Generated Narrative: StructureDefinition Referral

NameFlagsCard.TypeDescription & Constraintsdoco
Referral 0..*BaseClinical Referral
Instances of this type can be the target of a Reference
Referral.referralId 1..1IdentifierReferral ID
Referral.ubrn 0..1IdentifierUnique Booking Reference Number
Referral.patient 1..1BackboneElementPatient
Referral.patient.nhsNumber 0..1IdentifierNHS Number
Referral.patient.localIdentifier 0..*IdentifierLocal patient identifier
Referral.patient.demographics 1..1BackboneElementDemographics
Referral.referrer 1..1BackboneElementReferrer
Referral.referrer.clinician 1..1IdentifierReferring clinician
Referral.referrer.organisation 1..1IdentifierReferring organisation
Referral.recipient 0..1BackboneElementReferred to
Referral.recipient.service 0..1IdentifierService
Referral.recipient.clinician 0..1IdentifierClinician
Referral.recipient.organisation 0..1IdentifierOrganisation
Referral.serviceRequested 1..1CodeableConceptService requested
Referral.priority 0..1codePriority
Referral.expectedBy 0..1dateTimeExpected service provision time
Referral.validityPeriod 0..1PeriodValidity
Referral.reasonForReferral 1..*CodeableConceptReason for referral
Referral.referralQuestion 0..1stringReferral question
Referral.clinicalDocument 0..*Reference(DocumentReference | Bundle)Clinical document
Referral.patientSummary 0..1Reference(DocumentReference | Bundle)Patient summary
Referral.forms 0..*Reference(QuestionnaireResponse)Referral forms
Referral.observations 0..*Reference(Observation)Observations
Referral.carePlan 0..1Reference(CarePlan)Care plan
Referral.dateOfReferral 1..1dateTimeDate of referral
Referral.status 1..1codeReferral status
Referral.statusReason 0..1CodeableConceptReason for decline or cancellation
Referral.appointment 0..*BackboneElementAppointment
Referral.appointment.appointmentId 1..1IdentifierAppointment ID
Referral.appointment.dateTime 1..1dateTimeAppointment date and time
Referral.appointment.provider 0..1IdentifierAppointment provider
Referral.appointment.status 1..1codeAppointment status
Referral.interimNote 0..*Reference(DocumentReference | Bundle)Interim consultation note
Referral.outcome 0..1Reference(DocumentReference | Bundle)Referral outcome

doco Documentation for this format
 <status value="draft"/> <experimental value="true"/> <date value="2026-11-03T05:48:20+00:00"/> <publisher value="Kevin Mayfield"/> <contact> <telecom> <system value="url"/> <value value="https://github.com/KevinMayfield/PatientCareCoordination"/> </telecom> </contact> <description value="**Proof of concept - not an authoritative source.** The information exchanged during a closed loop referral, from the referral request to the referral outcome. Based on the data items of the [IHE 360X](https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_360X.pdf) transactions (PCC TF-2 3.55 to 3.61), FHIR Workflow and HL7 v2 orders, with the UBRN from [eRS](https://digital.nhs.uk/developer/api-catalogue/e-referral-service-fhir). It is the same for a referral to an outpatient clinic, a community service or a [virtual ward](VirtualWards.html). National services such as BaRS are mapped onto this model (see the [BaRS review](BaRS.html)), not the other way round. The PRSB [Clinical Referral Information Standard](https://theprsb.org/standards/clinical-referral-information-standard/) v1.0 gives the clinical headings. The referral stays small: the clinical content is in separate documents referenced as supporting information - a [Discharge Report](StructureDefinition-DischargeReport.html) or clinic letter for the episode, a [Patient Summary](StructureDefinition-PatientSummary.html) and referral forms. A referral may be one activity of a [Care Plan](StructureDefinition-CarePlanModel.html). The **Mappings** tab shows each element in HL7 v2 (360X) and FHIR."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="GB"/> <display value="United Kingdom of Great Britain and Northern Ireland"/> </coding> </jurisdiction> <fhirVersion value="4.0.1"/> <mapping> <identity value="hl7-v2-360x"/> <uri value="https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_360X.pdf"/> <name value="HL7 v2.5.1 (IHE 360X)"/> </mapping> <mapping> <identity value="fhir"/> <uri value="http://hl7.org/fhir/R4"/> <name value="FHIR R4"/> </mapping> <mapping> <identity value="prsb-cris"/> <uri value="https://theprsb.org/standards/clinical-referral-information-standard/"/> <name value="PRSB Clinical Referral Information Standard v1.0"/> </mapping> <kind value="logical"/> <abstract value="false"/> <type value="https://fhir.acmeexample.org.uk/PatientCareCoordination/StructureDefinition/Referral"/> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Base"/> <derivation value="specialization"/> <snapshot> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version"> <valueString value="4.0.1"/> </extension> <element id="Referral"> <path value="Referral"/> <short value="Clinical Referral"/> <definition value="**Proof of concept - not an authoritative source.