| Australian Digital Health Agency FHIR Implementation Guide 1.0.0

Australian Digital Health Agency FHIR Implementation Guide. This is the current published version. It is based on FHIR® version 4.0.1. See the Directory of published versions for a list of available versions.

### StructureDefinition: ADHA Core Encounter [Active]

The purpose of this profile is to provide a core representation of an encounter for the electronic exchange of health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.

This profile identifies the additional constraints, extensions, and value sets that build on and extend Encounter that are supported.

This profile is designed to set a core Encounter standard for:

- Query for a patient’s encounters
- Query for records associated with a specific patient encounter
- Record or update an encounter and records associated with an encounter

#### Profile specific guidance

- `Encounter.type` supports categorisation and provides an efficient way of supporting system interactions, e.g. restricting searches. Implementers need to understand that data categorisation is somewhat subjective. The categorisation applied by the source may not align with a receiver’s expectations.
- In an exchange with the My Health Record system `Encounter.status` is “finished”.
- The Encounter resource can represent a reason using either a code with `Encounter.reasonCode`, or a reference with `Encounter.reasonReference` to a Condition or other resource.
  - Although both are marked as must support, sending systems are not required to support both a code and a reference, but they SHALL support at least one of these elements.
  - A receiving or persisting system SHALL support both elements.

#### Boundaries and relationships

This profile is referenced by ADHA Core Condition, ADHA Core DocumentReference, ADHA Australian Immunisation Register Notice, ADHA Core Flag, ADHA Record of Immunisation from Australian Immunisation Register, ADHA Core Immunization, ADHA Core MedicationRequest, ADHA Core Observation, and ADHA Core Procedure.

#### Formal Views of Profile Content

The official URL for this profile is:

    http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-encounter-core-1

The purpose of this profile is to provide a core representation of an encounter for the electronic exchange of health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.

This profile builds on AUBaseEncounter.

