PATIENT ADMINISTRTAION (PA) Workgroup Development Draft

5.19 Resource Encounter - Content

This resource maintained by the Patient Administration Work Group

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.

5.19.1 Scope and Usage

A patient encounter is further characterized by the setting in which it takes place. Amongst them are ambulatory, emergency, home health, inpatient and virtual encounters. An Encounter encompasses the lifecycle from pre-admission, the actual encounter (for ambulatory encounters), and admission, stay and discharge (for inpatient encounters). During the encounter the patient may move from practitioner to practitioner and location to location.

Because of the broad scope of Encounter, not all elements will be relevant in all settings. For this reason, admission/discharge related information is kept in a separate Hospitalization component within Encounter. The class element is used to distinguish between these settings, which will guide further validation and application of business rules.

There is also substantial variance from organization to organization (and between jurisdictions and countries) on which business events translate to the start of a new Encounter, or what level of aggregation is used for Encounter. For example, each single visit of a practitioner during a hospitalization may lead to a new instance of Encounter, but depending on local practice and the systems involved, it may well be that this is aggregated to a single instance for a whole hospitalization. Even more aggregation may occur where jurisdictions introduce groups of Encounters for financial or other reasons. Encounters can be aggregated or grouped under other Encounters using the partOf element. See below for examples.

Encounter instances may exist before the actual encounter takes place to convey pre-admission information, including using Encounters elements to reflect the planned start date or planned encounter locations. In this case the status element is set to 'planned'.

The Hospitalization component is intended to store the extended information relating to a hospitalization event. This is always expected to be the same period as the encounter itself, where this is different then another encounter is entered which captures this information which is a partOf this encounter instance.

5.19.1.1 Status Management

During the life-cycle of an encounter it will pass through many statuses. Typically these are in order or the organizations workflow: planned, in-progress, finished/cancelled.
This status information is often used for other things, and often an analysis of the status history is required. This could be done my scanning throuh all the versions of the encounter and then checking the period of each, and doing some form of post processing. To ease the burden of this (or where a system doesn't support resource histories) a status history component is included.

5.19.2 Boundaries and Relationships

The Encounter resource is not to be used to store appointment information, the Appointment resource is intended to be used for that. Note that in many systems outpatient encounters (which are in scope for Encounter) and Appointment are used concurrently. In FHIR, Appointment is used for establishing a date for the encounter, while Encounter is applicable to information about the actual Encounter, i.e. the patient showing up.
As such an encounter in the "planned" status is not identical to the appointment that scheduled it, but it is the encounter prior to its actual occurrence, with the expectation that encounter will be updated as it progresses to completion. Patient arrival at a location does not necessarily mean the start of the encounter (e.g., a patient arrives an hour earlier than he is actually seen by a practitioner).

An appointment is normally used for the planning stage of an appointment, searching, locating an available time, then making the appointment. Once this process is completed and the appointment is about to start, then the appointment will be marked as fulfilled, and linked to the newly created encounter.
This new encounter may start in an "arrived" status when they are admitted with a location of the facility, and then will move to the ward where another part-of encounter may begin.

Standard Extension: Associated Encounter
This extension should be used to reference an encounter where there is no property that already defines this association on the resource.

This resource is referenced by Communication, CommunicationRequest, Composition, Condition, DeviceUseRequest, DiagnosticOrder, DiagnosticReport, Immunization, MedicationAdministration, MedicationPrescription, NutritionOrder, Observation, Procedure, ProcedureRequest, QuestionnaireAnswers, ReferralRequest and VisionPrescription