** The information exchanged during a closed loop referral, from the referral request to the referral outcome. Based on the data items of the [IHE 360X](https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_360X.pdf) transactions (PCC TF-2 3.55 to 3.61), FHIR Workflow and HL7 v2 orders, with the UBRN from [eRS](https://digital.nhs.uk/developer/api-catalogue/e-referral-service-fhir). It is the same for a referral to an outpatient clinic, a community service or a [virtual ward](VirtualWards.html). National services such as BaRS are mapped onto this model (see the [BaRS review](BaRS.html)), not the other way round. The PRSB [Clinical Referral Information Standard](https://theprsb.org/standards/clinical-referral-information-standard/) v1.0 gives the clinical headings. The referral stays small: the clinical content is in separate documents referenced as supporting information - a [Discharge Report](StructureDefinition-DischargeReport.html) or clinic letter for the episode, a [Patient Summary](StructureDefinition-PatientSummary.html) and referral forms. A referral may be one activity of a [Care Plan](StructureDefinition-CarePlanModel.html). The **Mappings** tab shows each element in HL7 v2 (360X) and FHIR."/> <min value="0"/> <max value="*"/> <base> <path value="Base"/> <min value="0"/> <max value="*"/> </base> <isModifier value="false"/> <mapping> <identity value="prsb-cris"/> <map value="Sections: GP Practice (M), Patient Demographics (M), Referral Details (M), Reason for referral (M), Allergies and adverse reactions (M), Person completing record (M); Individual requirements, Medications and medical devices, Safety Alerts, Person concerns, expectations and wishes, Legal Information, Information and advice given, Participation in research (R); Family History, Social Context, Examination Findings, Assessment Scales, Relevant clinical risk factors, Investigations and results, Distribution list (O). Referral Details sub-elements from the Core Information Standard v2.01. Mapping indicative - To confirm"/> </mapping> </element> <element id="Referral.referralId"> <path value="Referral.referralId"/> <short value="Referral ID"/> <definition value="Unique identifier assigned by the Referral Initiator, used in every message about the referral"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.referralId"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-2 and OBR-2 (OMG^O19); ORC-2 (OSU^O51); SCH-26 (SIU)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.identifier:referralId; Task.basedOn.identifier; Appointment.basedOn.identifier"/> </mapping> </element> <element id="Referral.ubrn"> <path value="Referral.ubrn"/> <short value="Unique Booking Reference Number"/> <definition value="eRS identifier, if the referral was made through eRS"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.ubrn"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="Not in 360X; NHS: ORC-2 or OBR-2 repetition with UBRN assigning authority (To confirm)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.identifier:ubrn"/> </mapping> </element> <element id="Referral.patient"> <path value="Referral.patient"/> <short value="Patient"/> <definition value="The patient referred"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.patient"/> <min value="1"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mapping> <identity value="hl7-v2-360x"/> <map value="PID"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.subject (Patient)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Patient Demographics; GP Practice"/> </mapping> </element> <element id="Referral.patient.id"> <path value="Referral.patient.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.patient.extension"> <path value="Referral.patient.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional content defined by implementations"/> <definition value="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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.patient.modifierExtension"> <path value="Referral.patient.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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)."/> <comment value="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."/> <requirements value="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)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Referral.patient.nhsNumber"> <path value="Referral.patient.nhsNumber"/> <short value="NHS Number"/> <definition value="Traced NHS Number"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.patient.nhsNumber"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="PID-3 (assigning authority NHS)"/> </mapping> <mapping> <identity value="fhir"/> <map value="Patient.identifier:nhsNumber"/> </mapping> </element> <element id="Referral.patient.localIdentifier"> <path value="Referral.patient.localIdentifier"/> <short value="Local patient identifier"/> <definition value="Referral Initiator's identifier (360X sourcePatientId), and any identifier the Referral Recipient adds"/> <min value="0"/> <max value="*"/> <base> <path value="Referral.patient.localIdentifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="PID-3"/> </mapping> <mapping> <identity value="fhir"/> <map value="Patient.identifier:MedicalRecordNumber"/> </mapping> </element> <element id="Referral.patient.demographics"> <path value="Referral.patient.demographics"/> <short value="Demographics"/> <definition value="Name, date of birth, sex, address"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.patient.demographics"/> <min value="1"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="PID-5, PID-7, PID-8, PID-11"/> </mapping> <mapping> <identity value="fhir"/> <map value="Patient.name, birthDate, gender, address"/> </mapping> </element> <element id="Referral.referrer"> <path value="Referral.referrer"/> <short value="Referrer"/> <definition value="The Referral Initiator"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.referrer"/> <min value="1"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Referrer details; Person completing record"/> </mapping> </element> <element id="Referral.referrer.id"> <path value="Referral.referrer.