This profile was published on 2023-04-14 04:02:01+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
--- | --- | --- | --- | ---
Encounter | C | 0..* | AUBaseEncounter | An encounter in an Australian healthcare context inv-dh-enc-04: If present, the service provider shall at least have a reference or display or a valid identifier
extension:encounterDescription | S | 0..1 | EncounterDescription | Description, overview or summary of an encounter
status | S | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled +
class | S | 1..1 | Coding | Classification of patient encounter
type | S | 0..* | CodeableConcept | Specific type of encounter Binding: https://healthterminologies.gov.au/fhir/ValueSet/encounter-type-1 (preferred)
serviceType | S | 0..1 | CodeableConcept | Specific type of service Binding: https://healthterminologies.gov.au/fhir/ValueSet/service-type-1 (preferred)
subject | S C | 1..1 | Reference(ADHA Core Patient) | The patient or group present at the encounter inv-dh-enc-01: At least reference or a valid identifier shall be present
participant | S C | 1..* | BackboneElement | List of participants involved in the encounter inv-dh-enc-02: If present, an individual shall at least have a reference, an identifier or a display
type | S | 0..* | CodeableConcept | Role of participant in encounter
individual | S C | 0..1 | Reference(ADHA Core PractitionerRole | ADHA Core RelatedPerson) | Persons involved in the encounter other than the patient
period | S | 1..1 | Period | The start and end time of the encounter
reasonCode | S | 0..* | CodeableConcept | Coded reason the encounter takes place
reasonReference[x] | S | 0..* | Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core Procedure) | Reason the encounter takes place (reference)
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
dischargeDisposition | S | 0..1 | CodeableConcept | Separation Mode
location | S C | 0..* | BackboneElement | List of locations where the patient has been inv-dh-enc-03: If present, location shall at least have a reference or display or a valid identifier
location | S C | 1..1 | Reference(ADHA Core Location) | Location the encounter takes place
serviceProvider | S C | 0..1 | Reference(ADHA Core Organization) | The organization (facility) responsible for this encounter
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Encounter | C | 0..* | AUBaseEncounter | An encounter in an Australian healthcare context inv-dh-enc-04: If present, the service provider shall at least have a reference or display or a valid identifier
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
encounterDescription | S | 0..1 | string | Description, overview or summary of an encounter URL: http://hl7.org.au/fhir/StructureDefinition/encounter-description
associatedHealthcareService |  | 0..* | Reference(HealthcareService) | Associated healthcare service URL: http://hl7.org.au/fhir/StructureDefinition/associated-healthcareservice
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Identifier(s) by which this encounter is known
status | ?!S Σ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory |  | 0..* | BackboneElement | List of past encounter statuses
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
status |  | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified status
class | S Σ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode - AU Extended (extensible)
classHistory |  | 0..* | BackboneElement | List of past encounter classes
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
class |  | 1..1 | Coding | inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified class
type | S Σ | 0..* | CodeableConcept | Specific type of encounter Binding: https://healthterminologies.gov.au/fhir/ValueSet/encounter-type-1 (preferred)
serviceType | S Σ | 0..1 | CodeableConcept | Specific type of service Binding: https://healthterminologies.gov.au/fhir/ValueSet/service-type-1 (preferred)
priority |  | 0..1 | CodeableConcept | Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject | S Σ C | 1..1 | Reference(ADHA Core Patient) | The patient or group present at the encounter inv-dh-enc-01: At least reference or a valid identifier shall be present
episodeOfCare | Σ | 0..* | Reference(EpisodeOfCare) | Episode(s) of care that this encounter should be recorded against
basedOn |  | 0..* | Reference(ServiceRequest) | The ServiceRequest that initiated this encounter
participant | S Σ C | 1..* | BackboneElement | List of participants involved in the encounter inv-dh-enc-02: If present, an individual shall at least have a reference, an identifier or a display
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | S Σ | 0..* | CodeableConcept | Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period |  | 0..1 | Period | Period of time during the encounter that the participant participated
individual | S Σ C | 0..1 | Reference(ADHA Core PractitionerRole | ADHA Core RelatedPerson) | Persons involved in the encounter other than the patient
appointment | Σ | 0..* | Reference(Appointment) | The appointment that scheduled this encounter
period | S | 1..1 | Period | The start and end time of the encounter
length |  | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
reasonCode | S Σ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference | S Σ | 0..* | Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core Procedure) | Reason the encounter takes place (reference)
diagnosis | Σ | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
condition | Σ | 1..1 | Reference(Condition | Procedure) | The diagnosis or procedure relevant to the encounter
use |  | 0..1 | CodeableConcept | Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank |  | 0..1 | positiveInt | Ranking of the diagnosis (for each role type)
account |  | 0..* | Reference(Account) | The set of accounts that may be used for billing for this Encounter
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier |  | 0..1 | Identifier | Pre-admission identifier
origin |  | 0..1 | Reference(Location | Organization) | The location/organization from which the patient came before admission
admitSource |  | 0..1 | CodeableConcept | From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission |  | 0..1 | CodeableConcept | The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference |  | 0..* | CodeableConcept | Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy |  | 0..* | CodeableConcept | Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement |  | 0..* | CodeableConcept | Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination |  | 0..1 | Reference(Location | Organization) | Location/organization to which the patient is discharged
dischargeDisposition | S | 0..1 | CodeableConcept | Separation Mode Binding: https://healthterminologies.gov.au/fhir/ValueSet/separation-mode-1 (extensible)
location | S C | 0..* | BackboneElement | List of locations where the patient has been inv-dh-enc-03: If present, location shall at least have a reference or display or a valid identifier
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
location | S C | 1..1 | Reference(ADHA Core Location) | Location the encounter takes place
status |  | 0..1 | code | planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType |  | 0..1 | CodeableConcept | The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period |  | 0..1 | Period | Time period during which the patient was present at the location
serviceProvider | S C | 0..1 | Reference(ADHA Core Organization) | The organization (facility) responsible for this encounter
partOf |  | 0..1 | Reference(Encounter) | Another Encounter this encounter is part of
Documentation for this format

