Da Vinci - Coverage Requirements Discovery
2.2.1 - STU 2.2

Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

## Resource Profile: CRD Encounter

Official URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-encounter | Version: 2.2.1 | Highlight text changes?
Standards status: Trial-use Active as of 2026-03-26 | Maturity Level: 4 | Computable Name: CRDEncounter
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.42.10

This profile specifies additional extensions and constraints on the US Core Encounter profile to support coverage requirements discovery.

### Usage

CRD Clients SHALL use the CRD Encounter profile to resolve references to Encounter resources passed to CRD Servers, including `encounterId` context references when invoking the following CDS Hooks: §prof-7

- appointment-book
- encounter-start
- encounter-discharge
- order-select
- order-sign
- order-dispatch

!

Information provided in Must Support elements will commonly be required for CRD Servers to perform coverage requirements discovery.

Usages:

- Use this Profile: CRD CDSHooks Coverage Information Response (Logical Definition) and CRD Bundle of Request Resources
- Refer to this Profile: CRD Communication Request, CRD Device Request, CRD Encounter, CRD Medication Request... Show 4 more, CRD Nutrition Order, CRD Service Request, CRD Questionnaire Task and CRD Vision Prescription
- CapabilityStatements using this Profile: CRD Client USCDI 1, CRD Client USCDI 3 and CRD Client USCDI 4