5.19.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter DomainResourceAn interaction during which services are provided to the patient
... identifier Σ0..*IdentifierIdentifier(s) by which this encounter is known
... status ?! Σ1..1codeplanned | arrived | in-progress | onleave | finished | cancelled
EncounterState (Required)
... statusHistory 0..*ElementList of Encounter statuses
.... status 1..1codeplanned | arrived | in-progress | onleave | finished | cancelled
EncounterState (Required)
.... period 1..1PeriodThe time that the episode was in the specified status
... class Σ0..1codeinpatient | outpatient | ambulatory | emergency +
EncounterClass (Required)
... type Σ0..*CodeableConceptSpecific type of encounter
EncounterType (Example)
... patient Σ0..1PatientThe patient present at the encounter
... episodeOfCare Σ0..1EpisodeOfCareAn episode of care that this encounter should be recorded against
... incomingReferralRequest 0..*ReferralRequestIncoming Referral Request
... participant Σ0..*ElementList of participants involved in the encounter
.... type Σ0..*CodeableConceptRole of participant in encounter
ParticipantType (Required)
.... period 0..1PeriodPeriod of time during the encounter participant was present
.... individual Σ0..1Practitioner | RelatedPersonPersons involved in the encounter other than the patient
... fulfills Σ0..1AppointmentThe appointment that scheduled this encounter
... period 0..1PeriodThe start and end time of the encounter
... length 0..1DurationQuantity of time the encounter lasted (less time absent)
... reason Σ0..*CodeableConceptReason the encounter takes place (code)
Encounter Reason Codes (Example)
... indication 0..*AnyReason the encounter takes place (resource)
... priority 0..1CodeableConceptIndicates the urgency of the encounter
Encounter Priority (Example)
... hospitalization 0..1ElementDetails about an admission to a clinic
.... preAdmissionIdentifier 0..1IdentifierPre-admission identifier
.... origin 0..1LocationThe location from which the patient came before admission
.... admitSource 0..1CodeableConceptFrom where patient was admitted (physician referral, transfer)
AdmitSource (Required)
.... dietPreference 0..1CodeableConceptDiet preferences reported by the patient
Diet (Example)
.... specialCourtesy 0..*CodeableConceptSpecial courtesies (VIP, board member)
SpecialCourtesy (Required)
.... specialArrangement 0..*CodeableConceptWheelchair, translator, stretcher, etc
SpecialArrangements (Required)
.... destination 0..1LocationLocation to which the patient is discharged
.... dischargeDisposition 0..1CodeableConceptCategory or kind of location after discharge
DischargeDisposition (Required)
.... dischargeDiagnosis 0..1AnyThe final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
.... reAdmission 0..1booleanIs this hospitalization a readmission?
... location 0..*ElementList of locations the patient has been at
.... location 1..1LocationLocation the encounter takes place
.... status 0..1codeplanned | present | reserved
EncounterLocationStatus (Required)
.... period 0..1PeriodTime period during which the patient was present at the location
... serviceProvider 0..1OrganizationThe custodian organization of this Encounter record
... partOf 0..1EncounterAnother Encounter this encounter is part of

UML Diagram

Encounter (DomainResource)Identifier(s) by which this encounter is knownidentifier : Identifier 0..*planned | arrived | in-progress | onleave | finished | cancelled (this element modifies the meaning of other elements)status : code 1..1 « Current state of the encounterEncounterState »inpatient | outpatient | ambulatory | emergency +class : code 0..1 « Classification of the encounterEncounterClass »Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation)type : CodeableConcept 0..* « (The type of encounterEncounterType) »The patient present at the encounterpatient : Reference(Patient) 0..1Where a specific encounter should be classified as a part of a specific episode of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as govt reporting, or issue trackingepisodeOfCare : Reference(EpisodeOfCare) 0..1The referral request that this encounter is satisfies (incoming referral)incomingReferralRequest : Reference(ReferralRequest) 0..*The appointment that scheduled this encounterfulfills : Reference(Appointment) 0..1The start and end time of the encounterperiod : Period 0..1Quantity of time the encounter lasted. This excludes the time during leaves of absencelength : Duration 0..1Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosisreason : CodeableConcept 0..* « (Reason why the encounter takes placeEncounter Reason Codes) »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 Procedureindication : Reference(Any) 0..*Indicates the urgency of the encounterpriority : CodeableConcept 0..1 « (Indicates the urgency of the encounterEncounter Priority) »An organization that is in charge of maintaining the information of this Encounter (e.g., who maintains the report or the master service catalog item, etc.). This MAY be the same as the organization on the Patient record, however it could be different. This MAY not be not the Service Delivery Location's OrganizationserviceProvider : Reference(Organization) 0..1Another Encounter of which this encounter is a part of (administratively or in time)partOf : Reference(Encounter) 0..1StatusHistoryplanned | arrived | in-progress | onleave | finished | cancelledstatus : code 1..1 « Current state of the encounterEncounterState »The time that the episode was in the specified statusperiod : Period 1..1ParticipantRole of participant in encountertype : CodeableConcept 0..* « Role of participant in encounterParticipantType »The period of time that the specified participant was present during the encounter. These can overlap or be sub-sets of the overall encounters periodperiod : Period 0..1Persons involved in the encounter other than the patientindividual : Reference(Practitioner|RelatedPerson) 0..1HospitalizationPre-admission identifierpreAdmissionIdentifier : Identifier 0..1The location from which the patient came before admissionorigin : Reference(Location) 0..1From where patient was admitted (physician referral, transfer)admitSource : CodeableConcept 0..1 « From where the patient was admittedAdmitSource »Diet preferences reported by the patientdietPreference : CodeableConcept 0..1 « (Medical, cultural or ethical food preferences to help with catering requirementsDiet) »Special courtesies (VIP, board member)specialCourtesy : CodeableConcept 0..* « Special courtesiesSpecialCourtesy »Wheelchair, translator, stretcher, etcspecialArrangement : CodeableConcept 0..* « Special arrangementsSpecialArrangements »Location to which the patient is dischargeddestination : Reference(Location) 0..1Category or kind of location after dischargedischargeDisposition : CodeableConcept 0..1 « Discharge DispositionDischargeDisposition »The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are completedischargeDiagnosis : Reference(Any) 0..1Whether this hospitalization is a readmissionreAdmission : boolean 0..1LocationThe location where the encounter takes placelocation : Reference(Location) 1..1The status of the participants presence at the specified location during the period specified. If the participant is is no longer at the location, then the period will have an end date/timestatus : code 0..1 « The status of the locationEncounterLocationStatus »Time period during which the patient was present at the locationperiod : Period 0..1The current status is always found in the current version of the resource. This status history permits the encounter resource to contain the status history without the needing to read through the historical versions of the resource, or even have the server store themstatusHistory0..*The main practitioner responsible for providing the serviceparticipant0..*Details about an admission to a clinichospitalization0..1List of locations at which the patient has beenlocation0..*

