MyHealth@Eu Laboratory Report
0.0.1 - qa-preview 150

This page is part of the MyHealth@Eu Laboratory Report (v0.0.1: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: ServiceRequestLabMyHealthEu - Detailed Descriptions

Draft as of 2024-04-18

Definitions for the ServiceRequest-lab-myhealtheu resource profile.

Guidance on how to interpret the contents of this table can be found here

0. ServiceRequest
2. ServiceRequest.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Obligations
    ObligationsActor
    handleLabReportHandler
    4. ServiceRequest.requisition
    Obligations
      ObligationsActor
      handleLabReportHandler
      6. ServiceRequest.status
      ShortThe status of a service order
      8. ServiceRequest.intent
      ShortThe kind of service reques
      10. ServiceRequest.code
      BindingThe codes SHALL be taken from eHDSI Laboratory Codes with exceptions
      (required to http://fhir.ehdsi.eu/laboratory/ValueSet/eHDSILabCodeWithExceptions)
      12. ServiceRequest.subject
      TypeReference(Patient: Laboratory)
      14. ServiceRequest.authoredOn
      Obligations
        ObligationsActor
        handleLabReportHandler
        16. ServiceRequest.requester
        Obligations
          ObligationsActor
          handleLabReportHandler
          18. ServiceRequest.reasonCode
          BindingThe codes SHALL be taken from eHDSI Order Reason
          (required to http://fhir.ehdsi.eu/laboratory/ValueSet/eHDSIOrderReason)
          Obligations
            ObligationsActor
            handleLabReportHandler
            20. ServiceRequest.reasonReference
            Obligations
              ObligationsActor
              handleLabReportHandler
              22. ServiceRequest.insurance
              TypeReference(Coverage: Laboratory)
              Obligations
                ObligationsActor
                handleLabReportHandler
                24. ServiceRequest.specimen
                TypeReference(Specimen: Laboratory)

                Guidance on how to interpret the contents of this table can be found here

                0. ServiceRequest
                Definition

                Laboratory Order composition.


                A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.

                ShortLaboratory OrderA request for a service to be performed
                Control0..*
                Is Modifierfalse
                Summaryfalse
                Alternate Namesdiagnostic request, referral, referral request, transfer of care request
                Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                dom-3: 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())
                dom-4: 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())
                dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                dom-6: A resource should have narrative for robust management (text.`div`.exists())
                prr-1: orderDetail SHALL only be present if code is present (orderDetail.empty() or code.exists())
                prr-1: orderDetail SHALL only be present if code is present (orderDetail.empty() or code.exists())
                2. ServiceRequest.implicitRules
                Definition

                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.

                ShortA set of rules under which this content was created
                Comments

                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.

                Control0..1
                Typeuri
                Is Modifiertrue because 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
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                4. ServiceRequest.modifierExtension
                Definition

                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).

                ShortExtensions that cannot be ignored
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                Summaryfalse
                Requirements

                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.

                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                6. ServiceRequest.identifier
                Definition

                Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.

                ShortIdentifiers assigned to this order
                Comments

                The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.

                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control10..*
                TypeIdentifier
                Is Modifierfalse
                Obligations
                  ObligationsActor
                  handleLabReportHandler
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  8. ServiceRequest.requisition
                  Definition

                  A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.

                  ShortComposite Request ID.
                  Comments

                  Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

                  Control0..1
                  TypeIdentifier
                  Is Modifierfalse
                  Obligations
                    ObligationsActor
                    handleLabReportHandler
                    Summarytrue
                    Requirements

                    Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

                    Alternate NamesgrouperId, groupIdentifier
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    10. ServiceRequest.status
                    Definition

                    The status of the order.

                    ShortThe status of a service orderdraft | active | on-hold | revoked | completed | entered-in-error | unknown
                    Comments

                    The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.


                    The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

                    Control1..1
                    BindingThe codes SHALL be taken from RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1
                    (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

                    The status of a service order.

                    Typecode
                    Is Modifiertrue because 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
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    12. ServiceRequest.intent
                    Definition

                    Whether the request is a proposal, plan, an original order or a reflex order.

                    ShortThe kind of service requesproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
                    Comments

                    This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

                    Control1..1
                    BindingThe codes SHALL be taken from RequestIntenthttp://hl7.org/fhir/ValueSet/request-intent|4.0.1
                    (required to http://hl7.org/fhir/ValueSet/request-intent|4.0.1)

                    The kind of service request.