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Encounter |  | 0..* | USCoreEncounterProfile(7.0.0) | An interaction during which services are provided to the patient This profile also complies with the profiles US Core Encounter Profile (6.1.0) and US Core Encounter Profile (3.1.1)
meta | S Σ | 0..1 | Meta | Metadata about the resource
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained | S | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:Coverage-Information | S C | 0..* | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information Constraints: crd-ci-q1, crd-ci-q2, crd-ci-q3, crd-ci-q4, crd-ci-q5, crd-ci-q6, crd-ci-q7, crd-ci-q8, crd-ci-q9
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Identifier(s) by which this encounter is known
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system | S Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | S Σ | 1..1 | string | The value that is unique Example General: 123456
status | ?!S Σ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
class | S Σ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode (3.0.0) (extensible): Classification of the encounter.
type | S Σ | 1..* | CodeableConcept | Specific type of encounter Binding: USCoreEncounterType (7.0.0) (extensible): Valueset to describe the Encounter Type
serviceType | S Σ | 0..1 | CodeableConcept | Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
Slices for extension |  |  |  | Content/Rules for all slices
extension:BillingOptions | S | 0..* | CodeableConcept | Expected Billing Code(s) URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options Binding: CRD Billing Codes Value Set (extensible)
subject | S Σ | 1..1 | Reference(CRD Patient) | The patient or group present at the encounter
basedOn |  | 0..* | Reference(CRD Service Request) | The ServiceRequest that initiated this encounter
participant | S Σ | 0..* | BackboneElement | List of participants involved in the encounter
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | S Σ | 0..* | CodeableConcept | Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period | S | 0..1 | Period | Period of time during the encounter that the participant participated
individual | S Σ | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) | Persons involved in the encounter other than the patient
appointment | S Σ | 0..* | Reference(CRD Appointment with Order | CRD Appointment without Order) | The appointment that scheduled this encounter
period | S | 0..1 | Period | The start and end time of the encounter
length | S | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
reasonCode | S Σ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference | S Σ | 0..* | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) S | US Core Condition Encounter Diagnosis Profile(7.0.0) S | US Core Procedure Profile(7.0.0) | Observation | ImmunizationRecommendation) | Reason the encounter takes place (reference)
diagnosis | S Σ | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
condition | S Σ | 1..1 | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Procedure Profile(7.0.0)) | The diagnosis or procedure relevant to the encounter
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
dischargeDisposition | S | 0..1 | CodeableConcept | Category or kind of location after discharge Binding: USCoreDischargeDisposition (7.0.0) (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location | S | 0..* | BackboneElement | List of locations where the patient has been
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
location | S | 1..1 | Reference(CRD Location) | Location the encounter takes place
status | S | 0..1 | code | planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
period | S | 0..1 | Period | Time period during which the patient was present at the location
serviceProvider | S | 0..1 | Reference(US Core Organization Profile(7.0.0)) | The organization (facility) responsible for this encounter
partOf |  | 0..1 | Reference(CRD Encounter) | Another Encounter this encounter is part of
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Encounter.identifier.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Encounter.status | Base | required | EncounterStatus | 📍4.0.1 | FHIR Std.
Encounter.class | Base | extensible | ActEncounterCode | 📍3.0.0 | THO v7.1
Encounter.type | Base | extensible | US Core Encounter Type | 📍7.0.0 | US Core v7.0
Encounter.serviceType | Base | example | Service type | 📦4.0.1 | FHIR Std.
Encounter.participant.​type | Base | extensible | Participant type | 📦4.0.1 | FHIR Std.
Encounter.reasonCode | Base | preferred | Encounter Reason Codes | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​dischargeDisposition | Base | preferred | US Core Discharge Disposition | 📍7.0.0 | US Core v7.0
Encounter.location.status | Base | required | EncounterLocationStatus | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
crd-ci-q1 | error | Encounter.extension:Coverage-Information | Questionnaire is only allowed when doc-needed exists | `extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists()`
crd-ci-q2 | error | Encounter.extension:Coverage-Information | If covered is set to 'not-covered', then 'pa-needed' must not exist. | `extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not()`
crd-ci-q3 | error | Encounter.extension:Coverage-Information | 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists()`
crd-ci-q4 | error | Encounter.extension:Coverage-Information | If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' cannot be 'withpa'. | `extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa')`
crd-ci-q5 | error | Encounter.extension:Coverage-Information | 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. | `extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()`
crd-ci-q6 | error | Encounter.extension:Coverage-Information | If 'info-needed' is OTH, then reason must be specified | `extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q7 | error | Encounter.extension:Coverage-Information | If reason.coding is present and is not from the extensible value set, then reason.text must be present | `extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons')`
