderDetail SHALL only be present if code is present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility.
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 Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required)
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required)
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
imageGuidedRadiotherapyModality	SC	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality IGRTEnergyAllowed: Energy is only allowed for X-Ray, Fluorograph, or CT Modalities.
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
radiotherapyDosePlannedToVolume	S	0..*	(Complex)	Planned Dose to a Dose Reference URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:volume	S	1..1	Extension	Volume targeted by the planned dose
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"volume"
value[x]		1..1	Reference(Radiotherapy Volume)	Value of extension
extension:totalDose	S	0..1	Extension	Total Planned Radiation Dose
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"totalDose"
value[x]		1..1	Quantity	Value of extension Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
value		0..1	decimal	Numerical value (with implicit precision)
comparator		0..1	code	< | <= | >= | > - how to understand the value
unit		0..1	string	Unit representation
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractions	S	0..1	Extension	Number of Planned Fractions
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"fractions"
value[x]		0..1	positiveInt	Value of extension
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
url		1..1	uri	"http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume"
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
intrafractionVerification	SC	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification IntrafractionVerificationQualifierAllowed: Qualifier is only allowed for X-Ray procedure.
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Identifiers assigned to this order Slice: Unordered, Open by value:use
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: usual
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
instantiatesCanonical	Σ	0..*	canonical(ActivityDefinition | PlanDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
Slices for basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest | MedicationRequest)	What request fulfills Slice: Unordered, Open by profile:$this.resolve()
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that this Radiotherapy Planned Course fulfills.
replaces	Σ	0..*	Reference(Radiotherapy Planned Course)	What request replaces
requisition	Σ	0..1	Identifier	Composite Request ID
status	?!SΣ	1..1	code	(USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent	?!SΣ	1..1	code	(USCDI) proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Required Pattern: filler-order
Slices for category	SΣ	1..*	CodeableConcept	(USCDI) Classification of service Slice: Unordered, Open by pattern:$this Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
category:us-core	SΣ	0..*	CodeableConcept	(USCDI) Classification of service Binding: US Core ServiceRequest Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:radiotherapy	SΣ	1..1	CodeableConcept	(USCDI) Classification of service Binding: Radiotherapy Category Code Max Value Set (required)
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	(USCDI) What is being requested/ordered Binding: US Core Procedure Codes (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		1..1	string	Representation defined by the system Fixed Value: Radiotherapy course of treatment (regime/therapy)
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
orderDetail	ΣC	0..*	CodeableConcept	Additional order information Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Individual or Entity the service is ordered for
encounter	Σ	0..1	Reference(Encounter)	Encounter in which the request was created
occurrence[x]	SΣ	0..1		(USCDI) When service should occur
occurrencePeriod			Period S
occurrenceDateTime			dateTime
occurrenceTiming			Timing
authoredOn	SΣ	0..1	dateTime	(USCDI) Date request signed
requester	SΣ	0..1	Reference(US Core Practitioner Profile S | US Core PractitionerRole Profile | US Core Organization Profile)	(USCDI) 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.
Slices for performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)	Requested performer Slice: Unordered, Open by profile:$this.resolve()
performer:treatmentOrSeedDevice	SΣ	0..*	Reference(Radiotherapy Treatment Device | Radiotherapy Seed Device)	Radiotherapy Treatment Device or Seed Device used as part of therapy.
locationCode	Σ	0..*	CodeableConcept	Requested location Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.
locationReference	SΣ	0..*	Reference(US Core Location Profile)	Location where the radiotherapy treatment is requested.
reasonCode	SΣ	0..*	CodeableConcept	(USCDI) Explanation/Justification for procedure or service Binding: Cancer Disorder Value Set (extensible)
reasonReference	SΣ	0..*	Reference(Condition)	(USCDI) US Core Profile that supports the requested service
insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
supportingInfo		0..*	Reference(Resource)	Additional clinical information
bodySite	SΣ	0..*	CodeableConcept	Body site that is treated with radiotherapy Binding: Radiotherapy Treatment Location Value Set (extensible)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
note		0..*	Annotation	Comments
patientInstruction	Σ	0..1	string	Patient or consumer-oriented instructions
relevantHistory		0..*	Reference(Provenance)	Request provenance
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ServiceRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ServiceRequest.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
ServiceRequest.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
ServiceRequest.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.identifier:displayName.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
ServiceRequest.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
ServiceRequest.identifier:official.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
ServiceRequest.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 from the FHIR Standard
ServiceRequest.intent	required	Pattern: filler-order http://hl7.org/fhir/ValueSet/request-intent|4.0.1 from the FHIR Standard
ServiceRequest.category	example	ServiceRequestCategoryCodes http://hl7.org/fhir/ValueSet/servicerequest-category from the FHIR Standard
ServiceRequest.category:us-core	required	USCoreServiceRequestCategoryCodes http://hl7.org/fhir/us/core/ValueSet/us-core-servicerequest-category
ServiceRequest.category:radiotherapy	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
ServiceRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
ServiceRequest.code	extensible	Pattern: SNOMED-CT Code 1217123003("Radiotherapy course of treatment (regime/therapy)") http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
ServiceRequest.orderDetail	example	ServiceRequestOrderDetailsCodes http://hl7.org/fhir/ValueSet/servicerequest-orderdetail from the FHIR Standard
ServiceRequest.performerType	example	ParticipantRoles http://hl7.org/fhir/ValueSet/participant-role from the FHIR Standard
ServiceRequest.locationCode	example	ServiceDeliveryLocationRoleType http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
ServiceRequest.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	ServiceRequest	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	ServiceRequest	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	ServiceRequest	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1

This structure is derived from USCoreServiceRequestProfile

Summary

Mandatory: 10 elements
Must-Support: 28 elements
Prohibited: 5 elements

Structures

This structure refers to these other structures:

• Radiotherapy Course Prescription (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-prescription)
• Radiotherapy Planned Course (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-planned-course)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• Radiotherapy Treatment Device (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-device)
• Radiotherapy Seed Device (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-seed-device)
• US Core Location Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-location)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-dose-planned-to-volume
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ServiceRequest.identifier
• The element 1 is sliced based on the value of ServiceRequest.basedOn
• The element 1 is sliced based on the value of ServiceRequest.category
• The element 1 is sliced based on the value of ServiceRequest.performer