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.referrer.extension"> <path value="Referral.referrer.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional content defined by implementations"/> <definition value="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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.referrer.modifierExtension"> <path value="Referral.referrer.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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)."/> <comment value="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."/> <requirements value="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)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Referral.referrer.clinician"> <path value="Referral.referrer.clinician"/> <short value="Referring clinician"/> <definition value="Professional registration or GP code"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.referrer.clinician"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-12 and OBR-16"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.requester (PractitionerRole.practitioner)"/> </mapping> </element> <element id="Referral.referrer.organisation"> <path value="Referral.referrer.organisation"/> <short value="Referring organisation"/> <definition value="ODS code"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.referrer.organisation"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-21 (required in this guide) / MSH-4"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.requester (PractitionerRole.organization)"/> </mapping> </element> <element id="Referral.recipient"> <path value="Referral.recipient"/> <short value="Referred to"/> <definition value="The Referral Recipient"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.recipient"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mapping> <identity value="hl7-v2-360x"/> <map value="MSH-5 / MSH-6"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.performer; Task.owner"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Referral to"/> </mapping> </element> <element id="Referral.recipient.id"> <path value="Referral.recipient.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.recipient.extension"> <path value="Referral.recipient.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional content defined by implementations"/> <definition value="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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.recipient.modifierExtension"> <path value="Referral.recipient.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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)."/> <comment value="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."/> <requirements value="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)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Referral.recipient.service"> <path value="Referral.recipient.service"/> <short value="Service"/> <definition value="eRS service ID, Directory of Services ID or local service"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.recipient.service"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> </element> <element id="Referral.recipient.clinician"> <path value="Referral.recipient.clinician"/> <short value="Clinician"/> <definition value="Named clinician, if any"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.recipient.clinician"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> </element> <element id="Referral.recipient.organisation"> <path value="Referral.recipient.organisation"/> <short value="Organisation"/> <definition value="ODS code"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.recipient.organisation"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> </element> <element id="Referral.serviceRequested"> <path value="Referral.serviceRequested"/> <short value="Service requested"/> <definition value="Specialty, clinic type or referral procedure"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.serviceRequested"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBR-4 (360X default LOINC 57133-1 Referral note)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.code"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Referral to; Referral criteria"/> </mapping> </element> <element id="Referral.priority"> <path value="Referral.priority"/> <short value="Priority"/> <definition value="routine, urgent, urgent suspected cancer, two week wait"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.priority"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-9"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.priority"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Clinical urgency of referral"/> </mapping> </element> <element id="Referral.expectedBy"> <path value="Referral.expectedBy"/> <short value="Expected service provision time"/> <definition value="The date by which the service should be provided (urgency converted to a date)"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.expectedBy"/> <min value="0"/> <max value="1"/> </base> <type> <code