crd-ci-q8 | error | Encounter.extension:Coverage-Information | If doc-purpose is present with a value other than 'conditional', then reason must be present | `extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q9 | error | Encounter.extension:Coverage-Information | If any of 'covered', 'pa-needed', or 'doc-needed' is set to 'indeterminate', then reason must be present to explain the issue that is preventing the payer from making a coverage determination. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'indeterminate').count() >= 1 implies extension.where(url = 'reason').exists()`
dom-2 | error | Encounter | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Encounter | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Encounter | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Encounter |  |  | USCoreEncounterProfile(7.0.0) | This profile also complies with the profiles US Core Encounter Profile (6.1.0) and US Core Encounter Profile (3.1.1)
contained | S | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:Coverage-Information | S | 0..* | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
serviceType | S | 0..1 | CodeableConcept | Specific type of service
Slices for extension |  |  |  | Content/Rules for all slices
extension:BillingOptions | S | 0..* | CodeableConcept | Expected Billing Code(s) URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options Binding: CRD Billing Codes Value Set (extensible)
subject |  | 1..1 | Reference(CRD Patient) | The patient or group present at the encounter
basedOn |  | 0..* | Reference(CRD Service Request) | The ServiceRequest that initiated this encounter
participant |  |  |  |
individual |  | 0..1 | Reference(US Core Practitioner Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) | Persons involved in the encounter other than the patient
appointment | S | 0..* | Reference(CRD Appointment with Order | CRD Appointment without Order) | The appointment that scheduled this encounter
length | S | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
diagnosis | S | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
condition | S | 1..1 | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Procedure Profile(7.0.0)) | The diagnosis or procedure relevant to the encounter
location |  |  |  |
location |  | 1..1 | Reference(CRD Location) | Location the encounter takes place
status | S | 0..1 | code | planned | active | reserved | completed
period | S | 0..1 | Period | Time period during which the patient was present at the location
partOf |  | 0..1 | Reference(CRD Encounter) | Another Encounter this encounter is part of
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Encounter |  | 0..* | USCoreEncounterProfile(7.0.0) | An interaction during which services are provided to the patient This profile also complies with the profiles US Core Encounter Profile (6.1.0) and US Core Encounter Profile (3.1.1)
id | Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained | S | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:Coverage-Information | S C | 0..* | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information Constraints: crd-ci-q1, crd-ci-q2, crd-ci-q3, crd-ci-q4, crd-ci-q5, crd-ci-q6, crd-ci-q7, crd-ci-q8, crd-ci-q9
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Identifier(s) by which this encounter is known
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 | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
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 | S Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | S Σ | 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)
status | ?!S Σ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory |  | 0..* | BackboneElement | List of past encounter statuses
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
status |  | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified status
class | S Σ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode (3.0.0) (extensible): Classification of the encounter.
classHistory |  | 0..* | BackboneElement | List of past encounter classes
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
class |  | 1..1 | Coding | inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (3.0.0) (extensible): Classification of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified class
type | S Σ | 1..* | CodeableConcept | Specific type of encounter Binding: USCoreEncounterType (7.0.0) (extensible): Valueset to describe the Encounter Type
serviceType | S Σ | 0..1 | CodeableConcept | Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
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
extension:BillingOptions | S | 0..* | CodeableConcept | Expected Billing Code(s) URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options Binding: CRD Billing Codes Value Set (extensible)
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
priority |  | 0..1 | CodeableConcept | Indicates the urgency of the encounter Binding: ActPriority (3.0.0) (example): Indicates the urgency of the encounter.
subject | S Σ | 1..1 | Reference(CRD Patient) | The patient or group present at the encounter
episodeOfCare | Σ | 0..* | Reference(EpisodeOfCare) | Episode(s) of care that this encounter should be recorded against
basedOn |  | 0..* | Reference(CRD Service Request) | The ServiceRequest that initiated this encounter
participant | S Σ | 0..* | BackboneElement | List of participants involved in the encounter
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | S Σ | 0..* | CodeableConcept | Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period | S | 0..1 | Period | Period of time during the encounter that the participant participated
individual | S Σ | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) | Persons involved in the encounter other than the patient
appointment | S Σ | 0..* | Reference(CRD Appointment with Order | CRD Appointment without Order) | The appointment that scheduled this encounter
period | S | 0..1 | Period | The start and end time of the encounter
length | S | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
reasonCode | S Σ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference | S Σ | 0..* | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) S | US Core Condition Encounter Diagnosis Profile(7.0.0) S | US Core Procedure Profile(7.0.0) | Observation | ImmunizationRecommendation) | Reason the encounter takes place (reference)
diagnosis | S Σ | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
condition | S Σ | 1..1 | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Procedure Profile(7.0.0)) | The diagnosis or procedure relevant to the encounter
