HL7 Electronic Health Record System Functional Model, Release 2.1.1
2.1.1 - Normative

HL7 Electronic Health Record System Functional Model, Release 2.1.1, published by HL7 International / Electronic Health Records. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ehrsfm-ig/ and changes regularly. See the Directory of published versions

## : CP.4.6 Manage Orders for Referral (Function)

Page standards status: Normative

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    <Requirements xmlns="http://hl7.org/fhir">
      <id value="EHRSFMR2-CP.4.6"/>
      <meta>
        <profile
                 value="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/FMFunction"/>
      </meta>
      <language value="en"/>
      <text>
        <status value="extensions"/>
        <div xml:lang="en" xmlns="http://www.w3.org/1999/xhtml" lang="en">

        <div id="description"><b>Description <a href="https://hl7.org/fhir/versions.html#std-process" title="Informative Content" class="informative-flag">I</a>:</b> <div><p>Documentation and tracking of a referral from one care provider to another is supported, whether the referred to or referring providers are internal or external to the healthcare organization. Guidelines for whether a particular referral for a particular patient is appropriate in a clinical context and with regard to administrative factors such as insurance may be provided to the care provider at the time the referral is created. The EHR-S provides the ability to receive and act upon referral responses from providers. The EHR-S may provide the ability to capture completion of the referral appointment. Referrals may be received electronically (i.e. e-Referrals); or may be received non-electronically. If non-electronic, the system needs to allow the user to capture the referral information and manage referral request. If the system supports e-Referrals, then the system will also need to support additional functionality to manage the receipt of the referral request.</p>
    </div></div>

        <div id="requirements"><b>Criteria <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b></div>

        <table id="statements" class="grid dict">

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#01
                </td>
                <td style="padding-left: 4px;">
                SHALL

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHALL provide the ability to manage outbound referral(s), whether internal or external to the organization.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#02
                </td>
                <td style="padding-left: 4px;">
                SHALL

                    <span style="border-radius: 999px;margin: 2px 2px;font-size: 10px;display: inline-block;padding: 3px 5px;letter-spacing: 0.5px;line-height: 1;white-space: nowrap;background-color: #e5f5e5;color: #388e3c;border: 1px solid #a2d1a2;">dependent</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHALL provide the ability to capture clinical details necessary for the referral according to scope of practice of the referral recipient.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#03
                </td>
                <td style="padding-left: 4px;">
                SHALL

                    <span style="border-radius: 999px;margin: 2px 2px;font-size: 10px;display: inline-block;padding: 3px 5px;letter-spacing: 0.5px;line-height: 1;white-space: nowrap;background-color: #e5f5e5;color: #388e3c;border: 1px solid #a2d1a2;">dependent</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHALL provide the ability to link (e.g., link to image stored in PACS) clinical details as necessary for the referral according to scope of practice of the referral recipient.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#04
                </td>
                <td style="padding-left: 4px;">
                SHALL

                    <span style="border-radius: 999px;margin: 2px 2px;font-size: 10px;display: inline-block;padding: 3px 5px;letter-spacing: 0.5px;line-height: 1;white-space: nowrap;background-color: #e5f5e5;color: #388e3c;border: 1px solid #a2d1a2;">dependent</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHALL provide the ability to render clinical details as appropriate for the referral according to scope of practice of the referral recipient (e.g., clinical details required for dermatologist differ from those required by oncologist).</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#05
                </td>
                <td style="padding-left: 4px;">
                SHOULD

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHOULD provide the ability to capture administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#06
                </td>
                <td style="padding-left: 4px;">
                SHOULD

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHOULD provide the ability to link to administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#07
                </td>
                <td style="padding-left: 4px;">
                SHOULD

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHOULD provide the ability to render administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#08
                </td>
                <td style="padding-left: 4px;">
                SHALL

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHALL provide the ability to capture, store, and render an inbound referral response (e.g., referral accepted, referral denied, or more information needed).</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#09
                </td>
                <td style="padding-left: 4px;">
                SHALL

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHALL provide the ability to determine and render recommended actions based on an inbound referral response (e.g., referral accepted, referral denied, or more information needed).</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#10
                </td>
                <td style="padding-left: 4px;">
                MAY

