| Australian Digital Health Agency Medicare Records FHIR Implementation Guide 2.1.0

Australian Digital Health Agency Medicare Records FHIR Implementation Guide. The current version which supersedes this version is 2.2.0. It is based on FHIR® version 3.0.2. See the Directory of published versions for a list of available versions.

### StructureDefinition: ADHA MBS DVA ReferralRequest [Active]

The purpose of this profile is to define a representation of service item claimed information, including practitioner that requested the service, in a claim against the Medicare Benefits Schedule (MBS) or Department of Veterans’ Affairs (DVA) for the electronic exchange of digital health information between Medicare repositories and the My Health Record system infrastructure in Australia.

##### Usage scenarios

The following are the usage scenarios expected:

- An individual’s MBS claim item records are uploaded to the My Health Record system from a Medicare repository

##### Each ReferralRequest SHALL have

1. a profile assertion to this profile
2. a status of referral request
3. an intent
4. a patient
5. a practitioner that requested the service

##### Must Support

In the context of this profile Must Support SHALL be interpreted as follows.

- The system SHALL be able to store and retrieve the following elements:
  - status
  - intent
  - requester
  - requester.agent
  - requester.onBehalfOf
  - specialty
- The system SHALL be able to take the following elements into account when performing processing:
  - identifier
  - subject

##### Profile-specific implementation guidance

- The patient resource should be identified in the subject element with a logical reference, i.e. an Australian IHI

#### Formal Views of Profile Content

The official URL for this profile is:

    http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/referralrequest-mbsdva

The purpose of this profile is to define a representation of service item claimed information, including practitioner that requested the service, in a claim against the Medicare Benefits Schedule (MBS) or Department of Veterans' Affairs (DVA) for the electronic exchange of digital health information between Medicare repositories and the My Health Record system infrastructure in Australia.

This profile builds on ReferralRequest.

This profile was published on 2023-04-14 04:15:22+0000 as a active by Australian Digital Health Agency.

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

- Differential Table
- Snapshot Table
- All

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ReferralRequest | C | 0..* | ReferralRequest | A request for referral or transfer of care inv-dh-rr-01: One meta.profile SHALL have value 'http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/referralrequest-mbsdva'
meta |  | 1..1 | Meta | Metadata about the resource
profile |  | 1..* | uri | Profiles this resource claims to conform to
identifier | S | 0..* | Identifier | Business identifier
status | S | 1..1 | code | draft | active | suspended | cancelled | completed | entered-in-error | unknown Fixed Value: completed
intent | S | 1..1 | code | proposal | plan | order Fixed Value: order
subject | S | 1..1 | Reference(AU Base Patient) | Patient referred to care or transfer
requester | S | 1..1 | BackboneElement | Who/what is requesting service
agent | S | 1..1 | Reference(AU Base Practitioner) | Individual making the request
onBehalfOf | S | 0..1 | Reference(AU Base Organisation) | Organization agent is acting for
specialty | S | 0..1 | CodeableConcept | The clinical specialty (discipline) that the referral is requested for Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ReferralRequest | C | 0..* | ReferralRequest | A request for referral or transfer of care inv-dh-rr-01: One meta.profile SHALL have value 'http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/referralrequest-mbsdva'
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 1..1 | Meta | Metadata about the resource
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
profile | Σ | 1..* | uri | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Business identifier
definition | Σ | 0..* | Reference(ActivityDefinition | PlanDefinition) | Instantiates protocol or definition
basedOn | Σ | 0..* | Reference(ReferralRequest | CarePlan | ProcedureRequest) | Request fulfilled by this request
replaces | Σ | 0..* | Reference(ReferralRequest) | Request(s) replaced by this request
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
status | ?!S Σ | 1..1 | code | draft | active | suspended | cancelled | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of the referral. Fixed Value: completed
intent | ?!S Σ | 1..1 | code | proposal | plan | order Binding: RequestIntent (required): Codes identifying the stage lifecycle stage of a request Fixed Value: order
type | Σ | 0..1 | CodeableConcept | Referral/Transition of care request type Binding: SNOMED CT Patient Referral (example): Codes for types of referral; e.g. consult, transfer, temporary transfer.
priority | Σ | 0..1 | code | Urgency of referral / transfer of care request Binding: RequestPriority (required): Codes indicating the relative priority of the referral.
serviceRequested | Σ | 0..* | CodeableConcept | Actions requested as part of the referral Binding: Practice Setting Code Value Set (example): Codes indicating the types of services that might be requested as part of a referral.
subject | S Σ | 1..1 | Reference(AU Base Patient) | Patient referred to care or transfer
context | Σ | 0..1 | Reference(Encounter | EpisodeOfCare) | Originating encounter
occurrence[x] | Σ | 0..1 |  | When the service(s) requested in the referral should occur
occurrenceDateTime |  |  | dateTime |
occurrencePeriod |  |  | Period |
authoredOn | Σ | 0..1 | dateTime | Date of creation/activation
requester | S Σ C | 1..1 | BackboneElement | Who/what is requesting service
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
agent | S Σ | 1..1 | Reference(AU Base Practitioner) | Individual making the request
onBehalfOf | S Σ C | 0..1 | Reference(AU Base Organisation) | Organization agent is acting for
specialty | S | 0..1 | CodeableConcept | The clinical specialty (discipline) that the referral is requested for Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)
recipient | Σ | 0..* | Reference(Practitioner | Organization | HealthcareService) | Receiver of referral / transfer of care request
reasonCode | Σ | 0..* | CodeableConcept | Reason for referral / transfer of care request Binding: SNOMED CT Clinical Findings (example): Codes indicating why the referral is being requested.
reasonReference | Σ | 0..* | Reference(Condition | Observation) | Why is service needed?
description |  | 0..1 | string | A textual description of the referral
supportingInfo |  | 0..* | Reference(Resource) | Additonal information to support referral or transfer of care request
note |  | 0..* | Annotation | Comments made about referral request
relevantHistory |  | 0..* | Reference(Provenance) | Key events in history of request
Documentation for this format

