Generated Narrative: StructureDefinition uds-plus-encounter version: 12; Last updated: 2022-07-12 02:03:11+0000; Information Source: #3LDMUQYYwafwTzqK Name Flags Card. Type Description & Constraints Encounter 0..* Encounter De-Identified UDS Plus Encounter #xD; Slices for extension Content/Rules for all slices #xD; extension:uds-plus-age-extension S 1..1 Quantity Age of the Patient computed using birthDate and the visit dates of the encounter URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-age-extension #xD; status S 1..1 code planned | arrived | triaged | in-progress | onleave | finished | cancelled + #xD; class S 1..1 Coding Classification of patient encounter #xD; type S 1..* CodeableConcept Specific type of encounter Binding: http://hl7.org/fhir/us/core/ValueSet/us-core-encounter-type (extensible): The set of codes indicating the type of encounter #xD; text 0..0 Plain text representation of the concept #xD; subject S 1..1 Reference(De-Identified UDS Plus Patient) The patient or group present at the encounter #xD; display 0..0 Text alternative for the resource #xD; participant S 0..1 BackboneElement List of participants involved in the encounter #xD; type S 0..* CodeableConcept Role of participant in encounter #xD; text 0..0 Plain text representation of the concept #xD; period S 0..1 Period Period of time during the encounter that the participant participated #xD; individual S 0..1 Reference(US Core Practitioner Profile) Persons involved in the encounter other than the patient #xD; period S 0..1 Period The start and end time of the encounter #xD; reasonCode S 0..* CodeableConcept Coded reason the encounter takes place #xD; text 0..0 Plain text representation of the concept #xD; reasonReference S 0..* Reference(De-Identified UDS Plus Diagnosis) Reason the encounter takes place (reference) #xD; display 0..0 Text alternative for the resource #xD; diagnosis S 0..* BackboneElement The list of diagnosis relevant to this encounter #xD; condition S 1..1 Reference(De-Identified UDS Plus Diagnosis) The diagnosis or procedure relevant to the encounter #xD; use S 0..1 CodeableConcept Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) #xD; rank S 0..1 positiveInt Ranking of the diagnosis (for each role type) #xD; hospitalization S 0..1 BackboneElement Details about the admission to a healthcare service #xD; dischargeDisposition S 0..1 CodeableConcept Category or kind of location after discharge Binding: http://hl7.org/fhir/us/core/ValueSet/us-core-discharge-disposition (preferred): The set of codes indicating the discharge disposition #xD; text 0..0 Plain text representation of the concept #xD; location S 0..* BackboneElement List of locations where the patient has been #xD; location S 1..1 Reference(UDS Plus Location) Location the encounter takes place #xD; serviceProvider S 0..1 Reference(US Core Organization Profile) The organization (facility) responsible for this encounter #xD; Documentation for this format
HL7 International / Cross Group Projects
The UDS+ profile is based on the Encounter resource and establishes the core elements, extensions, vocabularies and value sets for representing encounters,visit information for UDS+ program.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Age of the Patient computed using birthDate and the visit dates of the encounter
Indicates the age of the Patient computed based on date of birth at a specific time
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifier(s) by which this encounter is known
Identifier(s) by which this encounter is known.
planned | arrived | triaged | in-progress | onleave | finished | cancelled +
planned | arrived | triaged | in-progress | onleave | finished | cancelled +.
Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
No clear equivalent in HL7 v2; active/finished could be inferred from PV1-44, PV1-45, PV2-24; inactive could be inferred from PV2-16
The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.
The current status is always found in the current version of the resource, not the status history.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The time that the episode was in the specified status
The time that the episode was in the specified status.
Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.
inpatient | outpatient | ambulatory | emergency +
inpatient | outpatient | ambulatory | emergency +.
The time that the episode was in the specified class
The time that the episode was in the specified class.
Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).
Since there are many ways to further classify encounters, this element is 0..*.
The set of codes indicating the type of encounter
Extensions are always sliced by (at least) url
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Broad categorization of the service that is to be provided (e.g. cardiology).
Broad categorization of the service that is to be provided.
The patient or group present at the encounter
The patient or group present at the encounter.
While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Episode(s) of care that this encounter should be recorded against
Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).
The ServiceRequest that initiated this encounter
The request this encounter satisfies (e.g. incoming referral or procedure request).
List of participants involved in the encounter
The list of people responsible for providing the service.
The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.
Period of time during the encounter that the participant participated
The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
Persons involved in the encounter other than the patient
Persons involved in the encounter other than the patient.
The appointment that scheduled this encounter
The appointment that scheduled this encounter.
.outboundRelationship[typeCode=FLFS].target[classCode=ENC, moodCode=APT]
The start and end time of the encounter.
If not (yet) known, the end of the Period may be omitted.
Quantity of time the encounter lasted (less time absent)
Quantity of time the encounter lasted. This excludes the time during leaves of absence.
May differ from the time the Encounter.period lasted because of leave of absence.
(PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations )
Reason the encounter takes place (reference)
The list of diagnosis relevant to this encounter
The list of diagnosis relevant to this encounter.
The diagnosis or procedure relevant to the encounter
Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.
Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively.
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).
The type of diagnosis this condition represents.
Ranking of the diagnosis (for each role type)
Ranking of the diagnosis (for each role type).
The set of accounts that may be used for billing for this Encounter
The set of accounts that may be used for billing for this Encounter.
The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
Details about the admission to a healthcare service
Details about the admission to a healthcare service.
An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.
.outboundRelationship[typeCode=COMP].target[classCode=ENC, moodCode=EVN]
The location/organization from which the patient came before admission
The location/organization from which the patient came before admission.
From where patient was admitted (physician referral, transfer)
From where patient was admitted (physician referral, transfer).
The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Whether this hospitalization is a readmission and why if known.
The reason for re-admission of this hospitalization encounter.
Diet preferences reported by the patient
Diet preferences reported by the patient.
For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.
Medical, cultural or ethical food preferences to help with catering requirements.
.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=EVN, code="diet"]
Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
Location/organization to which the patient is discharged
Location/organization to which the patient is discharged.
Category or kind of location after discharge
Category or kind of location after discharge.
The set of codes indicating the discharge disposition
List of locations where the patient has been
List of locations where the patient has been during this encounter.
Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".
The location where the encounter takes place.
The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.
When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.
The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.
This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query. There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.
Time period during which the patient was present at the location
Time period during which the patient was present at the location.
The organization (facility) responsible for this encounter
The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.
Another Encounter this encounter is part of
Another Encounter of which this encounter is a part of (administratively or in time).
This is also used for associating a child's encounter back to the mother's encounter. Refer to the Notes section in the Patient resource for further details.
.inboundRelationship[typeCode=COMP].source[classCode=COMP, moodCode=EVN]