Care Coordination and 360 Referrals (Proof of Concept)
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Care Coordination and 360 Referrals (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Referral Decline [PCC-56]

Referral Decline [PCC-56] - the Referral Recipient declines a referral after it has accepted it (for example after the patient did not attend, or when the patient turns out to be unsuitable). It ends the referral.

References

Interaction

sequenceDiagram
    participant RI as Referral Initiator
    participant RR as Referral Recipient
    Note over RI,RR: Referral already accepted [PCC-55]
    RR ->> RI: Referral Decline<br/>OSU^O51 UA/CA / Task rejected
    RI -->> RI: Show decline, end referral
Actor Optionality
Referral Initiator R - must handle a decline at any point of the workflow
Referral Recipient O - but must send a decline as the first response if it cannot accept (PCC-55)

Content

The message is the same as the Referral Decline in PCC-55:

Data item 360X HL7 v2 FHIR (Referral Task)
Order control ORC-1 UA status rejected (Task was accepted or in-progress)
Referral ID ORC-2 basedOn.identifier, focus
Order status ORC-5 CA businessStatus declined
Reason ORC-16 (at least text) statusReason, e.g. no-show, patient-declined, not-eligible

A clinical document is not required. If the patient was seen before the decline, the Referral Recipient SHOULD send what it found as an Interim Consultation Note [PCC-59] or use a Referral Outcome [PCC-57] instead.

Example

The Tameside cardiology referral was accepted [PCC-55] and an appointment booked for 7 September 2026 [PCC-60]. The patient did not attend and did not respond to the offer to rebook, so cardiology declines the referral and discharges the patient back to the GP. The HL7 v2 message is the same OSU^O51 as the first-response decline on PCC-55; only the timing and reason differ.

MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260915100000+0100||OSU^O51^OSU_O51|MFT-MSG-779100|P|2.5.1|||AL|NE
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
ORC|UA|REF-2026-000123^P89020|||CA||||20260915100000+0100|||G1234567^Allen^^^^Dr^^^GMP||||NO-SHOW^Patient did not attend on 7 September 2026 and did not respond to the offer to rebook. Discharged to GP care.^L|||||HT PRACTICE^^P89020^^^ODS

FHIR Message: Bundle Message - Referral Order Status (O51), declined after acceptance (focus Referral Task - Declined after acceptance: status rejected, businessStatus declined, statusReason no-show with the text). If the appointment no-show itself is sent first, it is a No-Show Notification [PCC-61] (SIU^S26).

Expected Actions

  • The Referral Initiator SHALL record that the referral has ended without being completed and show the reason, so the clinician can decide whether to refer again (with a new Referral ID).
  • 360X allows a no-show to be reported as a decline reason when the Scheduling Option is not used. In the NHS this matches discharging a patient back to the GP after they did not attend (DNA letter).