                    Typecode
                    Is Modifiertrue because 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
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    14. ServiceRequest.doNotPerform
                    Definition

                    Set this to true if the record is saying that the service/procedure should NOT be performed.

                    ShortTrue if service/procedure should not be performed
                    Comments

                    In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

                    Control0..1
                    Typeboolean
                    Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a procedure, it is a request for the procedure to not occur.
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

                    Meaning if MissingIf missing, the request is a positive request e.g. "do perform"
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    16. ServiceRequest.code
                    Definition

                    A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.

                    ShortWhat is being requested/ordered
                    Comments

                    Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.

                    Control0..1
                    BindingThe codes SHALL be taken from For example codes, see eHDSI Laboratory Codes with exceptionshttp://hl7.org/fhir/ValueSet/procedure-code
                    (required to http://fhir.ehdsi.eu/laboratory/ValueSet/eHDSILabCodeWithExceptions)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Summarytrue
                    Alternate Namesservice requested
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    18. ServiceRequest.subject
                    Definition

                    On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).

                    ShortIndividual or Entity the service is ordered for
                    Control1..1
                    TypeReference(Patient: Laboratory, Patient, Group, Location, Device)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    20. ServiceRequest.authoredOn
                    Definition

                    When the request transitioned to being actionable.

                    ShortWhen the order was placedDate request signed
                    Control0..1
                    TypedateTime
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Obligations
                      ObligationsActor
                      handleLabReportHandler
                      Summarytrue
                      Alternate NamesorderedOn
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      22. ServiceRequest.requester
                      Definition

                      The individual who initiated the request and has responsibility for its activation.

                      ShortWho/what is requesting service
                      Comments

                      This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.

                      Control0..1
                      TypeReference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
                      Is Modifierfalse
                      Obligations
                        ObligationsActor
                        handleLabReportHandler
                        Summarytrue
                        Alternate Namesauthor, orderer
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        24. ServiceRequest.reasonCode
                        Definition

                        An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

                        ShortExplanation/Justification for procedure or service
                        Comments

                        This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

                        Control0..*
                        BindingThe codes SHALL be taken from For example codes, see eHDSI Order Reasonhttp://hl7.org/fhir/ValueSet/procedure-reason
                        (required to http://fhir.ehdsi.eu/laboratory/ValueSet/eHDSIOrderReason)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Obligations
                          ObligationsActor
                          handleLabReportHandler
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          26. ServiceRequest.reasonReference
                          Definition

                          Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.

                          ShortExplanation/Justification for service or service
                          Comments

                          This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

                          Control0..*
                          TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
                          Is Modifierfalse
                          Obligations
                            ObligationsActor
                            handleLabReportHandler
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            28. ServiceRequest.insurance
                            Definition

                            Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.

                            ShortAssociated insurance coverage
                            Control0..*
                            TypeReference(Coverage: Laboratory, Coverage, ClaimResponse)
                            Is Modifierfalse
                            Obligations
                              ObligationsActor
                              handleLabReportHandler
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              30. ServiceRequest.specimen
                              Definition

                              One or more specimens that the laboratory procedure will use.

                              ShortSpecimens to be used by the laboratory procedureProcedure Samples
                              Comments

                              If the specimen information are known when the order is created then the ServiceRequest.specimen should be used. If the ServiceRequest can be updated when the specimen is collected then the ServiceRequest.specimen or the Specimen.request could be used. Otherwise the relationship is recorded in the Specimen.request element


                              Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.

                              Control0..*
                              TypeReference(Specimen: Laboratory, Specimen)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                              Guidance on how to interpret the contents of this table can be found here

                              0. ServiceRequest
                              Definition

                              Laboratory Order composition.

                              ShortLaboratory Order
                              Control0..*
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesdiagnostic request, referral, referral request, transfer of care request
                              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                              dom-3: 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())
                              dom-4: 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())
                              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                              dom-6: A resource should have narrative for robust management (text.`div`.exists())
                              prr-1: orderDetail SHALL only be present if code is present (orderDetail.empty() or code.exists())
                              2. ServiceRequest.id
                              Definition

                              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                              ShortLogical id of this artifact
                              Comments

                              The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                              Control0..1
                              Typeid
                              Is Modifierfalse
                              Summarytrue
                              4. ServiceRequest.meta
                              Definition

                              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.

