Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-ballot - STU 2.2 - Ballot

Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

## Resource Profile: PAS Service Request

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest | Version: 2.2.0-ballot
Standards status: Trial-use | Maturity Level: 3 | Computable Name: PASServiceRequest
Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.72

PAS constraints on ServiceRequest resource mandating support for elements relevant to the generic services being requested on a prior authorization request

Usages:

- Refer to this Profile: RequestedService
- Examples for this Profile: ServiceRequest/ReferralRequestExample

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ServiceRequest | C | 0..* | ServiceRequest | A request for a service to be performed Constraints: prr-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceCodeEnd | S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:coverage | S C | 0..1 | (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
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent | ?!S Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Fixed Value: order
doNotPerform | ?!Σ | 0..1 | boolean | True if service/procedure should not be performed
code | S Σ | 0..1 | CodeableConcept | What is being requested/ordered Binding: X12 278 Requested Service Type (required)
quantity[x] | S Σ | 0..1 | PASQuantity | Service amount
subject | S Σ | 1..1 | Reference(PAS Beneficiary Patient) | Individual or Entity the service is ordered for
occurrence[x] | S Σ | 0..1 | PASTiming | When service should occur
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
ServiceRequest.status | required | RequestStatus `http://hl7.org/fhir/ValueSet/request-status|4.0.1` From the FHIR Standard
ServiceRequest.intent | required | Fixed Value: order `http://hl7.org/fhir/ValueSet/request-intent|4.0.1` From the FHIR Standard
ServiceRequest.code | required | X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` From this IG

#### Constraints

Id | Grade | Path(s) | Details | Requirements
crd-ci-q1 | error | ServiceRequest.extension:coverage | Questionnaire is only allowed when doc-needed exists : extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists() |
crd-ci-q2 | error | ServiceRequest.extension:coverage | 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 | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'withpa'. : extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa') |
crd-ci-q5 | error | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'info-needed' is Other, then reason must be specified : extension.where(url = 'info-needed' and value = 'Other').exists() implies extension.where(url = 'reason').exists() |
crd-ci-q7 | error | ServiceRequest.extension:coverage | 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') |
dom-2 | error | ServiceRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | ServiceRequest | 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 | ServiceRequest | 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 | ServiceRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | ServiceRequest | 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() |
prr-1 | error | ServiceRequest | orderDetail SHALL only be present if code is present : orderDetail.empty() or code.exists() |

This structure is derived from ServiceRequest

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ServiceRequest |  | 0..* | ServiceRequest | A request for a service to be performed
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceCodeEnd | S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:coverage | S | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
intent | S | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Fixed Value: order
code | S | 0..1 | CodeableConcept | What is being requested/ordered Binding: X12 278 Requested Service Type (required)
quantity[x] | S | 0..1 | PASQuantity | Service amount
subject | S | 1..1 | Reference(PAS Beneficiary Patient) | Individual or Entity the service is ordered for
occurrence[x] | S | 0..1 | PASTiming | When service should occur
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
ServiceRequest.code | required | X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` From this IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ServiceRequest | C | 0..* | ServiceRequest | A request for a service to be performed Constraints: prr-1
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceCodeEnd | S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:coverage | S C | 0..1 | (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
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Identifiers assigned to this order
instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | PlanDefinition) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(CarePlan | ServiceRequest | MedicationRequest) | What request fulfills
replaces | Σ | 0..* | Reference(ServiceRequest) | What request replaces
requisition | Σ | 0..1 | Identifier | Composite Request ID
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent | ?!S Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Fixed Value: order
category | Σ | 0..* | CodeableConcept | Classification of service Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform | ?!Σ | 0..1 | boolean | True if service/procedure should not be performed
code | S Σ | 0..1 | CodeableConcept | What is being requested/ordered Binding: X12 278 Requested Service Type (required)
orderDetail | Σ C | 0..* | CodeableConcept | Additional order information Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.
quantity[x] | S Σ | 0..1 | PASQuantity | Service amount
subject | S Σ | 1..1 | Reference(PAS Beneficiary Patient) | Individual or Entity the service is ordered for
encounter | Σ | 0..1 | Reference(Encounter) | Encounter in which the request was created
occurrence[x] | S Σ | 0..1 | PASTiming | When service should occur
asNeeded[x] | Σ | 0..1 |  | Preconditions for service Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
authoredOn | Σ | 0..1 | dateTime | Date request signed
requester | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | Who/what is requesting service
performerType | Σ | 0..1 | CodeableConcept | Performer role Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
performer | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) | Requested performer
locationCode | Σ | 0..* | CodeableConcept | Requested location Binding: ServiceDeliveryLocationRoleType (3.0.0) (example): A location type where services are delivered.
locationReference | Σ | 0..* | Reference(Location) | Requested location
reasonCode | Σ | 0..* | CodeableConcept | Explanation/Justification for procedure or service Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Explanation/Justification for service or service
insurance |  | 0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage
supportingInfo |  | 0..* | Reference(Resource) | Additional clinical information
specimen | Σ | 0..* | Reference(Specimen) | Procedure Samples
bodySite | Σ | 0..* | CodeableConcept | Location on Body Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
note |  | 0..* | Annotation | Comments
patientInstruction | Σ | 0..1 | string | Patient or consumer-oriented instructions
relevantHistory |  | 0..* | Reference(Provenance) | Request provenance
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
ServiceRequest.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
ServiceRequest.status | required | RequestStatus `http://hl7.org/fhir/ValueSet/request-status|4.0.1` From the FHIR Standard
ServiceRequest.intent | required | Fixed Value: 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.priority | required | RequestPriority `http://hl7.org/fhir/ValueSet/request-priority|4.0.1` From the FHIR Standard
ServiceRequest.code | required | X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` From this IG
ServiceRequest.orderDetail | example | ServiceRequestOrderDetailsCodes `http://hl7.org/fhir/ValueSet/servicerequest-orderdetail` From the FHIR Standard
ServiceRequest.asNeeded[x] | example | SNOMEDCTMedicationAsNeededReasonCodes `http://hl7.org/fhir/ValueSet/medication-as-needed-reason` 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|3.0.0`
ServiceRequest.reasonCode | example | ProcedureReasonCodes `http://hl7.org/fhir/ValueSet/procedure-reason` From the FHIR Standard
ServiceRequest.bodySite | example | SNOMEDCTBodyStructures `http://hl7.org/fhir/ValueSet/body-site` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
crd-ci-q1 | error | ServiceRequest.extension:coverage | Questionnaire is only allowed when doc-needed exists : extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists() |
crd-ci-q2 | error | ServiceRequest.extension:coverage | 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 | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'withpa'. : extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa') |
crd-ci-q5 | error | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'info-needed' is Other, then reason must be specified : extension.where(url = 'info-needed' and value = 'Other').exists() implies extension.where(url = 'reason').exists() |
crd-ci-q7 | error | ServiceRequest.extension:coverage | 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') |
dom-2 | error | ServiceRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | ServiceRequest | 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 | ServiceRequest | 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 | ServiceRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | ServiceRequest | 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() |
prr-1 | error | ServiceRequest | orderDetail SHALL only be present if code is present : orderDetail.empty() or code.exists() |

