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.

NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest C0..*ReferralRequestA 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..1MetaMetadata about the resource
.... profile 1..*uriProfiles this resource claims to conform to
... identifier S0..*IdentifierBusiness identifier
... status S1..1codedraft | active | suspended | cancelled | completed | entered-in-error | unknown
Fixed Value: completed
... intent S1..1codeproposal | plan | order
Fixed Value: order
... subject S1..1Reference(AU Base Patient)Patient referred to care or transfer
... requester S1..1BackboneElementWho/what is requesting service
.... agent S1..1Reference(AU Base Practitioner)Individual making the request
.... onBehalfOf S0..1Reference(AU Base Organisation)Organization agent is acting for
... specialty S0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest C0..*ReferralRequestA 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 Σ0..1idLogical id of this artifact
... meta Σ1..1MetaMetadata about the resource
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ0..1instantWhen the resource version last changed
.... profile Σ1..*uriProfiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags 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 ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible): A human language.

Additional BindingsPurpose
All LanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierBusiness identifier
... definition Σ0..*Reference(ActivityDefinition | PlanDefinition)Instantiates protocol or definition
... basedOn Σ0..*Reference(ReferralRequest | CarePlan | ProcedureRequest)Request fulfilled by this request
... replaces Σ0..*Reference(ReferralRequest)Request(s) replaced by this request
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... status ?!SΣ1..1codedraft | active | suspended | cancelled | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of the referral.


Fixed Value: completed
... intent ?!SΣ1..1codeproposal | plan | order
Binding: RequestIntent (required): Codes identifying the stage lifecycle stage of a request


Fixed Value: order
... type Σ0..1CodeableConceptReferral/Transition of care request type
Binding: SNOMED CT Patient Referral (example): Codes for types of referral; e.g. consult, transfer, temporary transfer.

... priority Σ0..1codeUrgency of referral / transfer of care request
Binding: RequestPriority (required): Codes indicating the relative priority of the referral.

... serviceRequested Σ0..*CodeableConceptActions 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 SΣ1..1Reference(AU Base Patient)Patient referred to care or transfer
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating encounter
... occurrence[x] Σ0..1When the service(s) requested in the referral should occur
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... authoredOn Σ0..1dateTimeDate of creation/activation
... requester SΣC1..1BackboneElementWho/what is requesting service
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... agent SΣ1..1Reference(AU Base Practitioner)Individual making the request
.... onBehalfOf SΣC0..1Reference(AU Base Organisation)Organization agent is acting for
... specialty S0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)
... recipient Σ0..*Reference(Practitioner | Organization | HealthcareService)Receiver of referral / transfer of care request
... reasonCode Σ0..*CodeableConceptReason for referral / transfer of care request
Binding: SNOMED CT Clinical Findings (example): Codes indicating why the referral is being requested.


... reasonReference Σ0..*Reference(Condition | Observation)Why is service needed?
... description 0..1stringA textual description of the referral
... supportingInfo 0..*Reference(Resource)Additonal information to support referral or transfer of care request
... note 0..*AnnotationComments made about referral request
... relevantHistory 0..*Reference(Provenance)Key events in history of request

doco Documentation for this format

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest C0..*ReferralRequestA 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..1MetaMetadata about the resource
.... profile 1..*uriProfiles this resource claims to conform to
... identifier S0..*IdentifierBusiness identifier
... status S1..1codedraft | active | suspended | cancelled | completed | entered-in-error | unknown
Fixed Value: completed
... intent S1..1codeproposal | plan | order
Fixed Value: order
... subject S1..1Reference(AU Base Patient)Patient referred to care or transfer
... requester S1..1BackboneElementWho/what is requesting service
.... agent S1..1Reference(AU Base Practitioner)Individual making the request
.... onBehalfOf S0..1Reference(AU Base Organisation)Organization agent is acting for
... specialty S0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ReferralRequest C0..*ReferralRequestA 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 Σ0..1idLogical id of this artifact
... meta Σ1..1MetaMetadata about the resource
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ0..1instantWhen the resource version last changed
.... profile Σ1..*uriProfiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags 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 ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible): A human language.

Additional BindingsPurpose
All LanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierBusiness identifier
... definition Σ0..*Reference(ActivityDefinition | PlanDefinition)Instantiates protocol or definition
... basedOn Σ0..*Reference(ReferralRequest | CarePlan | ProcedureRequest)Request fulfilled by this request
... replaces Σ0..*Reference(ReferralRequest)Request(s) replaced by this request
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... status ?!SΣ1..1codedraft | active | suspended | cancelled | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of the referral.


Fixed Value: completed
... intent ?!SΣ1..1codeproposal | plan | order
Binding: RequestIntent (required): Codes identifying the stage lifecycle stage of a request


Fixed Value: order
... type Σ0..1CodeableConceptReferral/Transition of care request type
Binding: SNOMED CT Patient Referral (example): Codes for types of referral; e.g. consult, transfer, temporary transfer.

... priority Σ0..1codeUrgency of referral / transfer of care request
Binding: RequestPriority (required): Codes indicating the relative priority of the referral.

... serviceRequested Σ0..*CodeableConceptActions 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 SΣ1..1Reference(AU Base Patient)Patient referred to care or transfer
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating encounter
... occurrence[x] Σ0..1When the service(s) requested in the referral should occur
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... authoredOn Σ0..1dateTimeDate of creation/activation
... requester SΣC1..1BackboneElementWho/what is requesting service
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... agent SΣ1..1Reference(AU Base Practitioner)Individual making the request
.... onBehalfOf SΣC0..1Reference(AU Base Organisation)Organization agent is acting for
... specialty S0..1CodeableConceptThe clinical specialty (discipline) that the referral is requested for
Binding: https://healthterminologies.gov.au/fhir/ValueSet/anzsco-1 (extensible)
... recipient Σ0..*Reference(Practitioner | Organization | HealthcareService)Receiver of referral / transfer of care request
... reasonCode Σ0..*CodeableConceptReason for referral / transfer of care request
Binding: SNOMED CT Clinical Findings (example): Codes indicating why the referral is being requested.


... reasonReference Σ0..*Reference(Condition | Observation)Why is service needed?
... description 0..1stringA textual description of the referral
... supportingInfo 0..*Reference(Resource)Additonal information to support referral or transfer of care request
... note 0..*AnnotationComments made about referral request
... relevantHistory 0..*Reference(Provenance)Key events in history of request

doco 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