                              ShortMetadata about the resource
                              Control0..1
                              TypeMeta
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              6. ServiceRequest.implicitRules
                              Definition

                              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.

                              ShortA set of rules under which this content was created
                              Comments

                              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.

                              Control0..1
                              Typeuri
                              Is Modifiertrue because 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
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              8. ServiceRequest.language
                              Definition

                              The base language in which the resource is written.

                              ShortLanguage of the resource content
                              Comments

                              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).

                              Control0..1
                              BindingThe codes SHOULD be taken from CommonLanguages
                              (preferred to http://hl7.org/fhir/ValueSet/languages)

                              A human language.

                              Additional BindingsPurpose
                              AllLanguagesMax Binding
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              10. ServiceRequest.text
                              Definition

                              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.

                              ShortText summary of the resource, for human interpretation
                              Comments

                              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.

                              Control0..1
                              TypeNarrative
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesnarrative, html, xhtml, display
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              12. ServiceRequest.contained
                              Definition

                              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.

                              ShortContained, inline Resources
                              Comments

                              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.

                              Control0..*
                              TypeResource
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesinline resources, anonymous resources, contained resources
                              14. ServiceRequest.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the resource. 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.

                              ShortAdditional content defined by implementations
                              Comments

                              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.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              16. ServiceRequest.modifierExtension
                              Definition

                              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).

                              ShortExtensions that cannot be ignored
                              Comments

                              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.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                              Summaryfalse
                              Requirements

                              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.

                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              18. ServiceRequest.identifier
                              Definition

                              Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.

                              ShortIdentifiers assigned to this order
                              Comments

                              The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.

                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control1..*
                              TypeIdentifier
                              Is Modifierfalse
                              Obligations
                                ObligationsActor
                                handleLabReportHandler
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                20. ServiceRequest.instantiatesCanonical
                                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 ServiceRequest.

                                ShortInstantiates FHIR protocol or definition
                                Comments

                                Note: This is a business identifier, not a resource identifier (see discussion). 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.

                                Control0..*
                                Typecanonical(ActivityDefinition, PlanDefinition)
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                22. ServiceRequest.instantiatesUri
                                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 ServiceRequest.

                                ShortInstantiates external protocol or definition
                                Comments

                                This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

                                Control0..*
                                Typeuri
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                24. ServiceRequest.basedOn
                                Definition

                                Plan/proposal/order fulfilled by this request.

                                ShortWhat request fulfills
                                Control0..*
                                TypeReference(CarePlan, ServiceRequest, MedicationRequest)
                                Is Modifierfalse
                                Summarytrue
                                Alternate Namesfulfills
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                26. ServiceRequest.replaces
                                Definition

                                The request takes the place of the referenced completed or terminated request(s).

                                ShortWhat request replaces
                                Control0..*
                                TypeReference(ServiceRequest)
                                Is Modifierfalse
                                Summarytrue
                                Alternate Namessupersedes, prior, renewed order
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                28. ServiceRequest.requisition
                                Definition

                                A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.

                                ShortComposite Request ID.
                                Comments

                                Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

                                Control0..1
                                TypeIdentifier
                                Is Modifierfalse
                                Obligations
                                  ObligationsActor
                                  handleLabReportHandler
                                  Summarytrue
                                  Requirements

                                  Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

                                  Alternate NamesgrouperId, groupIdentifier
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  30. ServiceRequest.status
                                  Definition

                                  The status of the order.

                                  ShortThe status of a service order
                                  Comments

                                  The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

                                  Control1..1
                                  BindingThe codes SHALL be taken from RequestStatus
                                  (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

                                  The status of a service order.

                                  Typecode
                                  Is Modifiertrue because 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
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  32. ServiceRequest.intent
                                  Definition

                                  Whether the request is a proposal, plan, an original order or a reflex order.

                                  ShortThe kind of service reques
                                  Comments

                                  This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

                                  Control1..1
                                  BindingThe codes SHALL be taken from RequestIntent
                                  (required to http://hl7.org/fhir/ValueSet/request-intent|4.0.1)

                                  The kind of service request.