This structure is derived from ServiceRequest

Summary

Must-Support: 7 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- PAS Quantity (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-quantity)
- PAS Beneficiary Patient (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary)
- PAS Timing (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-datatype-timing)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
- http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information

Maturity: 3

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ServiceRequest | C | 0..* | ServiceRequest | A request for a service to be performed Constraints: prr-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceCodeEnd | S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:coverage | S C | 0..1 | (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
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent | ?!S Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Fixed Value: order
doNotPerform | ?!Σ | 0..1 | boolean | True if service/procedure should not be performed
code | S Σ | 0..1 | CodeableConcept | What is being requested/ordered Binding: X12 278 Requested Service Type (required)
quantity[x] | S Σ | 0..1 | PASQuantity | Service amount
subject | S Σ | 1..1 | Reference(PAS Beneficiary Patient) | Individual or Entity the service is ordered for
occurrence[x] | S Σ | 0..1 | PASTiming | When service should occur
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
ServiceRequest.status | required | RequestStatus `http://hl7.org/fhir/ValueSet/request-status|4.0.1` From the FHIR Standard
ServiceRequest.intent | required | Fixed Value: order `http://hl7.org/fhir/ValueSet/request-intent|4.0.1` From the FHIR Standard
ServiceRequest.code | required | X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` From this IG

#### Constraints

Id | Grade | Path(s) | Details | Requirements
crd-ci-q1 | error | ServiceRequest.extension:coverage | Questionnaire is only allowed when doc-needed exists : extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists() |
crd-ci-q2 | error | ServiceRequest.extension:coverage | 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 | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'withpa'. : extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa') |
crd-ci-q5 | error | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'info-needed' is Other, then reason must be specified : extension.where(url = 'info-needed' and value = 'Other').exists() implies extension.where(url = 'reason').exists() |
crd-ci-q7 | error | ServiceRequest.extension:coverage | 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') |
dom-2 | error | ServiceRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | ServiceRequest | 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 | ServiceRequest | 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 | ServiceRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | ServiceRequest | 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() |
prr-1 | error | ServiceRequest | orderDetail SHALL only be present if code is present : orderDetail.empty() or code.exists() |