value="dateTime"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-8"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.occurrenceDateTime"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Clinical urgency of referral"/> </mapping> </element> <element id="Referral.validityPeriod"> <path value="Referral.validityPeriod"/> <short value="Validity"/> <definition value="Period the referral is valid for"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.validityPeriod"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-6"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.restriction.period (or ServiceRequest.occurrencePeriod)"/> </mapping> </element> <element id="Referral.reasonForReferral"> <path value="Referral.reasonForReferral"/> <short value="Reason for referral"/> <definition value="Coded (SNOMED CT) or text"/> <min value="1"/> <max value="*"/> <base> <path value="Referral.reasonForReferral"/> <min value="1"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBR-31"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.reasonCode / reasonReference"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Reason for referral"/> </mapping> </element> <element id="Referral.referralQuestion"> <path value="Referral.referralQuestion"/> <short value="Referral question"/> <definition value="The clinical question for the Referral Recipient"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.referralQuestion"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBX-5 (OBX-11 O, OBX-29 QST)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.note"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Reason for referral"/> </mapping> </element> <element id="Referral.clinicalDocument"> <path value="Referral.clinicalDocument"/> <short value="Clinical document"/> <definition value="The referrer's account of the episode that led to the referral - Discharge Report (HL7 Europe HDR) or clinic letter"/> <min value="0"/> <max value="*"/> <base> <path value="Referral.clinicalDocument"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="CDA document in the XDM package (360X); NHS: OBX type ED or RP, or MDM^T02"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (Bundle - HL7 Europe HDR, or DocumentReference)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Examination Findings; Investigations and results; Relevant clinical risk factors; Information and advice given"/> </mapping> </element> <element id="Referral.patientSummary"> <path value="Referral.patientSummary"/> <short value="Patient summary"/> <definition value="The patient's background (HL7 Europe Patient Summary), when the recipient cannot query the record"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.patientSummary"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="CDA document in the XDM package (360X); NHS: OBX type ED or RP"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (Bundle - HL7 Europe EPS, or DocumentReference)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Allergies and adverse reactions; Medications and medical devices; Safety Alerts; Legal Information; Individual requirements; Family History; Social Context"/> </mapping> </element> <element id="Referral.forms"> <path value="Referral.forms"/> <short value="Referral forms"/> <definition value="Forms completed for the referral - see Referral Forms"/> <min value="0"/> <max value="*"/> <base> <path value="Referral.forms"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBX (ask at order entry)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (QuestionnaireResponse)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Assessment Scales"/> </mapping> </element> <element id="Referral.observations"> <path value="Referral.observations"/> <short value="Observations"/> <definition value="Findings needed by the recipient, e.g. vital signs"/> <min value="0"/> <max value="*"/> <base> <path value="Referral.observations"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="https://fhir.acmeexample.org.uk/PatientCareCoordination/StructureDefinition/Observation"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBX"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (Observation)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Examination Findings; Investigations and results"/> </mapping> </element> <element id="Referral.carePlan"> <path value="Referral.carePlan"/> <short value="Care plan"/> <definition value="The care plan this referral carries out, if any"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.carePlan"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan"/> </type> <mapping> <identity value="fhir"/> <map value="ServiceRequest.basedOn (CarePlan)"/> </mapping> </element> <element id="Referral.dateOfReferral"> <path value="Referral.dateOfReferral"/> <short value="Date of referral"/> <definition value="When the referral was made"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.dateOfReferral"/> <min value="1"/> <max value="1"/> </base> <type> <code value="dateTime"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-9"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.authoredOn"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Date"/> </mapping> </element> <element id="Referral.status"> <path value="Referral.status"/> <short value="Referral status"/> <definition value="360X state - see Referral Workflow Status"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.status"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-1 / ORC-5"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.businessStatus (and Task.status, ServiceRequest.status)"/> </mapping> </element> <element id="Referral.statusReason"> <path value="Referral.statusReason"/> <short value="Reason for decline or cancellation"/> <definition value="Free text at least"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.statusReason"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-16"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.statusReason"/> </mapping> </element> <element id="Referral.appointment"> <path value="Referral.appointment"/> <short value="Appointment"/> <definition value="Appointments booked to carry out the referral"/> <min value="0"/> <max value="*"/> <base> <path value="Referral.appointment"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mapping> <identity value="fhir"/> <map value="Appointment (basedOn the ServiceRequest)"/> </mapping> </element> <element id="Referral.appointment.id"> <path value="Referral.appointment.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.appointment.extension"> <path value="Referral.appointment.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional content defined by implementations"/> <definition value="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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Referral.appointment.modifierExtension"> <path value="Referral.appointment.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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)."/> <comment value="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."/> <requirements value="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)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Referral.appointment.appointmentId"> <path value="Referral.appointment.appointmentId"/> <short value="Appointment ID"/> <definition value="Unique identifier of the appointment"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.appointment.appointmentId"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="SCH-2"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.identifier"/> </mapping> </element> <element id="Referral.appointment.dateTime"> <path value="Referral.appointment.dateTime"/> <short value="Appointment date and time"/> <definition value="At least the date"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.appointment.dateTime"/> <min value="1"/> <max value="1"/> </base> <type> <code value="dateTime"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-7"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.start"/> </mapping> </element> <element id="Referral.appointment.provider"> <path value="Referral.appointment.provider"/> <short value="Appointment provider"/> <definition value="Clinician or service seeing the patient"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.appointment.provider"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="AIP-3"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.participant.actor"/> </mapping> </element> <element id="Referral.appointment.status"> <path value="Referral.appointment.status"/> <short value="Appointment status"/> <definition value="booked, rescheduled, cancelled, no-show"/> <min value="1"/> <max value="1"/> <base> <path value="Referral.appointment.status"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="SIU trigger S12 / S13 / S15 / S26 (RGS-2)"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.status"/> </mapping> </element> <element id="Referral.interimNote"> <path value="Referral.interimNote"/> <short value="Interim consultation note"/> <definition value="Results sent before the end of care"/> <min value="0"/> <max value="*"/> <base> <path value="Referral.interimNote"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OSU^O51 (ORC-1 SC, ORC-5 A) with document"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.output (clinical document - Composition with HL7 Europe HDR section codes)"/> </mapping> </element> <element id="Referral.outcome"> <path value="Referral.outcome"/> <short value="Referral outcome"/> <definition value="Report that closes the loop - consultation note, discharge report or care plan"/> <min value="0"/> <max value="1"/> <base> <path value="Referral.outcome"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OSU^O51 (ORC-1 SC, ORC-5 CM) with document"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.output (Discharge Report - HL7 Europe HDR, or clinic letter)"/> </mapping> </element> </snapshot> <differential> <element id="Referral"> <path value="Referral"/> <short value="Clinical Referral"/> <definition value="**Proof of concept - not an authoritative source.** The information exchanged during a closed loop referral, from the referral request to the referral outcome. Based on the data items of the [IHE 360X](https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_360X.pdf) transactions (PCC TF-2 3.55 to 3.61), FHIR Workflow and HL7 v2 orders, with the UBRN from [eRS](https://digital.nhs.uk/developer/api-catalogue/e-referral-service-fhir). It is the same for a referral to an outpatient clinic, a community service or a [virtual ward](VirtualWards.html). National services such as BaRS are mapped onto this model (see the [BaRS review](BaRS.html)), not the other way round. The PRSB [Clinical Referral Information Standard](https://theprsb.org/standards/clinical-referral-information-standard/) v1.0 gives the clinical headings. The referral stays small: the clinical content is in separate documents referenced as supporting information - a [Discharge Report](StructureDefinition-DischargeReport.html) or clinic letter for the episode, a [Patient Summary](StructureDefinition-PatientSummary.html) and referral forms. A referral may be one activity of a [Care Plan](StructureDefinition-CarePlanModel.html). The **Mappings** tab shows each element in HL7 v2 (360X) and FHIR."