ServiceRequest

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

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Identifiers assigned to this order Details Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller. 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.
instantiatesCanonical		canonical[]	Instantiates FHIR protocol or definition Details 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. Note: This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
instantiatesUri		uri[]	Instantiates external protocol or definition Details 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. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
basedOn		Reference< CarePlan | ServiceRequest | MedicationRequest >[]	What request fulfills Details Plan/proposal/order fulfilled by this request.
replaces		Reference<ServiceRequest>[]	What request replaces Details The request takes the place of the referenced completed or terminated request(s).
requisition		Identifier	Composite Request ID Details 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. 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.
status	✓	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Details The status of the order. 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](event.html) for general discussion) or using the [Task](task.html) resource.
intent	✓	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Details Whether the request is a proposal, plan, an original order or a reflex order. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
category		CodeableConcept[]	Classification of service Details A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure"). 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.
priority		code	routine | urgent | asap | stat Details Indicates how quickly the ServiceRequest should be addressed with respect to other requests.
doNotPerform		boolean	True if service/procedure should not be performed Details Set this to true if the record is saying that the service/procedure should NOT be performed. 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.
code		CodeableConcept	What is being requested/ordered Details A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested. 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.
orderDetail		CodeableConcept[]	Additional order information Details 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. For information from the medical record intended to support the delivery of the requested services, use the `supportingInformation` element.
quantity[x]		Quantity, Ratio, Range	Service amount Details 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).
subject	✓	Reference< Patient | Group | Location | Device >	Individual or Entity the service is ordered for Details 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).
encounter		Reference<Encounter>	Encounter in which the request was created Details An encounter that provides additional information about the healthcare context in which this request is made.
occurrence[x]		dateTime, Period, Timing	When service should occur Details The date/time at which the requested service should occur.
asNeeded[x]		boolean, CodeableConcept	Preconditions for service Details If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.
authoredOn		dateTime	Date request signed Details When the request transitioned to being actionable.
requester		Reference< Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device >	Who/what is requesting service Details The individual who initiated the request and has responsibility for its activation. 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.
performerType		CodeableConcept	Performer role Details Desired type of performer for doing the requested service. 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”.
performer		Reference< Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson >[]	Requested performer Details The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc. 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](extension-request-performerorder.html). Use CareTeam to represent a group of performers (for example, Practitioner A *and* Practitioner B).
locationCode		CodeableConcept[]	Requested location Details 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.
locationReference		Reference<Location>[]	Requested location Details A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.
reasonCode		CodeableConcept[]	Explanation/Justification for procedure or service Details 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`. 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](servicerequest-example-di.html).
reasonReference		Reference< Condition | Observation | DiagnosticReport | DocumentReference >[]	Explanation/Justification for service or service Details Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo`. 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](servicerequest-example-di.html).
insurance		Reference<Coverage | ClaimResponse>[]	Associated insurance coverage Details Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.
supportingInfo		Reference<Resource>[]	Additional clinical information Details 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. To represent information about how the services are to be delivered use the `instructions` element.
specimen		Reference<Specimen>[]	Procedure Samples Details One or more specimens that the laboratory procedure will use. 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](specimen.html) resource points to the ServiceRequest.
bodySite		CodeableConcept[]	Location on Body Details Anatomic location where the procedure should be performed. This is the target site. 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](extension-procedure-targetbodystructure.html).
note		Annotation[]	Comments Details Any other notes and comments made about the service request. For example, internal billing notes.
patientInstruction		string	Patient or consumer-oriented instructions Details Instructions in terms that are understood by the patient or consumer.
relevantHistory		Reference<Provenance>[]	Request provenance Details Key events in the history of the request. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.

Search Parameters

Name	Type	Description	Expression
code	token	What is being requested/ordered	ServiceRequest.code
identifier	token	Identifiers assigned to this order	ServiceRequest.identifier
patient	reference	Search by subject - a patient	ServiceRequest.subject.where(resolve() is Patient)
encounter	reference	An encounter in which this request is made	ServiceRequest.encounter
authored	date	Date request signed	ServiceRequest.authoredOn
based-on	reference	What request fulfills	ServiceRequest.basedOn
body-site	token	Where procedure is going to be done	ServiceRequest.bodySite
category	token	Classification of service	ServiceRequest.category
instantiates-canonical	reference	Instantiates FHIR protocol or definition	ServiceRequest.instantiatesCanonical
instantiates-uri	uri	Instantiates external protocol or definition	ServiceRequest.instantiatesUri
intent	token	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option	ServiceRequest.intent
occurrence	date	When service should occur	ServiceRequest.occurrence
order-details	token	Order detail	ServiceRequest.orderDetail.text
performer	reference	Requested performer	ServiceRequest.performer
performer-type	token	Performer role	ServiceRequest.performerType
priority	token	routine | urgent | asap | stat	ServiceRequest.priority
replaces	reference	What request replaces	ServiceRequest.replaces
requester	reference	Who/what is requesting service	ServiceRequest.requester
requisition	token	Composite Request ID	ServiceRequest.requisition
specimen	reference	Specimen to be tested	ServiceRequest.specimen
status	token	draft | active | on-hold | revoked | completed | entered-in-error | unknown	ServiceRequest.status
subject	reference	Search by subject	ServiceRequest.subject
priority-order	number	Numeric priority order for resource types using http://hl7.org/fhir/ValueSet/request-priority	iif(priority = 'stat', 50, iif(priority = 'asap', 40, iif(priority = 'urgent', 30, iif(priority = 'routine', 20, 10))))