                                  Typecode
                                  Is Modifiertrue because 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
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  34. ServiceRequest.category
                                  Definition

                                  A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").

                                  ShortClassification of service
                                  Comments

                                  There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.

                                  Control0..*
                                  BindingFor example codes, see ServiceRequestCategoryCodes
                                  (example to http://hl7.org/fhir/ValueSet/servicerequest-category)

                                  Classification of the requested service.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Used for filtering what service request are retrieved and displayed.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  36. ServiceRequest.priority
                                  Definition

                                  Indicates how quickly the ServiceRequest should be addressed with respect to other requests.

                                  Shortroutine | urgent | asap | stat
                                  Control0..1
                                  BindingThe codes SHALL be taken from RequestPriority
                                  (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

                                  Identifies the level of importance to be assigned to actioning the request.

                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Meaning if MissingIf missing, this task should be performed with normal priority
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  38. ServiceRequest.doNotPerform
                                  Definition

                                  Set this to true if the record is saying that the service/procedure should NOT be performed.

                                  ShortTrue if service/procedure should not be performed
                                  Comments

                                  In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

                                  Control0..1
                                  Typeboolean
                                  Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a procedure, it is a request for the procedure to not occur.
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

                                  Meaning if MissingIf missing, the request is a positive request e.g. "do perform"
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  40. ServiceRequest.code
                                  Definition

                                  A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.

                                  ShortWhat is being requested/ordered
                                  Comments

                                  Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.

                                  Control0..1
                                  BindingThe codes SHALL be taken from eHDSI Laboratory Codes with exceptions
                                  (required to http://fhir.ehdsi.eu/laboratory/ValueSet/eHDSILabCodeWithExceptions)
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Alternate Namesservice requested
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  42. ServiceRequest.orderDetail
                                  Definition

                                  Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.

                                  ShortAdditional order information
                                  Comments

                                  For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

                                  Control0..*
                                  This element is affected by the following invariants: prr-1
                                  BindingFor example codes, see ServiceRequestOrderDetailsCodes
                                  (example to http://hl7.org/fhir/ValueSet/servicerequest-orderdetail)

                                  Codified order entry details which are based on order context.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Alternate Namesdetailed instructions
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  44. ServiceRequest.quantity[x]
                                  Definition

                                  An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).

                                  ShortService amount
                                  Control0..1
                                  TypeChoice of: Quantity, Ratio, Range
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  When ordering a service the number of service items may need to be specified separately from the the service item.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  46. ServiceRequest.subject
                                  Definition

                                  On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).

                                  ShortIndividual or Entity the service is ordered for
                                  Control1..1
                                  TypeReference(Patient: Laboratory)
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  48. ServiceRequest.encounter
                                  Definition

                                  An encounter that provides additional information about the healthcare context in which this request is made.

                                  ShortEncounter in which the request was created
                                  Control0..1
                                  TypeReference(Encounter)
                                  Is Modifierfalse
                                  Summarytrue
                                  Alternate Namescontext
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  50. ServiceRequest.occurrence[x]
                                  Definition

                                  The date/time at which the requested service should occur.

                                  ShortWhen service should occur
                                  Control0..1
                                  TypeChoice of: dateTime, Period, Timing
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Alternate Namesschedule
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  52. ServiceRequest.asNeeded[x]
                                  Definition

                                  If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.

                                  ShortPreconditions for service
                                  Control0..1
                                  BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
                                  (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

                                  A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

                                  TypeChoice of: boolean, CodeableConcept
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  54. ServiceRequest.authoredOn
                                  Definition

                                  When the request transitioned to being actionable.

                                  ShortWhen the order was placed
                                  Control0..1
                                  TypedateTime
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Obligations
                                    ObligationsActor
                                    handleLabReportHandler
                                    Summarytrue
                                    Alternate NamesorderedOn
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    56. ServiceRequest.requester
                                    Definition

                                    The individual who initiated the request and has responsibility for its activation.

                                    ShortWho/what is requesting service
                                    Comments

                                    This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.

                                    Control0..1
                                    TypeReference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
                                    Is Modifierfalse
                                    Obligations
                                      ObligationsActor
                                      handleLabReportHandler
                                      Summarytrue
                                      Alternate Namesauthor, orderer
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      58. ServiceRequest.performerType
                                      Definition

                                      Desired type of performer for doing the requested service.