use |  | 0..1 | CodeableConcept | Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank |  | 0..1 | positiveInt | Ranking of the diagnosis (for each role type)
account |  | 0..* | Reference(Account) | The set of accounts that may be used for billing for this Encounter
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier |  | 0..1 | Identifier | Pre-admission identifier
origin |  | 0..1 | Reference(Location | Organization) | The location/organization from which the patient came before admission
admitSource |  | 0..1 | CodeableConcept | From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission |  | 0..1 | CodeableConcept | The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: Hl7VSReAdmissionIndicator (3.0.0) (example): The reason for re-admission of this hospitalization encounter.
dietPreference |  | 0..* | CodeableConcept | Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy |  | 0..* | CodeableConcept | Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement |  | 0..* | CodeableConcept | Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination |  | 0..1 | Reference(Location | Organization) | Location/organization to which the patient is discharged
dischargeDisposition | S | 0..1 | CodeableConcept | Category or kind of location after discharge Binding: USCoreDischargeDisposition (7.0.0) (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location | S | 0..* | BackboneElement | List of locations where the patient has been
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
location | S | 1..1 | Reference(CRD Location) | Location the encounter takes place
status | S | 0..1 | code | planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType |  | 0..1 | CodeableConcept | The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period | S | 0..1 | Period | Time period during which the patient was present at the location
serviceProvider | S | 0..1 | Reference(US Core Organization Profile(7.0.0)) | The organization (facility) responsible for this encounter
partOf |  | 0..1 | Reference(CRD Encounter) | Another Encounter this encounter is part of
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Encounter.meta.security | Base | extensible | SecurityLabels | 📦4.0.1 | FHIR Std.
Encounter.meta.tag | Base | example | Common Tags | 📦4.0.1 | FHIR Std.
Encounter.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Encounter.identifier.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Encounter.identifier.​type | Base | extensible | IdentifierType | 📦4.0.1 | FHIR Std.
Encounter.status | Base | required | EncounterStatus | 📍4.0.1 | FHIR Std.
Encounter.statusHistory.​status | Base | required | EncounterStatus | 📍4.0.1 | FHIR Std.
Encounter.class | Base | extensible | ActEncounterCode | 📍3.0.0 | THO v7.1
Encounter.classHistory.​class | Base | extensible | ActEncounterCode | 📍3.0.0 | THO v7.1
Encounter.type | Base | extensible | US Core Encounter Type | 📍7.0.0 | US Core v7.0
Encounter.serviceType | Base | example | Service type | 📦4.0.1 | FHIR Std.
Encounter.priority | Base | example | ActPriority | 📍3.0.0 | THO v7.1
Encounter.participant.​type | Base | extensible | Participant type | 📦4.0.1 | FHIR Std.
Encounter.reasonCode | Base | preferred | Encounter Reason Codes | 📦4.0.1 | FHIR Std.
Encounter.diagnosis.​use | Base | preferred | DiagnosisRole | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​admitSource | Base | preferred | Admit source | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​reAdmission | Base | example | hl7VS-re-admissionIndicator | 📍3.0.0 | THO v7.1
Encounter.hospitalization.​dietPreference | Base | example | Diet | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​specialCourtesy | Base | preferred | Special courtesy | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​specialArrangement | Base | preferred | Special arrangements | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​dischargeDisposition | Base | preferred | US Core Discharge Disposition | 📍7.0.0 | US Core v7.0
Encounter.location.status | Base | required | EncounterLocationStatus | 📍4.0.1 | FHIR Std.
Encounter.location.physicalType | Base | example | Location type | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
crd-ci-q1 | error | Encounter.extension:Coverage-Information | Questionnaire is only allowed when doc-needed exists | `extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists()`
crd-ci-q2 | error | Encounter.extension:Coverage-Information | If covered is set to 'not-covered', then 'pa-needed' must not exist. | `extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not()`
crd-ci-q3 | error | Encounter.extension:Coverage-Information | 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists()`
crd-ci-q4 | error | Encounter.extension:Coverage-Information | If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' cannot be 'withpa'. | `extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa')`
crd-ci-q5 | error | Encounter.extension:Coverage-Information | 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. | `extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()`
crd-ci-q6 | error | Encounter.extension:Coverage-Information | If 'info-needed' is OTH, then reason must be specified | `extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q7 | error | Encounter.extension:Coverage-Information | If reason.coding is present and is not from the extensible value set, then reason.text must be present | `extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons')`
crd-ci-q8 | error | Encounter.extension:Coverage-Information | If doc-purpose is present with a value other than 'conditional', then reason must be present | `extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q9 | error | Encounter.extension:Coverage-Information | If any of 'covered', 'pa-needed', or 'doc-needed' is set to 'indeterminate', then reason must be present to explain the issue that is preventing the payer from making a coverage determination. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'indeterminate').count() >= 1 implies extension.where(url = 'reason').exists()`
dom-2 | error | Encounter | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Encounter | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Encounter | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Must-Support: 10 elements

