Narrativa gerada: StructureDefinition EncounterBRIPES Nome Bandeiras Card. Tipo Descrição e condicionalismos Encounter Encounter #xD; Fatias para identifier 0..* Identifier Identifier(s) by which this encounter is known Fatia: Não ordenado, Aberto por type:type.coding.id #xD; identifier:localIdentifier 0..1 Identifier Identifier(s) by which this encounter is known #xD; use 0..0 #xD; type 0..1 CodeableConcept Description of identifier Valor fixo: Como mostrado #xD; coding 1..1 Coding Code defined by a terminology system Valor fixo: (complexo) #xD; system 1..1 uri Identity of the terminology system Valor fixo: http://ehrrunner.com/fhir/CodingSystem/identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Valor fixo: local #xD; system 1..1 uri The namespace for the identifier value #xD; value 1..1 string The value that is unique #xD; period 0..0 #xD; assigner 0..0 #xD; identifier:rndsIdentifier 0..1 Identifier Identifier(s) by which this encounter is known #xD; use 0..0 #xD; type 0..1 CodeableConcept Description of identifier Valor fixo: Como mostrado #xD; coding 1..1 Coding Code defined by a terminology system Valor fixo: (complexo) #xD; system 1..1 uri Identity of the terminology system Valor fixo: http://ehrrunner.com/fhir/CodingSystem/identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Valor fixo: rnds #xD; text 0..0 #xD; system 1..1 uri The namespace for the identifier value Valor fixo: urn:oid:1.3.6.1.4.1.54413.1.1.5.13 #xD; value 1..1 string The value that is unique #xD; period 0..0 #xD; assigner 0..0 #xD; identifier:mhdIdentifier 0..1 Identifier Identifier(s) by which this encounter is known #xD; use 0..0 #xD; type 0..1 CodeableConcept Description of identifier Valor fixo: Como mostrado #xD; coding 1..1 Coding Code defined by a terminology system Valor fixo: (complexo) #xD; system 1..1 uri Identity of the terminology system Valor fixo: http://ehrrunner.com/fhir/CodingSystem/identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Valor fixo: mhd #xD; system 1..1 uri The namespace for the identifier value Valor fixo: http://ehrrunner.com/fhir/NamingSystem/MHDDocumentOID #xD; value 1..1 string The value that is unique #xD; period 0..0 #xD; assigner 0..0 #xD; status 1..1 code finished | entered-in-error #xD; statusHistory 0..0 #xD; class 1..1 Coding Classification of patient encounter Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRModalidadeAssistencial (extensible) #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; classHistory 0..0 #xD; type 0..0 #xD; serviceType 0..0 #xD; priority 0..1 CodeableConcept Indicates the urgency of the encounter Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (preferred) #xD; coding #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; subject 1..1 Reference(Paciente) The patient or group present at the encounter #xD; type 0..0 #xD; identifier 0..0 #xD; display 0..0 #xD; episodeOfCare 0..0 #xD; basedOn 0..1 Reference(Solicitação de Serviço) The ServiceRequest that initiated this encounter #xD; display 0..0 #xD; participant 1..* BackboneElement List of participants involved in the encounter #xD; Fatias para type 1..* CodeableConcept Role of participant in encounter Fatia: Não ordenado, Aberto por type:$this #xD; type:funcao 1..1 CodeableConcept Role of participant in encounter Vínculo: http://www.saude.gov.br/fhir/r4/ValueSet/BRResponsabilidadeParticipante-1.0 (extensible) #xD; coding 1..1 Coding Code defined by a terminology system #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; text 0..0 #xD; type:ocupacaoProfissional 0..1 CodeableConcept Role of participant in encounter Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BROcupacao (required) #xD; coding 1..1 Coding Code defined by a terminology system #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; text 0..0 #xD; type:especialidade 0..1 CodeableConcept Role of participant in encounter #xD; coding 0..1 Coding Code defined by a terminology system Vínculo: Especialidade (extensible) #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; type:areaAtuacao 0..1 CodeableConcept Role of participant in encounter #xD; coding 0..1 Coding Code defined by a terminology system Vínculo: Área de Atuação (preferred) #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; period 0..0 #xD; individual #xD; reference 0..0 #xD; type 0..1 uri Type the reference refers to (e.g. "Patient") Valor fixo: Practitioner #xD; identifier 1..1 Identifier Logical reference, when literal reference is not known #xD; use 0..0 #xD; type 1..1 CodeableConcept Description of identifier Vínculo: http://ehrrunner.com/fhir/ValueSet/IdentifierType-1.0 (extensible) #xD; coding 1..1 Coding Code defined by a terminology system #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; text 0..0 #xD; value 1..1 string The value that is unique #xD; period 0..0 #xD; appointment 0..1 Reference(Agendamento de Consulta ou Procedimento) The appointment that scheduled this encounter #xD; display 0..0 #xD; period 1..1 Period The start and end time of the encounter #xD; Fatias para reasonReference 0..* Reference(Condition | Procedure | Observation | ImmunizationRecommendation) Reason the encounter takes place (reference) Fatia: Não ordenado, Aberto por value:identifier.value #xD; reasonReference:motivoAtendimentoSubjetivo 0..1 Reference(Observação - Descritiva) Reason the encounter takes place (reference) #xD; type 0..0 #xD; identifier 0..0 #xD; display 0..0 #xD; reasonReference:diagnosticoPrincipal 0..1 Reference(Problema ou Diagnóstico) Reason the encounter takes place (reference) #xD; type 0..0 #xD; identifier 0..0 #xD; diagnosis 0..* BackboneElement The list of diagnosis relevant to this encounter #xD; condition 1..1 Reference(Problema ou Diagnóstico | Procedimento) The diagnosis or procedure relevant to the encounter #xD; type 0..0 #xD; identifier 0..0 #xD; display 0..0 #xD; use 0..0 #xD; rank 0..0 #xD; account 0..0 #xD; hospitalization #xD; preAdmissionIdentifier 0..0 #xD; origin 0..0 #xD; admitSource 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) Vínculo: http://www.saude.gov.br/fhir/r4/ValueSet/BRProcedencia-1.0 (preferred) #xD; coding 1..1 Coding Code defined by a terminology system #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; text 0..0 #xD; reAdmission #xD; coding 1..1 Coding Code defined by a terminology system #xD; text 0..0 #xD; dietPreference 0..0 #xD; specialCourtesy 0..0 #xD; specialArrangement 0..0 #xD; destination 0..1 Reference(Estabelecimento de Saúde) Location/organization to which the patient is discharged #xD; reference 0..0 #xD; identifier 1..1 Identifier Logical reference, when literal reference is not known #xD; use 0..0 #xD; type 1..1 CodeableConcept Description of identifier Vínculo: http://ehrrunner.com/fhir/ValueSet/IdentifierType-1.0 (extensible) #xD; coding 1..1 Coding Code defined by a terminology system #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; display 0..0 #xD; userSelected 0..0 #xD; text 0..0 #xD; dischargeDisposition 0..1 CodeableConcept Category or kind of location after discharge Vínculo: http://www.saude.gov.br/fhir/r4/ValueSet/BRMotivoDesfecho-1.0 (example) #xD; coding 1..1 Coding Code defined by a terminology system #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; text 0..0 #xD; location 0..0 #xD; serviceProvider 1..1 Reference(Estabelecimento de Saúde) The organization (facility) responsible for this encounter #xD; type 0..0 #xD; identifier #xD; use 0..0 #xD; type 1..1 CodeableConcept Description of identifier Vínculo: http://ehrrunner.com/fhir/ValueSet/IdentifierType-1.0 (extensible) #xD; coding 1..1 Coding Code defined by a terminology system #xD; system 1..1 uri Identity of the terminology system #xD; version 0..0 #xD; code 1..1 code Symbol in syntax defined by the system #xD; userSelected 0..0 #xD; value 1..1 string The value that is unique #xD; period 0..0 #xD; assigner 0..0 #xD; partOf 0..0 #xD; Documentação para este formato
Encontro ou Contato assistencial. Interação formal entre o paciente e profissional(is) de saúde(s) para prestação de serviços de saúde. Tipicamente, representa uma consulta ambulatorial (atenção primária e secundária), um internação, um atendimento em urgência/emergência ou um atendimento em telemedicina. O recurso é utilizado para indexação da informação na "linha do tempo" do Registro Eletrônico de Saúde do paciente. É parte estruturante dos seguintes modelos de informação: Registro de Atendimento Clínico (RAC), Sumário de Alta (SA), Registro de Pronto Atendimento (RPA) ou Conjunto Mínimo de Dados (CMD).