Differential View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ReferralRequest | C | 0..* | ReferralRequest | A request for referral or transfer of care inv-dh-rr-01: One meta.profile SHALL have value 'http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/referralrequest-mbsdva'
meta |  | 1..1 | Meta | Metadata about the resource
profile |  | 1..* | uri | Profiles this resource claims to conform to
identifier | S | 0..* | Identifier | Business identifier
status | S | 1..1 | code | draft | active | suspended | cancelled | completed | entered-in-error | unknown Fixed Value: completed
intent | S | 1..1 | code | proposal | plan | order Fixed Value: order
subject | S | 1..1 | Reference(AU Base Patient) | Patient referred to care or transfer
requester | S | 1..1 | BackboneElement | Who/what is requesting service
agent | S | 1..1 | Reference(AU Base Practitioner) | Individual making the request
onBehalfOf | S | 0..1 | Reference(AU Base Organisation) | Organization agent is acting for
specialty | S | 0..1 | CodeableConcept | The clinical specialty (discipline) that the referral is requested for Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ReferralRequest | C | 0..* | ReferralRequest | A request for referral or transfer of care inv-dh-rr-01: One meta.profile SHALL have value 'http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/referralrequest-mbsdva'
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 1..1 | Meta | Metadata about the resource
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
profile | Σ | 1..* | uri | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Business identifier
definition | Σ | 0..* | Reference(ActivityDefinition | PlanDefinition) | Instantiates protocol or definition
basedOn | Σ | 0..* | Reference(ReferralRequest | CarePlan | ProcedureRequest) | Request fulfilled by this request
replaces | Σ | 0..* | Reference(ReferralRequest) | Request(s) replaced by this request
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
status | ?!S Σ | 1..1 | code | draft | active | suspended | cancelled | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of the referral. Fixed Value: completed
intent | ?!S Σ | 1..1 | code | proposal | plan | order Binding: RequestIntent (required): Codes identifying the stage lifecycle stage of a request Fixed Value: order
type | Σ | 0..1 | CodeableConcept | Referral/Transition of care request type Binding: SNOMED CT Patient Referral (example): Codes for types of referral; e.g. consult, transfer, temporary transfer.
priority | Σ | 0..1 | code | Urgency of referral / transfer of care request Binding: RequestPriority (required): Codes indicating the relative priority of the referral.
serviceRequested | Σ | 0..* | CodeableConcept | Actions requested as part of the referral Binding: Practice Setting Code Value Set (example): Codes indicating the types of services that might be requested as part of a referral.
subject | S Σ | 1..1 | Reference(AU Base Patient) | Patient referred to care or transfer
context | Σ | 0..1 | Reference(Encounter | EpisodeOfCare) | Originating encounter
occurrence[x] | Σ | 0..1 |  | When the service(s) requested in the referral should occur
occurrenceDateTime |  |  | dateTime |
occurrencePeriod |  |  | Period |
authoredOn | Σ | 0..1 | dateTime | Date of creation/activation
requester | S Σ C | 1..1 | BackboneElement | Who/what is requesting service
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
agent | S Σ | 1..1 | Reference(AU Base Practitioner) | Individual making the request
onBehalfOf | S Σ C | 0..1 | Reference(AU Base Organisation) | Organization agent is acting for
specialty | S | 0..1 | CodeableConcept | The clinical specialty (discipline) that the referral is requested for Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)
recipient | Σ | 0..* | Reference(Practitioner | Organization | HealthcareService) | Receiver of referral / transfer of care request
reasonCode | Σ | 0..* | CodeableConcept | Reason for referral / transfer of care request Binding: SNOMED CT Clinical Findings (example): Codes indicating why the referral is being requested.
reasonReference | Σ | 0..* | Reference(Condition | Observation) | Why is service needed?
description |  | 0..1 | string | A textual description of the referral
supportingInfo |  | 0..* | Reference(Resource) | Additonal information to support referral or transfer of care request
note |  | 0..* | Annotation | Comments made about referral request
relevantHistory |  | 0..* | Reference(Provenance) | Key events in history of request
Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron

#### 1.0.2 Quick Start

Below is an overview of the required search and read operations.

Summary of Search Criteria for StructureDefinition-referralrequest-mbsdva

none defined