Structures

This structure refers to these other structures:

- CRD Patient (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient)
- CRD Service Request (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest)
- CRD Appointment with Order (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-with-order)
- CRD Appointment without Order (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-no-order)
- US Core Condition Problems and Health Concerns Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns|7.0.0)
- US Core Condition Encounter Diagnosis Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis|7.0.0)
- US Core Procedure Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure|7.0.0)
- CRD Location (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-location)
- CRD Encounter (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-encounter)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
- http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Encounter |  | 0..* | USCoreEncounterProfile(7.0.0) | An interaction during which services are provided to the patient This profile also complies with the profiles US Core Encounter Profile (6.1.0) and US Core Encounter Profile (3.1.1)
meta | S Σ | 0..1 | Meta | Metadata about the resource
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained | S | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:Coverage-Information | S C | 0..* | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information Constraints: crd-ci-q1, crd-ci-q2, crd-ci-q3, crd-ci-q4, crd-ci-q5, crd-ci-q6, crd-ci-q7, crd-ci-q8, crd-ci-q9
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Identifier(s) by which this encounter is known
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system | S Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | S Σ | 1..1 | string | The value that is unique Example General: 123456
status | ?!S Σ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
class | S Σ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode (3.0.0) (extensible): Classification of the encounter.
type | S Σ | 1..* | CodeableConcept | Specific type of encounter Binding: USCoreEncounterType (7.0.0) (extensible): Valueset to describe the Encounter Type
serviceType | S Σ | 0..1 | CodeableConcept | Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
Slices for extension |  |  |  | Content/Rules for all slices
extension:BillingOptions | S | 0..* | CodeableConcept | Expected Billing Code(s) URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options Binding: CRD Billing Codes Value Set (extensible)
subject | S Σ | 1..1 | Reference(CRD Patient) | The patient or group present at the encounter
basedOn |  | 0..* | Reference(CRD Service Request) | The ServiceRequest that initiated this encounter
participant | S Σ | 0..* | BackboneElement | List of participants involved in the encounter
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | S Σ | 0..* | CodeableConcept | Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period | S | 0..1 | Period | Period of time during the encounter that the participant participated
individual | S Σ | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) | Persons involved in the encounter other than the patient
appointment | S Σ | 0..* | Reference(CRD Appointment with Order | CRD Appointment without Order) | The appointment that scheduled this encounter
period | S | 0..1 | Period | The start and end time of the encounter
length | S | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
reasonCode | S Σ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference | S Σ | 0..* | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) S | US Core Condition Encounter Diagnosis Profile(7.0.0) S | US Core Procedure Profile(7.0.0) | Observation | ImmunizationRecommendation) | Reason the encounter takes place (reference)
diagnosis | S Σ | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
condition | S Σ | 1..1 | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Procedure Profile(7.0.0)) | The diagnosis or procedure relevant to the encounter
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
dischargeDisposition | S | 0..1 | CodeableConcept | Category or kind of location after discharge Binding: USCoreDischargeDisposition (7.0.0) (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location | S | 0..* | BackboneElement | List of locations where the patient has been
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
location | S | 1..1 | Reference(CRD Location) | Location the encounter takes place
status | S | 0..1 | code | planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
period | S | 0..1 | Period | Time period during which the patient was present at the location
serviceProvider | S | 0..1 | Reference(US Core Organization Profile(7.0.0)) | The organization (facility) responsible for this encounter