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system MAY provide the ability to capture a notification that the patient fulfilled a referred appointment.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#11
                </td>
                <td style="padding-left: 4px;">
                SHOULD

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHOULD provide the ability to determine and render diagnosis-based clinical guidelines for making a referral.</p>
    </div>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">
                CP.4.6#12
                </td>
                <td style="padding-left: 4px;">
                SHOULD

                </td>
                <td style="padding-left: 4px;" class="requirement">
                    <div><p>The system SHOULD provide the ability to determine the contents of a referral order by rendering order sets for review by the provider.</p>
    </div>

                </td>
            </tr>

        </table>
    </div>
      </text>
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      <url value="http://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-CP.4.6"/>
      <version value="2.1.1"/>
      <name value="CP_4_6_Manage_Orders_for_Referral"/>
      <title value="CP.4.6 Manage Orders for Referral (Function)"/>
      <status value="active"/>
      <date value="2025-12-13T09:06:06+00:00"/>
      <publisher value="HL7 International / Electronic Health Records"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/ehr"/>
        </telecom>
      </contact>
      <description
                   value="Enable the origination, documentation and tracking of referrals between care providers or healthcare organizations, including clinical and administrative details of the referral, and consents and authorizations for disclosures as required."/>
      <jurisdiction>
        <coding>
          <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
          <code value="001"/>
          <display value="World"/>
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      </jurisdiction>
      <purpose
               value="Documentation and tracking of a referral from one care provider to another is supported, whether the referred to or referring providers are internal or external to the healthcare organization. Guidelines for whether a particular referral for a particular patient is appropriate in a clinical context and with regard to administrative factors such as insurance may be provided to the care provider at the time the referral is created. The EHR-S provides the ability to receive and act upon referral responses from providers. The EHR-S may provide the ability to capture completion of the referral appointment. Referrals may be received electronically (i.e. e-Referrals); or may be received non-electronically. If non-electronic, the system needs to allow the user to capture the referral information and manage referral request. If the system supports e-Referrals, then the system will also need to support additional functionality to manage the receipt of the referral request."/>
      <statement>
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        <conditionality value="false"/>
        <requirement
                     value="The system SHALL provide the ability to manage outbound referral(s), whether internal or external to the organization."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.1.7.2.4#1"/>
      </statement>
      <statement>
        <extension
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        <requirement
                     value="The system SHALL provide the ability to capture clinical details necessary for the referral according to scope of practice of the referral recipient."/>
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        <requirement
                     value="The system SHALL provide the ability to link (e.g., link to image stored in PACS) clinical details as necessary for the referral according to scope of practice of the referral recipient."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.1.7.2.4#2"/>
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        <requirement
                     value="The system SHALL provide the ability to render clinical details as appropriate for the referral according to scope of practice of the referral recipient (e.g., clinical details required for dermatologist differ from those required by oncologist)."/>
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        <conditionality value="false"/>
        <requirement
                     value="The system SHOULD provide the ability to capture administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.1.7.2.4#3"/>
      </statement>
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        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
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        <label value="CP.4.6#06"/>
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        <conditionality value="false"/>
        <requirement
                     value="The system SHOULD provide the ability to link to administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.1.7.2.4#3"/>
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        <requirement
                     value="The system SHOULD provide the ability to render administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral."/>
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      </statement>
      <statement>
        <extension
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        <conformance value="SHALL"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHALL provide the ability to capture, store, and render an inbound referral response (e.g., referral accepted, referral denied, or more information needed)."/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
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        <conformance value="SHALL"/>
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        <requirement
                     value="The system SHALL provide the ability to determine and render recommended actions based on an inbound referral response (e.g., referral accepted, referral denied, or more information needed)."/>
      </statement>
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        <requirement
                     value="The system MAY provide the ability to capture a notification that the patient fulfilled a referred appointment."/>
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        <requirement
                     value="The system SHOULD provide the ability to determine and render diagnosis-based clinical guidelines for making a referral."/>
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      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
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        <conformance value="SHOULD"/>
        <conditionality value="false"/>
        <requirement
                     value="The system SHOULD provide the ability to determine the contents of a referral order by rendering order sets for review by the provider."/>
        <derivedFrom value="EHR-S_FM_R1.1 DC.1.7.2.4#7"/>
      </statement>
    </Requirements>