XML Template

<Encounter xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known --></identifier>
 <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled -->
 <statusHistory>  <!-- 0..* List of Encounter statuses -->
  <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled -->
  <period><!-- 1..1 Period The time that the episode was in the specified status --></period>
 </statusHistory>
 <class value="[code]"/><!-- 0..1 inpatient | outpatient | ambulatory | emergency + -->
 <type><!-- 0..* CodeableConcept Specific type of encounter --></type>
 <patient><!-- 0..1 Reference(Patient) The patient present at the encounter --></patient>
 <episodeOfCare><!-- 0..1 Reference(EpisodeOfCare) An episode of care that this encounter should be recorded against --></episodeOfCare>
 <incomingReferralRequest><!-- 0..* Reference(ReferralRequest) Incoming Referral Request --></incomingReferralRequest>
 <participant>  <!-- 0..* List of participants involved in the encounter -->
  <type><!-- 0..* CodeableConcept Role of participant in encounter --></type>
  <period><!-- 0..1 Period Period of time during the encounter participant was present --></period>
  <individual><!-- 0..1 Reference(Practitioner|RelatedPerson) Persons involved in the encounter other than the patient --></individual>
 </participant>
 <fulfills><!-- 0..1 Reference(Appointment) The appointment that scheduled this encounter --></fulfills>
 <period><!-- 0..1 Period The start and end time of the encounter --></period>
 <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length>
 <reason><!-- 0..* CodeableConcept Reason the encounter takes place (code) --></reason>
 <indication><!-- 0..* Reference(Any) Reason the encounter takes place (resource) --></indication>
 <priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter --></priority>
 <hospitalization>  <!-- 0..1 Details about an admission to a clinic -->
  <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier>
  <origin><!-- 0..1 Reference(Location) The location from which the patient came before admission --></origin>
  <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource>
  <dietPreference><!-- 0..1 CodeableConcept Diet preferences reported by the patient --></dietPreference>
  <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy>
  <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc --></specialArrangement>
  <destination><!-- 0..1 Reference(Location) Location to which the patient is discharged --></destination>
  <dischargeDisposition><!-- 0..1 CodeableConcept Category or kind of location after discharge --></dischargeDisposition>
  <dischargeDiagnosis><!-- 0..1 Reference(Any) The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete --></dischargeDiagnosis>
  <reAdmission value="[boolean]"/><!-- 0..1 Is this hospitalization a readmission? -->
 </hospitalization>
 <location>  <!-- 0..* List of locations the patient has been at -->
  <location><!-- 1..1 Reference(Location) Location the encounter takes place --></location>
  <status value="[code]"/><!-- 0..1 planned | present | reserved -->
  <period><!-- 0..1 Period Time period during which the patient was present at the location --></period>
 </location>
 <serviceProvider><!-- 0..1 Reference(Organization) The custodian organization of this Encounter record --></serviceProvider>
 <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf>
</Encounter>