partOf |  | 0..1 | Reference(CRD Encounter) | Another Encounter this encounter is part of
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Encounter.identifier.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Encounter.status | Base | required | EncounterStatus | 📍4.0.1 | FHIR Std.
Encounter.class | Base | extensible | ActEncounterCode | 📍3.0.0 | THO v7.1
Encounter.type | Base | extensible | US Core Encounter Type | 📍7.0.0 | US Core v7.0
Encounter.serviceType | Base | example | Service type | 📦4.0.1 | FHIR Std.
Encounter.participant.​type | Base | extensible | Participant type | 📦4.0.1 | FHIR Std.
Encounter.reasonCode | Base | preferred | Encounter Reason Codes | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​dischargeDisposition | Base | preferred | US Core Discharge Disposition | 📍7.0.0 | US Core v7.0
Encounter.location.status | Base | required | EncounterLocationStatus | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
crd-ci-q1 | error | Encounter.extension:Coverage-Information | Questionnaire is only allowed when doc-needed exists | `extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists()`
crd-ci-q2 | error | Encounter.extension:Coverage-Information | If covered is set to 'not-covered', then 'pa-needed' must not exist. | `extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not()`
crd-ci-q3 | error | Encounter.extension:Coverage-Information | 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists()`
crd-ci-q4 | error | Encounter.extension:Coverage-Information | If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' cannot be 'withpa'. | `extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa')`
crd-ci-q5 | error | Encounter.extension:Coverage-Information | 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. | `extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()`
crd-ci-q6 | error | Encounter.extension:Coverage-Information | If 'info-needed' is OTH, then reason must be specified | `extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q7 | error | Encounter.extension:Coverage-Information | If reason.coding is present and is not from the extensible value set, then reason.text must be present | `extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons')`
crd-ci-q8 | error | Encounter.extension:Coverage-Information | If doc-purpose is present with a value other than 'conditional', then reason must be present | `extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q9 | error | Encounter.extension:Coverage-Information | If any of 'covered', 'pa-needed', or 'doc-needed' is set to 'indeterminate', then reason must be present to explain the issue that is preventing the payer from making a coverage determination. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'indeterminate').count() >= 1 implies extension.where(url = 'reason').exists()`
dom-2 | error | Encounter | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Encounter | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Encounter | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Encounter |  |  | USCoreEncounterProfile(7.0.0) | This profile also complies with the profiles US Core Encounter Profile (6.1.0) and US Core Encounter Profile (3.1.1)
contained | S | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:Coverage-Information | S | 0..* | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
serviceType | S | 0..1 | CodeableConcept | Specific type of service
Slices for extension |  |  |  | Content/Rules for all slices
extension:BillingOptions | S | 0..* | CodeableConcept | Expected Billing Code(s) URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options Binding: CRD Billing Codes Value Set (extensible)
subject |  | 1..1 | Reference(CRD Patient) | The patient or group present at the encounter
basedOn |  | 0..* | Reference(CRD Service Request) | The ServiceRequest that initiated this encounter
participant |  |  |  |
individual |  | 0..1 | Reference(US Core Practitioner Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) | Persons involved in the encounter other than the patient
appointment | S | 0..* | Reference(CRD Appointment with Order | CRD Appointment without Order) | The appointment that scheduled this encounter
length | S | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
diagnosis | S | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
condition | S | 1..1 | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Procedure Profile(7.0.0)) | The diagnosis or procedure relevant to the encounter
location |  |  |  |
location |  | 1..1 | Reference(CRD Location) | Location the encounter takes place
status | S | 0..1 | code | planned | active | reserved | completed
period | S | 0..1 | Period | Time period during which the patient was present at the location
partOf |  | 0..1 | Reference(CRD Encounter) | Another Encounter this encounter is part of
Documentation for this format

