Generated Narrative: StructureDefinition pfe-device-request Name Flags Card. Type Description & Constraints DeviceRequest 0..* DeviceRequest Medical device request #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:location S 0..* (Complex) Requested location URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-location #xD; extension:device-user S 0..* (Complex) Device user(s) URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-user #xD; extension:clinical-justification S 0..* markdown, string, Annotation Clinical justification URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-clinical-justification #xD; extension:assessment S 0..* Reference(US Core Observation Screening Assessment Profile(6.1.0)) Supporting assessment information URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-assessment #xD; extension:use-of-device S 0..* Reference(Personal Functioning and Engagement Use of Device) Supporting device usage information URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-use-of-device #xD; extension:goal S 0..* Reference(Goal) Supporting goal information URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal #xD; basedOn 0..* Reference(Resource) What request fulfills #xD; status S 0..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown #xD; priority S 0..1 code routine | urgent | asap | stat #xD; code[x] S 1..1 CodeableConcept Device requested Binding: Personal Functioning and Engagement Device Type Value Set (extensible) #xD; parameter S 0..* BackboneElement Device details #xD; subject S 1..1 Reference(US Core Patient Profile(6.1.0)) Focus of request #xD; encounter S 0..1 Reference(Encounter) Encounter motivating request #xD; occurrence[x] S 0..1 dateTime, Period, Timing Desired time or schedule for use #xD; authoredOn S 0..1 dateTime When recorded #xD; requester S 0..1 Reference(Device | Practitioner | PractitionerRole | Organization) Who/what is requesting diagnostics #xD; Slices for extension Content/Rules for all slices #xD; extension:requester-additional S 0..1 Reference(CareTeam | Group | Patient | RelatedPerson) Cross-version extension for R6 requester targets not supported in R4. URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-additional-requester #xD; performerType 0..1 CodeableConcept Device performer role (deprecated) #xD; performer 0..1 Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Requested Filler #xD; reasonCode 0..* CodeableConcept Coded Reason for request Binding: USCoreConditionCodes (6.1.0) (extensible) #xD; reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Linked Reason for request #xD; insurance S 0..* Reference(PAS Coverage | PAS Claim Response) Associated insurance coverage #xD; note S 0..* Annotation Notes or comments #xD; Documentation for this format
Personal Functioning and Engagement Device Request Profile
An exchange of post-acute care device requests for a patient. This profile is used for exchanging requests for assistive devices.
Quality Improvement and Clinical Knowledge (QUICK)
Represents a request for a patient to employ a medical device. The device may be an implantable device, or an external assistive device, such as a walker.
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")])
The preferred location(s) where the device should actually be used in coded or free text form. E.g. at home or nursing day care center.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Identifies the person(s) using the device, their role in using the device and, optionally, the nature of their relationship(s) to the device during use.
Captures the clinical justification or rationale for the medical necessity of a device request. Complements the DeviceRequest.reasonCode and DeviceRequest.reasonReference data elements.
Supporting information about patient assessments that may influence fulfillment of the device request.
This includes assessments documenting the patient's ability to use/interact with the device related to: - Cognition: If the patient has the cognitive capacity to use the device (e.g., via cognitive test/scale) - Physical Functioning: If the patient is physically able to use the device (e.g., assessment) - Vision: If the device supports the patient's visual capabilities (e.g., via ICD code) - Health Literacy: If the patient can learn how to use the device (e.g., via health literacy scale) - Disability: Refer to a profile where disability information would be indicated
Supporting information about the patient's usage of the requested device during an assessment that may influence fulfillment of the device request.
Example: Observation data about a patient admitted to a SNF using a cane to complete a walking assessment, such as CMS MDS section GG items on walking distance.
Supporting information about the patient's goals that may influence fulfillment of the device request.
This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.
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
Identifiers assigned to this order by the orderer or by the receiver.
Instantiates FHIR protocol or definition
The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this DeviceRequest.
Note: This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Instantiates external protocol or definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this DeviceRequest.
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Plan/proposal/order fulfilled by this request.
Examples: - A service request or order for physical, occupational, or speech-language therapy that describes medical necessity and use of the device - A care plan that describes how the device will be used to support patient participation in daily activities and care activities - An order to evaluate someone for the appropriateness of a device - A care plan requirement to maintain range of motion that a splint order helps fulfill - A portable oxygen pack request intended to support participation in a community event
The request takes the place of the referenced completed or terminated request(s).
Handled by message location of ORC (ORC.1=RO or RU)
draft | active | on-hold | revoked | completed | entered-in-error | unknown
This element is labeled as a modifier because the status contains the codes cancelled and entered-in-error that mark the request as not currently valid.
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
Codes representing the status of the request.
proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Whether the request is a proposal, plan, an original order or a reflex order.
This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
.moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
Indicates how quickly the {{title}} should be addressed with respect to other requests.
Identifies the level of importance to be assigned to actioning the request.
Information about the requested device. This can be captured through information documented via the Device profile, or using a codeable concept, such as a Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), or SNOMED-CT code.
Specific parameters for the ordered item. For example, the prism value for lenses.
Examples: - Wheelchair: Seat cushion requirements such as material, size, and air pressure or firmness - Boot: Weight-bearing or non-weight-bearing - Splints or braces: Range-of-motion setting - Device weight limits - Enteral feeding device: One port or two ports - TENS units: Frequency, duration, pulse length, and intensity - Crutches or walkers: Height or width adjustment, such as tall or pediatric - Hot or cold pack: Temperature
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
A code or string that identifies the device detail being asserted.
A code that identifies the device detail.
Range means device should have a value that falls somewhere within the specified range.
An encounter that provides additional context in which this request is made.
.inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
The timing schedule for the use of the device. The Schedule data type allows many different expressions, for example. "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013".
When the request transitioned to being actionable.
The individual who initiated the request and has responsibility for its activation.
Extensions are always sliced by (at least) url
Cross-version extension for R6 requester targets not supported in R4.
Carries DeviceRequest.requester when the requester is a CareTeam, Group, Patient, or RelatedPerson, which are allowed in FHIR R6 but not in FHIR R4.
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.
Desired type of performer for doing the diagnostic testing.
Implementer SHOULD use device-user extension.
Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
The desired individual or entity to provide the device to the subject of the request.
A code indicating the reason or justification for requesting the device. This can be a code for a diagnosis, problem, or condition that necessitates use of the requested device. Complements the DeviceRequest.extension:clinical-justification and DeviceRequest.reasonReference data elements.
Reason or justification for the request or use of this device. Complements the DeviceRequest.extension:clinical-justification and DeviceRequest.reasonCode data elements.
Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.
Additional clinical information about the patient that may influence the request fulfilment. For example, this may include where on the subject's body the device will be used (i.e. the target site).
Knowing where the device is targeted is important for tracking if multiple sites are possible.
Details about this request that were not represented at all or sufficiently in one of the attributes provided in a class. These may include for example a comment, an instruction, or a note associated with the statement.
.inboundRelationship(typeCode=SUBJ].source[classCode=ANNGEN, moodCode=EVN].value[xsi:type=ST]
Key events in the history of the request.
This might not include provenances for all versions of the request - only those deemed "relevant" or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a "relevant" change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.
.inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]