                                      ShortPerformer role
                                      Comments

                                      This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.

                                      Control0..1
                                      BindingFor example codes, see ParticipantRoles
                                      (example to http://hl7.org/fhir/ValueSet/participant-role)

                                      Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summarytrue
                                      Alternate Namesspecialty
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      60. ServiceRequest.performer
                                      Definition

                                      The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.

                                      ShortRequested performer
                                      Comments

                                      If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).

                                      Control0..*
                                      TypeReference(Practitioner, PractitionerRole, Organization, CareTeam, HealthcareService, Patient, Device, RelatedPerson)
                                      Is Modifierfalse
                                      Summarytrue
                                      Alternate Namesrequest recipient
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      62. ServiceRequest.locationCode
                                      Definition

                                      The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.

                                      ShortRequested location
                                      Control0..*
                                      BindingFor example codes, see ServiceDeliveryLocationRoleType
                                      (example to http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType)

                                      A location type where services are delivered.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      64. ServiceRequest.locationReference
                                      Definition

                                      A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.

                                      ShortRequested location
                                      Control0..*
                                      TypeReference(Location)
                                      Is Modifierfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      66. ServiceRequest.reasonCode
                                      Definition

                                      An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

                                      ShortExplanation/Justification for procedure or service
                                      Comments

                                      This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

                                      Control0..*
                                      BindingThe codes SHALL be taken from eHDSI Order Reason
                                      (required to http://fhir.ehdsi.eu/laboratory/ValueSet/eHDSIOrderReason)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Obligations
                                        ObligationsActor
                                        handleLabReportHandler
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        68. ServiceRequest.reasonReference
                                        Definition

                                        Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.

                                        ShortExplanation/Justification for service or service
                                        Comments

                                        This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

                                        Control0..*
                                        TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
                                        Is Modifierfalse
                                        Obligations
                                          ObligationsActor
                                          handleLabReportHandler
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          70. ServiceRequest.insurance
                                          Definition

                                          Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.

                                          ShortAssociated insurance coverage
                                          Control0..*
                                          TypeReference(Coverage: Laboratory)
                                          Is Modifierfalse
                                          Obligations
                                            ObligationsActor
                                            handleLabReportHandler
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            72. ServiceRequest.supportingInfo
                                            Definition

                                            Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.

                                            ShortAdditional information: e.g AOEs and prior results
                                            Comments

                                            To represent information about how the services are to be delivered use the instructions element.

                                            Control0..*
                                            TypeReference(Resource)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate NamesAsk at order entry question, AOE
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            74. ServiceRequest.specimen
                                            Definition

                                            One or more specimens that the laboratory procedure will use.

                                            ShortSpecimens to be used by the laboratory procedure
                                            Comments

                                            If the specimen information are known when the order is created then the ServiceRequest.specimen should be used. If the ServiceRequest can be updated when the specimen is collected then the ServiceRequest.specimen or the Specimen.request could be used. Otherwise the relationship is recorded in the Specimen.request element

                                            Control0..*
                                            TypeReference(Specimen: Laboratory)
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            76. ServiceRequest.bodySite
                                            Definition

                                            Anatomic location where the procedure should be performed. This is the target site.

                                            ShortLocation on Body
                                            Comments

                                            Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure.

                                            Control0..*
                                            BindingFor example codes, see SNOMEDCTBodyStructures
                                            (example to http://hl7.org/fhir/ValueSet/body-site)

                                            Codes describing anatomical locations. May include laterality.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summarytrue
                                            Requirements

                                            Knowing where the procedure is performed is important for tracking if multiple sites are possible.

                                            Alternate Nameslocation
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            78. ServiceRequest.note
                                            Definition

                                            Any other notes and comments made about the service request. For example, internal billing notes.

                                            ShortComments
                                            Control0..*
                                            TypeAnnotation
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            80. ServiceRequest.patientInstruction
                                            Definition

                                            Instructions in terms that are understood by the patient or consumer.

                                            ShortPatient or consumer-oriented instructions
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            82. ServiceRequest.relevantHistory
                                            Definition

                                            Key events in the history of the request.

                                            ShortRequest provenance
                                            Comments

                                            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.

                                            Control0..*
                                            TypeReference(Provenance)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))