Differential View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Encounter | C | 0..* | AUBaseEncounter | An encounter in an Australian healthcare context inv-dh-enc-04: If present, the service provider shall at least have a reference or display or a valid identifier
extension:encounterDescription | S | 0..1 | EncounterDescription | Description, overview or summary of an encounter
status | S | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled +
class | S | 1..1 | Coding | Classification of patient encounter
type | S | 0..* | CodeableConcept | Specific type of encounter Binding: https://healthterminologies.gov.au/fhir/ValueSet/encounter-type-1 (preferred)
serviceType | S | 0..1 | CodeableConcept | Specific type of service Binding: https://healthterminologies.gov.au/fhir/ValueSet/service-type-1 (preferred)
subject | S C | 1..1 | Reference(ADHA Core Patient) | The patient or group present at the encounter inv-dh-enc-01: At least reference or a valid identifier shall be present
participant | S C | 1..* | BackboneElement | List of participants involved in the encounter inv-dh-enc-02: If present, an individual shall at least have a reference, an identifier or a display
type | S | 0..* | CodeableConcept | Role of participant in encounter
individual | S C | 0..1 | Reference(ADHA Core PractitionerRole | ADHA Core RelatedPerson) | Persons involved in the encounter other than the patient
period | S | 1..1 | Period | The start and end time of the encounter
reasonCode | S | 0..* | CodeableConcept | Coded reason the encounter takes place
reasonReference[x] | S | 0..* | Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core Procedure) | Reason the encounter takes place (reference)
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
dischargeDisposition | S | 0..1 | CodeableConcept | Separation Mode
location | S C | 0..* | BackboneElement | List of locations where the patient has been inv-dh-enc-03: If present, location shall at least have a reference or display or a valid identifier
location | S C | 1..1 | Reference(ADHA Core Location) | Location the encounter takes place
serviceProvider | S C | 0..1 | Reference(ADHA Core Organization) | The organization (facility) responsible for this encounter
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Encounter | C | 0..* | AUBaseEncounter | An encounter in an Australian healthcare context inv-dh-enc-04: If present, the service provider shall at least have a reference or display or a valid identifier
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
encounterDescription | S | 0..1 | string | Description, overview or summary of an encounter URL: http://hl7.org.au/fhir/StructureDefinition/encounter-description
associatedHealthcareService |  | 0..* | Reference(HealthcareService) | Associated healthcare service URL: http://hl7.org.au/fhir/StructureDefinition/associated-healthcareservice
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Identifier(s) by which this encounter is known
status | ?!S Σ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory |  | 0..* | BackboneElement | List of past encounter statuses
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
status |  | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified status
class | S Σ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode - AU Extended (extensible)
classHistory |  | 0..* | BackboneElement | List of past encounter classes
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
class |  | 1..1 | Coding | inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period |  | 1..1 | Period | The time that the episode was in the specified class
type | S Σ | 0..* | CodeableConcept | Specific type of encounter Binding: https://healthterminologies.gov.au/fhir/ValueSet/encounter-type-1 (preferred)
serviceType | S Σ | 0..1 | CodeableConcept | Specific type of service Binding: https://healthterminologies.gov.au/fhir/ValueSet/service-type-1 (preferred)
priority |  | 0..1 | CodeableConcept | Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject | S Σ C | 1..1 | Reference(ADHA Core Patient) | The patient or group present at the encounter inv-dh-enc-01: At least reference or a valid identifier shall be present
episodeOfCare | Σ | 0..* | Reference(EpisodeOfCare) | Episode(s) of care that this encounter should be recorded against
basedOn |  | 0..* | Reference(ServiceRequest) | The ServiceRequest that initiated this encounter
participant | S Σ C | 1..* | BackboneElement | List of participants involved in the encounter inv-dh-enc-02: If present, an individual shall at least have a reference, an identifier or a display
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | S Σ | 0..* | CodeableConcept | Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period |  | 0..1 | Period | Period of time during the encounter that the participant participated
individual | S Σ C | 0..1 | Reference(ADHA Core PractitionerRole | ADHA Core RelatedPerson) | Persons involved in the encounter other than the patient
appointment | Σ | 0..* | Reference(Appointment) | The appointment that scheduled this encounter
period | S | 1..1 | Period | The start and end time of the encounter
length |  | 0..1 | Duration | Quantity of time the encounter lasted (less time absent)
reasonCode | S Σ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference | S Σ | 0..* | Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core Procedure) | Reason the encounter takes place (reference)
diagnosis | Σ | 0..* | BackboneElement | The list of diagnosis relevant to this encounter
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
condition | Σ | 1..1 | Reference(Condition | Procedure) | The diagnosis or procedure relevant to the encounter
use |  | 0..1 | CodeableConcept | Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank |  | 0..1 | positiveInt | Ranking of the diagnosis (for each role type)
account |  | 0..* | Reference(Account) | The set of accounts that may be used for billing for this Encounter
hospitalization | S | 0..1 | BackboneElement | Details about the admission to a healthcare service
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier |  | 0..1 | Identifier | Pre-admission identifier
origin |  | 0..1 | Reference(Location | Organization) | The location/organization from which the patient came before admission
admitSource |  | 0..1 | CodeableConcept | From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission |  | 0..1 | CodeableConcept | The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference |  | 0..* | CodeableConcept | Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy |  | 0..* | CodeableConcept | Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement |  | 0..* | CodeableConcept | Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination |  | 0..1 | Reference(Location | Organization) | Location/organization to which the patient is discharged
dischargeDisposition | S | 0..1 | CodeableConcept | Separation Mode Binding: https://healthterminologies.gov.au/fhir/ValueSet/separation-mode-1 (extensible)
location | S C | 0..* | BackboneElement | List of locations where the patient has been inv-dh-enc-03: If present, location shall at least have a reference or display or a valid identifier
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
location | S C | 1..1 | Reference(ADHA Core Location) | Location the encounter takes place
status |  | 0..1 | code | planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType |  | 0..1 | CodeableConcept | The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period |  | 0..1 | Period | Time period during which the patient was present at the location
serviceProvider | S C | 0..1 | Reference(ADHA Core Organization) | The organization (facility) responsible for this encounter
partOf |  | 0..1 | Reference(Encounter) | Another Encounter this encounter is part of
Documentation for this format