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details 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.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
text		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
contained		Resource[]	Contained, inline Resources Details These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details 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. 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.
modifierExtension		Extension[]	Extensions that cannot be ignored Details May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Usage

This resource is a request resource from a FHIR workflow perspective - see Workflow.

ServiceRequest is a record of a request for a procedure or diagnostic or other service to be planned, proposed, or performed, as distinguished by the ServiceRequest.intent field value, with or on a patient. The procedure will lead to either a Procedure or DiagnosticReport, which in turn may reference one or more Observations, which summarize the performance of the procedures and associated documentation such as observations, images, findings that are relevant to the treatment/management of the subject. This resource may be used to share relevant information required to support a referral or a transfer of care request from one practitioner or organization to another when a patient is required to be referred to another provider for a consultation /second opinion and/or for short term or longer term management of one or more health issues or problems.

Examples include:

• diagnostic tests/studies
• endoscopic procedures
• counseling
• biopsies
• therapies (e.g., physio-, social-, psychological-)
• (exploratory) surgeries or procedures
• exercises
• specialist consultation and assessments
• community services
• nursing services
• pharmacist medication review, and
• other clinical interventions.

Procedures may be performed by a healthcare professional, a friend or relative or in some cases by the patient themselves.

The principal intention of ServiceRequest is to support ordering procedures for one patient (which includes non-human patients in veterinary medicine). However, in many contexts, healthcare related processes include performing diagnostic investigations on groups of subjects, devices involved in the provision of healthcare, and even environmental locations such as ducts, bodies of water, etc. ServiceRequest supports all these usages. The service request may represent an order that is entered by a practitioner in a CPOE system as well as a proposal made by a clinical decision support (CDS) system based on a patient's clinical record and context of care. Planned procedures referenced by a CarePlan may also be represented by this resource.

The general work flow that this resource facilitates is that a clinical system creates a service request. The service request is then accessed by or exchanged with a system, perhaps via intermediaries, that represents an organization (e.g., diagnostic or imaging service, surgical team, physical therapy department) that can perform the procedure. The organization receiving the service request will, after it accepts the request, update the request as the work is performed, and then finally issue a report that references the requests that it fulfilled.

The ServiceRequest resource allows requesting only a single procedure. If a workflow requires requesting multiple procedures simultaneously, this is done using multiple instances of this resource. These instances can be linked in different ways, depending on the needs of the workflow. For guidance, refer to the Request pattern

Relationships

ServiceRequest is a record of a proposal/plan or order for a service to be performed that would result in a Procedure, Observation, DiagnosticReport, ImagingStudy or similar resource. In contrast to ServiceRequest, Task which spans both intent and event and tracks the execution through to completion and is intended for "administrative" actions like requesting and tracking things to be done to a record, or keeping track of a checklist of steps such to be performed as part of a fulfilment process. A ServiceRequest can be higher-level authorization that triggered the creation of Task, or it can be the "request" resource Task is seeking to fulfill.

ServiceRequest and CommunicationRequest are related. A CommunicationRequest is a request to merely disclose information. Whereas a ServiceRequest would be used to request information as part of training or counseling - i.e. when the process will involve verification of the patient's comprehension or an attempt to change the patient's mental state. In some workflows both may exist. For example, upon receiving a CommunicationRequest a practitioner might initiate a ServiceRequest.

Referenced By

• Appointment
• BiologicallyDerivedProduct
• CarePlan
• Claim
• DeviceUseStatement
• DiagnosticReport
• Encounter
• EpisodeOfCare
• ExplanationOfBenefit
• Goal
• ImagingStudy
• Media
• MedicationRequest
• MedicationStatement
• Observation
• Procedure
• QuestionnaireResponse
• Specimen