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Encounter |  | 0..* | USCoreEncounterProfile(7.0.0) | An interaction during which services are provided to the patient This profile also complies with the profiles US Core Encounter Profile (6.1.0) and US Core Encounter Profile (3.1.1)
id | Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained | S | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:Coverage-Information | S C | 0..* | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information Constraints: crd-ci-q1, crd-ci-q2, crd-ci-q3, crd-ci-q4, crd-ci-q5, crd-ci-q6, crd-ci-q7, crd-ci-q8, crd-ci-q9
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Identifier(s) by which this encounter is known
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 | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
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 | S Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | S Σ | 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)
status | ?!S Σ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory |  | 0..* | BackboneElement | List of past encounter statuses
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
status |  | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified status
class | S Σ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode (3.0.0) (extensible): Classification of the encounter.
classHistory |  | 0..* | BackboneElement | List of past encounter classes
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
class |  | 1..1 | Coding | inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (3.0.0) (extensible): Classification of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified class
type | S Σ | 1..* | CodeableConcept | Specific type of encounter Binding: USCoreEncounterType (7.0.0) (extensible): Valueset to describe the Encounter Type
serviceType | S Σ | 0..1 | CodeableConcept | Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
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
extension:BillingOptions | S | 0..* | CodeableConcept | Expected Billing Code(s) URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options Binding: CRD Billing Codes Value Set (extensible)
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
priority |  | 0..1 | CodeableConcept | Indicates the urgency of the encounter Binding: ActPriority (3.0.0) (example): Indicates the urgency of the encounter.
subject | S Σ | 1..1 | Reference(CRD Patient) | The patient or group present at the encounter
episodeOfCare | Σ | 0..* | Reference(EpisodeOfCare) | Episode(s) of care that this encounter should be recorded against
basedOn |  | 0..* | Reference(CRD Service Request) | The ServiceRequest that initiated this encounter
participant | S Σ | 0..* | BackboneElement | List of participants involved in the encounter
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | S Σ | 0..* | CodeableConcept | Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period | S | 0..1 | Period | Period of time during the encounter that the participant participated
individual | S Σ | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) | Persons involved in the encounter other than the patient
appointment | S Σ | 0..* | Reference(CRD Appointment with Order | CRD Appointment without Order) | The appointment that scheduled this encounter
period | S | 0..1 | Period | The start and end time of the encounter
length | S | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
reasonCode | S Σ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference | S Σ | 0..* | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) S | US Core Condition Encounter Diagnosis Profile(7.0.0) S | US Core Procedure Profile(7.0.0) | Observation | ImmunizationRecommendation) | Reason the encounter takes place (reference)
diagnosis | S Σ | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
condition | S Σ | 1..1 | Reference(US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Procedure Profile(7.0.0)) | The diagnosis or procedure relevant to the encounter
use |  | 0..1 | CodeableConcept | Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank |  | 0..1 | positiveInt | Ranking of the diagnosis (for each role type)
account |  | 0..* | Reference(Account) | The set of accounts that may be used for billing for this Encounter
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier |  | 0..1 | Identifier | Pre-admission identifier
origin |  | 0..1 | Reference(Location | Organization) | The location/organization from which the patient came before admission
admitSource |  | 0..1 | CodeableConcept | From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission |  | 0..1 | CodeableConcept | The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: Hl7VSReAdmissionIndicator (3.0.0) (example): The reason for re-admission of this hospitalization encounter.
dietPreference |  | 0..* | CodeableConcept | Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy |  | 0..* | CodeableConcept | Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement |  | 0..* | CodeableConcept | Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination |  | 0..1 | Reference(Location | Organization) | Location/organization to which the patient is discharged
dischargeDisposition | S | 0..1 | CodeableConcept | Category or kind of location after discharge Binding: USCoreDischargeDisposition (7.0.0) (preferred): National Uniform Billing Committee, manual UB-04, UB form locator 17
location | S | 0..* | BackboneElement | List of locations where the patient has been
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
location | S | 1..1 | Reference(CRD Location) | Location the encounter takes place