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

#### Terminology Bindings

Path | Conformance | ValueSet
Encounter.language | preferred | CommonLanguages
Additional Bindings | Purpose
AllLanguages | Max Binding
Encounter.status | required | EncounterStatus
Encounter.statusHistory.status | required | EncounterStatus
Encounter.class | extensible | ActEncounterCodeAUExtended
Encounter.classHistory.class | extensible | ActEncounterCode
Encounter.type | preferred | https://healthterminologies.gov.au/fhir/ValueSet/encounter-type-1
Encounter.serviceType | preferred | https://healthterminologies.gov.au/fhir/ValueSet/service-type-1
Encounter.priority | example | ActPriority
Encounter.participant.type | extensible | ParticipantType
Encounter.reasonCode | preferred | EncounterReasonCodes
Encounter.diagnosis.use | preferred | DiagnosisRole
Encounter.hospitalization.admitSource | preferred | AdmitSource
Encounter.hospitalization.reAdmission | example | Hl7VSReAdmissionIndicator
Encounter.hospitalization.dietPreference | example | Diet
Encounter.hospitalization.specialCourtesy | preferred | SpecialCourtesy
Encounter.hospitalization.specialArrangement | preferred | SpecialArrangements
Encounter.hospitalization.dischargeDisposition | extensible | https://healthterminologies.gov.au/fhir/ValueSet/separation-mode-1
Encounter.location.status | required | EncounterLocationStatus
Encounter.location.physicalType | example | LocationType

#### Search Parameters

None defined.