/> <mapping> <identity value="prsb-cris"/> <map value="Sections: GP Practice (M), Patient Demographics (M), Referral Details (M), Reason for referral (M), Allergies and adverse reactions (M), Person completing record (M); Individual requirements, Medications and medical devices, Safety Alerts, Person concerns, expectations and wishes, Legal Information, Information and advice given, Participation in research (R); Family History, Social Context, Examination Findings, Assessment Scales, Relevant clinical risk factors, Investigations and results, Distribution list (O). Referral Details sub-elements from the Core Information Standard v2.01. Mapping indicative - To confirm"/> </mapping> </element> <element id="Referral.referralId"> <path value="Referral.referralId"/> <short value="Referral ID"/> <definition value="Unique identifier assigned by the Referral Initiator, used in every message about the referral"/> <min value="1"/> <max value="1"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-2 and OBR-2 (OMG^O19); ORC-2 (OSU^O51); SCH-26 (SIU)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.identifier:referralId; Task.basedOn.identifier; Appointment.basedOn.identifier"/> </mapping> </element> <element id="Referral.ubrn"> <path value="Referral.ubrn"/> <short value="Unique Booking Reference Number"/> <definition value="eRS identifier, if the referral was made through eRS"/> <min value="0"/> <max value="1"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="Not in 360X; NHS: ORC-2 or OBR-2 repetition with UBRN assigning authority (To confirm)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.identifier:ubrn"/> </mapping> </element> <element id="Referral.patient"> <path value="Referral.patient"/> <short value="Patient"/> <definition value="The patient referred"/> <min value="1"/> <max value="1"/> <type> <code value="BackboneElement"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="PID"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.subject (Patient)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Patient Demographics; GP Practice"/> </mapping> </element> <element id="Referral.patient.nhsNumber"> <path value="Referral.patient.nhsNumber"/> <short value="NHS Number"/> <definition value="Traced NHS Number"/> <min value="0"/> <max value="1"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="PID-3 (assigning authority NHS)"/> </mapping> <mapping> <identity value="fhir"/> <map value="Patient.identifier:nhsNumber"/> </mapping> </element> <element id="Referral.patient.localIdentifier"> <path value="Referral.patient.localIdentifier"/> <short value="Local patient identifier"/> <definition value="Referral Initiator's identifier (360X sourcePatientId), and any identifier the Referral Recipient adds"/> <min value="0"/> <max value="*"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="PID-3"/> </mapping> <mapping> <identity value="fhir"/> <map value="Patient.identifier:MedicalRecordNumber"/> </mapping> </element> <element id="Referral.patient.demographics"> <path value="Referral.patient.demographics"/> <short value="Demographics"/> <definition value="Name, date of birth, sex, address"/> <min value="1"/> <max value="1"/> <type> <code value="BackboneElement"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="PID-5, PID-7, PID-8, PID-11"/> </mapping> <mapping> <identity value="fhir"/> <map value="Patient.name, birthDate, gender, address"/> </mapping> </element> <element id="Referral.referrer"> <path value="Referral.referrer"/> <short value="Referrer"/> <definition value="The Referral Initiator"/> <min value="1"/> <max value="1"/> <type> <code value="BackboneElement"/> </type> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Referrer details; Person completing record"/> </mapping> </element> <element id="Referral.referrer.clinician"> <path value="Referral.referrer.clinician"/> <short value="Referring clinician"/> <definition value="Professional registration or GP code"/> <min value="1"/> <max value="1"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-12 and OBR-16"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.requester (PractitionerRole.practitioner)"/> </mapping> </element> <element id="Referral.referrer.organisation"> <path value="Referral.referrer.organisation"/> <short value="Referring organisation"/> <definition value="ODS code"/> <min value="1"/> <max value="1"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-21 (required in this guide) / MSH-4"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.requester (PractitionerRole.organization)"/> </mapping> </element> <element id="Referral.recipient"> <path value="Referral.recipient"/> <short value="Referred to"/> <definition value="The Referral Recipient"/> <min value="0"/> <max value="1"/> <type> <code value="BackboneElement"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="MSH-5 / MSH-6"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.performer; Task.owner"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Referral