Differential View

This structure is derived from ServiceRequest

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ServiceRequest |  | 0..* | ServiceRequest | A request for a service to be performed
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceCodeEnd | S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:coverage | S | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
intent | S | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Fixed Value: order
code | S | 0..1 | CodeableConcept | What is being requested/ordered Binding: X12 278 Requested Service Type (required)
quantity[x] | S | 0..1 | PASQuantity | Service amount
subject | S | 1..1 | Reference(PAS Beneficiary Patient) | Individual or Entity the service is ordered for
occurrence[x] | S | 0..1 | PASTiming | When service should occur
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
ServiceRequest.code | required | X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` From this IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ServiceRequest | C | 0..* | ServiceRequest | A request for a service to be performed Constraints: prr-1
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceCodeEnd | S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:coverage | S C | 0..1 | (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
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Identifiers assigned to this order
instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | PlanDefinition) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(CarePlan | ServiceRequest | MedicationRequest) | What request fulfills
replaces | Σ | 0..* | Reference(ServiceRequest) | What request replaces
requisition | Σ | 0..1 | Identifier | Composite Request ID
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of a service order.
intent | ?!S Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of service request. Fixed Value: order
category | Σ | 0..* | CodeableConcept | Classification of service Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform | ?!Σ | 0..1 | boolean | True if service/procedure should not be performed
code | S Σ | 0..1 | CodeableConcept | What is being requested/ordered Binding: X12 278 Requested Service Type (required)
orderDetail | Σ C | 0..* | CodeableConcept | Additional order information Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.
quantity[x] | S Σ | 0..1 | PASQuantity | Service amount
subject | S Σ | 1..1 | Reference(PAS Beneficiary Patient) | Individual or Entity the service is ordered for
encounter | Σ | 0..1 | Reference(Encounter) | Encounter in which the request was created
occurrence[x] | S Σ | 0..1 | PASTiming | When service should occur
asNeeded[x] | Σ | 0..1 |  | Preconditions for service Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
authoredOn | Σ | 0..1 | dateTime | Date request signed
requester | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | Who/what is requesting service
performerType | Σ | 0..1 | CodeableConcept | Performer role Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
performer | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) | Requested performer
locationCode | Σ | 0..* | CodeableConcept | Requested location Binding: ServiceDeliveryLocationRoleType (3.0.0) (example): A location type where services are delivered.
locationReference | Σ | 0..* | Reference(Location) | Requested location
reasonCode | Σ | 0..* | CodeableConcept | Explanation/Justification for procedure or service Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Explanation/Justification for service or service
insurance |  | 0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage
supportingInfo |  | 0..* | Reference(Resource) | Additional clinical information
specimen | Σ | 0..* | Reference(Specimen) | Procedure Samples
bodySite | Σ | 0..* | CodeableConcept | Location on Body Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
note |  | 0..* | Annotation | Comments
patientInstruction | Σ | 0..1 | string | Patient or consumer-oriented instructions
relevantHistory |  | 0..* | Reference(Provenance) | Request provenance
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
ServiceRequest.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
ServiceRequest.status | required | RequestStatus `http://hl7.org/fhir/ValueSet/request-status|4.0.1` From the FHIR Standard
ServiceRequest.intent | required | Fixed Value: 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.priority | required | RequestPriority `http://hl7.org/fhir/ValueSet/request-priority|4.0.1` From the FHIR Standard
ServiceRequest.code | required | X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` From this IG
ServiceRequest.orderDetail | example | ServiceRequestOrderDetailsCodes `http://hl7.org/fhir/ValueSet/servicerequest-orderdetail` From the FHIR Standard
ServiceRequest.asNeeded[x] | example | SNOMEDCTMedicationAsNeededReasonCodes `http://hl7.org/fhir/ValueSet/medication-as-needed-reason` 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|3.0.0`
ServiceRequest.reasonCode | example | ProcedureReasonCodes `http://hl7.org/fhir/ValueSet/procedure-reason` From the FHIR Standard
ServiceRequest.bodySite | example | SNOMEDCTBodyStructures `http://hl7.org/fhir/ValueSet/body-site` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
crd-ci-q1 | error | ServiceRequest.extension:coverage | Questionnaire is only allowed when doc-needed exists : extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists() |
crd-ci-q2 | error | ServiceRequest.extension:coverage | 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 | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'withpa'. : extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa') |
crd-ci-q5 | error | ServiceRequest.extension:coverage | '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 | ServiceRequest.extension:coverage | If 'info-needed' is Other, then reason must be specified : extension.where(url = 'info-needed' and value = 'Other').exists() implies extension.where(url = 'reason').exists() |
crd-ci-q7 | error | ServiceRequest.extension:coverage | 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') |
dom-2 | error | ServiceRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | ServiceRequest | 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 | ServiceRequest | 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 | ServiceRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | ServiceRequest | 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() |
prr-1 | error | ServiceRequest | orderDetail SHALL only be present if code is present : orderDetail.empty() or code.exists() |

This structure is derived from ServiceRequest

Summary

Must-Support: 7 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- PAS Quantity (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-quantity)
- PAS Beneficiary Patient (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary)
- PAS Timing (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-datatype-timing)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
- http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information

Maturity: 3

Other representations of profile: CSV, Excel, Schematron