An interaction during which services are provided to the patient
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
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.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
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
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 summary of the resource, for human interpretation
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.
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.
Additional content defined by implementations
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
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).
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifier(s) by which this encounter is known
Identificador local no sistema de origem Identificador na RNDS Identificador na estrutura de documentos do MHD
Identificador local no sistema de origem;
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
May be used to represent additional information that is not part of the basic definition of the element. 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.
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Deve conter o identificador do sistema de informação (S-RES) de origem. Tipicamente, esse identificador é apresentado em formato de OID (urn:oid:{{oidSistemaOrigem}}:{{cnesOrganizacao}}). O OID do sistema de origem deve ser fornecido pela plataforma.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identificador (unívoco) do registro de atendimento / contato assistêncial no sistema de origem.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Identificador do registro na RNDS (id/identificador da Composition)
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Identificador do registro MHD correspondente (quando o recurso foi gerado a partir de uma representação OpenEHR e indexado através de um Bundle MHD).
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).
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
No clear equivalent in HL7 v2; active/finished could be inferred from PV1-44, PV1-45, PV2-24; inactive could be inferred from PV2-16
The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.
The current status is always found in the current version of the resource, not the status history.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
planned | arrived | triaged | in-progress | onleave | finished | cancelled +
The time that the episode was in the specified status
Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
The identification of the code system that defines the meaning of the symbol in the code.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.
inpatient | outpatient | ambulatory | emergency +
The time that the episode was in the specified class
Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).
Since there are many ways to further classify encounters, this element is 0..*.
Broad categorization of the service that is to be provided (e.g. cardiology).
Broad categorization of the service that is to be provided.
The patient or group present at the encounter
Deve conter uma referência para o paciente do Encontro.
While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Episode(s) of care that this encounter should be recorded against
Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).
The ServiceRequest that initiated this encounter
Referência para a solicitação de encaminhamento (referência ou regulação) que resultou no encontro, se disponível.
List of participants involved in the encounter
Lista de profissionais de saúde que participam do atendimento.
The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.
Period of time during the encounter that the participant participated
The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
Persons involved in the encounter other than the patient
The appointment that scheduled this encounter
Referência para o agendamento do encontro (sistema local ou regulação), se disponível.
.outboundRelationship[typeCode=FLFS].target[classCode=ENC, moodCode=APT]
The start and end time of the encounter.
If not (yet) known, the end of the Period may be omitted.
Quantity of time the encounter lasted (less time absent)
Quantity of time the encounter lasted. This excludes the time during leaves of absence.
May differ from the time the Encounter.period lasted because of leave of absence.
(PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations )
Reason the encounter takes place (reference)
Motivo subjetivo para o atendimento. Anamnese.
The list of diagnosis relevant to this encounter
Diagnósticos, problemas e procedimentos que justificam o encontro.
The diagnosis or procedure relevant to the encounter
Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.
Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively.
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
The type of diagnosis this condition represents.
Ranking of the diagnosis (for each role type)
The set of accounts that may be used for billing for this Encounter
The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
Details about the admission to a healthcare service
An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.
.outboundRelationship[typeCode=COMP].target[classCode=ENC, moodCode=EVN]
The location/organization from which the patient came before admission
From where patient was admitted (physician referral, transfer)
The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Whether this hospitalization is a readmission and why if known.
The reason for re-admission of this hospitalization encounter.
Diet preferences reported by the patient
For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.
Medical, cultural or ethical food preferences to help with catering requirements.
.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=EVN, code="diet"]
Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
Location/organization to which the patient is discharged
Category or kind of location after discharge
List of locations where the patient has been
List of locations where the patient has been during this encounter.
Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".
The location where the encounter takes place.
The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.
When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.
The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.
This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query. There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.
Time period during which the patient was present at the location
The organization (facility) responsible for this encounter
The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.
Another Encounter this encounter is part of
Another Encounter of which this encounter is a part of (administratively or in time).
This is also used for associating a child's encounter back to the mother's encounter. Refer to the Notes section in the Patient resource for further details.
.inboundRelationship[typeCode=COMP].source[classCode=COMP, moodCode=EVN]