to"/> </mapping> </element> <element id="Referral.recipient.service"> <path value="Referral.recipient.service"/> <short value="Service"/> <definition value="eRS service ID, Directory of Services ID or local service"/> <min value="0"/> <max value="1"/> <type> <code value="Identifier"/> </type> </element> <element id="Referral.recipient.clinician"> <path value="Referral.recipient.clinician"/> <short value="Clinician"/> <definition value="Named clinician, if any"/> <min value="0"/> <max value="1"/> <type> <code value="Identifier"/> </type> </element> <element id="Referral.recipient.organisation"> <path value="Referral.recipient.organisation"/> <short value="Organisation"/> <definition value="ODS code"/> <min value="0"/> <max value="1"/> <type> <code value="Identifier"/> </type> </element> <element id="Referral.serviceRequested"> <path value="Referral.serviceRequested"/> <short value="Service requested"/> <definition value="Specialty, clinic type or referral procedure"/> <min value="1"/> <max value="1"/> <type> <code value="CodeableConcept"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBR-4 (360X default LOINC 57133-1 Referral note)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.code"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Referral to; Referral criteria"/> </mapping> </element> <element id="Referral.priority"> <path value="Referral.priority"/> <short value="Priority"/> <definition value="routine, urgent, urgent suspected cancer, two week wait"/> <min value="0"/> <max value="1"/> <type> <code value="code"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-9"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.priority"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Clinical urgency of referral"/> </mapping> </element> <element id="Referral.expectedBy"> <path value="Referral.expectedBy"/> <short value="Expected service provision time"/> <definition value="The date by which the service should be provided (urgency converted to a date)"/> <min value="0"/> <max value="1"/> <type> <code value="dateTime"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-8"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.occurrenceDateTime"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Clinical urgency of referral"/> </mapping> </element> <element id="Referral.validityPeriod"> <path value="Referral.validityPeriod"/> <short value="Validity"/> <definition value="Period the referral is valid for"/> <min value="0"/> <max value="1"/> <type> <code value="Period"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-6"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.restriction.period (or ServiceRequest.occurrencePeriod)"/> </mapping> </element> <element id="Referral.reasonForReferral"> <path value="Referral.reasonForReferral"/> <short value="Reason for referral"/> <definition value="Coded (SNOMED CT) or text"/> <min value="1"/> <max value="*"/> <type> <code value="CodeableConcept"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBR-31"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.reasonCode / reasonReference"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Reason for referral"/> </mapping> </element> <element id="Referral.referralQuestion"> <path value="Referral.referralQuestion"/> <short value="Referral question"/> <definition value="The clinical question for the Referral Recipient"/> <min value="0"/> <max value="1"/> <type> <code value="string"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBX-5 (OBX-11 O, OBX-29 QST)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.note"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Reason for referral"/> </mapping> </element> <element id="Referral.clinicalDocument"> <path value="Referral.clinicalDocument"/> <short value="Clinical document"/> <definition value="The referrer's account of the episode that led to the referral - Discharge Report (HL7 Europe HDR) or clinic letter"/> <min value="0"/> <max value="*"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="CDA document in the XDM package (360X); NHS: OBX type ED or RP, or MDM^T02"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (Bundle - HL7 Europe HDR, or DocumentReference)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Examination Findings; Investigations and results; Relevant clinical risk factors; Information and advice given"/> </mapping> </element> <element id="Referral.patientSummary"> <path value="Referral.patientSummary"/> <short value="Patient summary"/> <definition value="The patient's background (HL7 Europe Patient Summary), when the recipient cannot query the record"/> <min value="0"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="CDA document in the XDM package (360X); NHS: OBX type ED or RP"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (Bundle - HL7 Europe EPS, or DocumentReference)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Allergies and adverse reactions; Medications and medical devices; Safety Alerts; Legal Information; Individual requirements; Family History; Social Context"/> </mapping> </element> <element id="Referral.forms"> <path value="Referral.forms"/> <short value="Referral forms"/> <definition value="Forms completed for the referral - see Referral Forms"/> <min value="0"/> <max value="*"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBX (ask at order