status | S | 0..1 | code | planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType |  | 0..1 | CodeableConcept | The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period | S | 0..1 | Period | Time period during which the patient was present at the location
serviceProvider | S | 0..1 | Reference(US Core Organization Profile(7.0.0)) | The organization (facility) responsible for this encounter
partOf |  | 0..1 | Reference(CRD Encounter) | Another Encounter this encounter is part of
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Encounter.meta.security | Base | extensible | SecurityLabels | 📦4.0.1 | FHIR Std.
Encounter.meta.tag | Base | example | Common Tags | 📦4.0.1 | FHIR Std.
Encounter.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Encounter.identifier.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Encounter.identifier.​type | Base | extensible | IdentifierType | 📦4.0.1 | FHIR Std.
Encounter.status | Base | required | EncounterStatus | 📍4.0.1 | FHIR Std.
Encounter.statusHistory.​status | Base | required | EncounterStatus | 📍4.0.1 | FHIR Std.
Encounter.class | Base | extensible | ActEncounterCode | 📍3.0.0 | THO v7.1
Encounter.classHistory.​class | Base | extensible | ActEncounterCode | 📍3.0.0 | THO v7.1
Encounter.type | Base | extensible | US Core Encounter Type | 📍7.0.0 | US Core v7.0
Encounter.serviceType | Base | example | Service type | 📦4.0.1 | FHIR Std.
Encounter.priority | Base | example | ActPriority | 📍3.0.0 | THO v7.1
Encounter.participant.​type | Base | extensible | Participant type | 📦4.0.1 | FHIR Std.
Encounter.reasonCode | Base | preferred | Encounter Reason Codes | 📦4.0.1 | FHIR Std.
Encounter.diagnosis.​use | Base | preferred | DiagnosisRole | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​admitSource | Base | preferred | Admit source | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​reAdmission | Base | example | hl7VS-re-admissionIndicator | 📍3.0.0 | THO v7.1
Encounter.hospitalization.​dietPreference | Base | example | Diet | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​specialCourtesy | Base | preferred | Special courtesy | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​specialArrangement | Base | preferred | Special arrangements | 📦4.0.1 | FHIR Std.
Encounter.hospitalization.​dischargeDisposition | Base | preferred | US Core Discharge Disposition | 📍7.0.0 | US Core v7.0
Encounter.location.status | Base | required | EncounterLocationStatus | 📍4.0.1 | FHIR Std.
Encounter.location.physicalType | Base | example | Location type | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
crd-ci-q1 | error | Encounter.extension:Coverage-Information | Questionnaire is only allowed when doc-needed exists | `extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists()`
crd-ci-q2 | error | Encounter.extension:Coverage-Information | If covered is set to 'not-covered', then 'pa-needed' must not exist. | `extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not()`
crd-ci-q3 | error | Encounter.extension:Coverage-Information | 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists()`
crd-ci-q4 | error | Encounter.extension:Coverage-Information | If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' cannot be 'withpa'. | `extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa')`
crd-ci-q5 | error | Encounter.extension:Coverage-Information | 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. | `extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()`
crd-ci-q6 | error | Encounter.extension:Coverage-Information | If 'info-needed' is OTH, then reason must be specified | `extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q7 | error | Encounter.extension:Coverage-Information | If reason.coding is present and is not from the extensible value set, then reason.text must be present | `extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons')`
crd-ci-q8 | error | Encounter.extension:Coverage-Information | If doc-purpose is present with a value other than 'conditional', then reason must be present | `extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists()`
crd-ci-q9 | error | Encounter.extension:Coverage-Information | If any of 'covered', 'pa-needed', or 'doc-needed' is set to 'indeterminate', then reason must be present to explain the issue that is preventing the payer from making a coverage determination. | `extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'indeterminate').count() >= 1 implies extension.where(url = 'reason').exists()`
dom-2 | error | Encounter | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Encounter | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Encounter | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Must-Support: 10 elements

Structures

This structure refers to these other structures:

- CRD Patient (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient)
- CRD Service Request (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest)
- CRD Appointment with Order (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-with-order)
- CRD Appointment without Order (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-no-order)
- US Core Condition Problems and Health Concerns Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns|7.0.0)
- US Core Condition Encounter Diagnosis Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis|7.0.0)
- US Core Procedure Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure|7.0.0)
- CRD Location (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-location)
- CRD Encounter (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-encounter)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
- http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options

Maturity: 4

Other representations of profile: CSV, Excel, Schematron