entry)"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (QuestionnaireResponse)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Assessment Scales"/> </mapping> </element> <element id="Referral.observations"> <path value="Referral.observations"/> <short value="Observations"/> <definition value="Findings needed by the recipient, e.g. vital signs"/> <min value="0"/> <max value="*"/> <type> <code value="Reference"/> <targetProfile value="https://fhir.acmeexample.org.uk/PatientCareCoordination/StructureDefinition/Observation"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OBX"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.supportingInfo (Observation)"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Examination Findings; Investigations and results"/> </mapping> </element> <element id="Referral.carePlan"> <path value="Referral.carePlan"/> <short value="Care plan"/> <definition value="The care plan this referral carries out, if any"/> <min value="0"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan"/> </type> <mapping> <identity value="fhir"/> <map value="ServiceRequest.basedOn (CarePlan)"/> </mapping> </element> <element id="Referral.dateOfReferral"> <path value="Referral.dateOfReferral"/> <short value="Date of referral"/> <definition value="When the referral was made"/> <min value="1"/> <max value="1"/> <type> <code value="dateTime"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-9"/> </mapping> <mapping> <identity value="fhir"/> <map value="ServiceRequest.authoredOn"/> </mapping> <mapping> <identity value="prsb-cris"/> <map value="Referral Details: Date"/> </mapping> </element> <element id="Referral.status"> <path value="Referral.status"/> <short value="Referral status"/> <definition value="360X state - see Referral Workflow Status"/> <min value="1"/> <max value="1"/> <type> <code value="code"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-1 / ORC-5"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.businessStatus (and Task.status, ServiceRequest.status)"/> </mapping> </element> <element id="Referral.statusReason"> <path value="Referral.statusReason"/> <short value="Reason for decline or cancellation"/> <definition value="Free text at least"/> <min value="0"/> <max value="1"/> <type> <code value="CodeableConcept"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="ORC-16"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.statusReason"/> </mapping> </element> <element id="Referral.appointment"> <path value="Referral.appointment"/> <short value="Appointment"/> <definition value="Appointments booked to carry out the referral"/> <min value="0"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mapping> <identity value="fhir"/> <map value="Appointment (basedOn the ServiceRequest)"/> </mapping> </element> <element id="Referral.appointment.appointmentId"> <path value="Referral.appointment.appointmentId"/> <short value="Appointment ID"/> <definition value="Unique identifier of the appointment"/> <min value="1"/> <max value="1"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="SCH-2"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.identifier"/> </mapping> </element> <element id="Referral.appointment.dateTime"> <path value="Referral.appointment.dateTime"/> <short value="Appointment date and time"/> <definition value="At least the date"/> <min value="1"/> <max value="1"/> <type> <code value="dateTime"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="TQ1-7"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.start"/> </mapping> </element> <element id="Referral.appointment.provider"> <path value="Referral.appointment.provider"/> <short value="Appointment provider"/> <definition value="Clinician or service seeing the patient"/> <min value="0"/> <max value="1"/> <type> <code value="Identifier"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="AIP-3"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.participant.actor"/> </mapping> </element> <element id="Referral.appointment.status"> <path value="Referral.appointment.status"/> <short value="Appointment status"/> <definition value="booked, rescheduled, cancelled, no-show"/> <min value="1"/> <max value="1"/> <type> <code value="code"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="SIU trigger S12 / S13 / S15 / S26 (RGS-2)"/> </mapping> <mapping> <identity value="fhir"/> <map value="Appointment.status"/> </mapping> </element> <element id="Referral.interimNote"> <path value="Referral.interimNote"/> <short value="Interim consultation note"/> <definition value="Results sent before the end of care"/> <min value="0"/> <max value="*"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OSU^O51 (ORC-1 SC, ORC-5 A) with document"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.output (clinical document - Composition with HL7 Europe HDR section codes)"/> </mapping> </element> <element id="Referral.outcome"> <path value="Referral.outcome"/> <short value="Referral outcome"/> <definition value="Report that closes the loop - consultation note, discharge report or care plan"/> <min value="0"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Bundle"/> </type> <mapping> <identity value="hl7-v2-360x"/> <map value="OSU^O51 (ORC-1 SC, ORC-5 CM) with document"/> </mapping> <mapping> <identity value="fhir"/> <map value="Task.output (Discharge Report - HL7 Europe HDR, or clinic letter)"/> </mapping> </element> </differential> </StructureDefinition>