JSON Template

{doco
  "resourceType" : "Encounter",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
  "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled
  "statusHistory" : [{ // List of Encounter statuses
    "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled
    "period" : { Period } // R!  The time that the episode was in the specified status
  }],
  "class" : "<code>", // inpatient | outpatient | ambulatory | emergency +
  "type" : [{ CodeableConcept }], // Specific type of encounter
  "patient" : { Reference(Patient) }, // The patient present at the encounter
  "episodeOfCare" : { Reference(EpisodeOfCare) }, // An episode of care that this encounter should be recorded against
  "incomingReferralRequest" : [{ Reference(ReferralRequest) }], // Incoming Referral Request
  "participant" : [{ // List of participants involved in the encounter
    "type" : [{ CodeableConcept }], // Role of participant in encounter
    "period" : { Period }, // Period of time during the encounter participant was present
    "individual" : { Reference(Practitioner|RelatedPerson) } // Persons involved in the encounter other than the patient
  }],
  "fulfills" : { Reference(Appointment) }, // The appointment that scheduled this encounter
  "period" : { Period }, // The start and end time of the encounter
  "length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
  "reason" : [{ CodeableConcept }], // Reason the encounter takes place (code)
  "indication" : [{ Reference(Any) }], // Reason the encounter takes place (resource)
  "priority" : { CodeableConcept }, // Indicates the urgency of the encounter
  "hospitalization" : { // Details about an admission to a clinic
    "preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
    "origin" : { Reference(Location) }, // The location from which the patient came before admission
    "admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
    "dietPreference" : { CodeableConcept }, // Diet preferences reported by the patient
    "specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
    "specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc
    "destination" : { Reference(Location) }, // Location to which the patient is discharged
    "dischargeDisposition" : { CodeableConcept }, // Category or kind of location after discharge
    "dischargeDiagnosis" : { Reference(Any) }, // The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
    "reAdmission" : <boolean> // Is this hospitalization a readmission?
  },
  "location" : [{ // List of locations the patient has been at
    "location" : { Reference(Location) }, // R!  Location the encounter takes place
    "status" : "<code>", // planned | present | reserved
    "period" : { Period } // Time period during which the patient was present at the location
  }],
  "serviceProvider" : { Reference(Organization) }, // The custodian organization of this Encounter record
  "partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter DomainResourceAn interaction during which services are provided to the patient
... identifier Σ0..*IdentifierIdentifier(s) by which this encounter is known
... status ?! Σ1..1codeplanned | arrived | in-progress | onleave | finished | cancelled
EncounterState (Required)
... statusHistory 0..*ElementList of Encounter statuses
.... status 1..1codeplanned | arrived | in-progress | onleave | finished | cancelled
EncounterState (Required)
.... period 1..1PeriodThe time that the episode was in the specified status
... class Σ0..1codeinpatient | outpatient | ambulatory | emergency +
EncounterClass (Required)
... type Σ0..*CodeableConceptSpecific type of encounter
EncounterType (Example)
... patient Σ0..1PatientThe patient present at the encounter
... episodeOfCare Σ0..1EpisodeOfCareAn episode of care that this encounter should be recorded against
... incomingReferralRequest 0..*ReferralRequestIncoming Referral Request
... participant Σ0..*ElementList of participants involved in the encounter
.... type Σ0..*CodeableConceptRole of participant in encounter
ParticipantType (Required)
.... period 0..1PeriodPeriod of time during the encounter participant was present
.... individual Σ0..1Practitioner | RelatedPersonPersons involved in the encounter other than the patient
... fulfills Σ0..1AppointmentThe appointment that scheduled this encounter
... period 0..1PeriodThe start and end time of the encounter
... length 0..1DurationQuantity of time the encounter lasted (less time absent)
... reason Σ0..*CodeableConceptReason the encounter takes place (code)
Encounter Reason Codes (Example)
... indication 0..*AnyReason the encounter takes place (resource)
... priority 0..1CodeableConceptIndicates the urgency of the encounter
Encounter Priority (Example)
... hospitalization 0..1ElementDetails about an admission to a clinic
.... preAdmissionIdentifier 0..1IdentifierPre-admission identifier
.... origin 0..1LocationThe location from which the patient came before admission
.... admitSource 0..1CodeableConceptFrom where patient was admitted (physician referral, transfer)
AdmitSource (Required)
.... dietPreference 0..1CodeableConceptDiet preferences reported by the patient
Diet (Example)
.... specialCourtesy 0..*CodeableConceptSpecial courtesies (VIP, board member)
SpecialCourtesy (Required)
.... specialArrangement 0..*CodeableConceptWheelchair, translator, stretcher, etc
SpecialArrangements (Required)
.... destination 0..1LocationLocation to which the patient is discharged
.... dischargeDisposition 0..1CodeableConceptCategory or kind of location after discharge
DischargeDisposition (Required)
.... dischargeDiagnosis 0..1AnyThe final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
.... reAdmission 0..1booleanIs this hospitalization a readmission?
... location 0..*ElementList of locations the patient has been at
.... location 1..1LocationLocation the encounter takes place
.... status 0..1codeplanned | present | reserved
EncounterLocationStatus (Required)
.... period 0..1PeriodTime period during which the patient was present at the location
... serviceProvider 0..1OrganizationThe custodian organization of this Encounter record
... partOf 0..1EncounterAnother Encounter this encounter is part of

UML Diagram

Encounter (DomainResource)Identifier(s) by which this encounter is knownidentifier : Identifier 0..*planned | arrived | in-progress | onleave | finished | cancelled (this element modifies the meaning of other elements)status : code 1..1 « Current state of the encounterEncounterState »inpatient | outpatient | ambulatory | emergency +class : code 0..1 « Classification of the encounterEncounterClass »Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation)type : CodeableConcept 0..* « (The type of encounterEncounterType) »The patient present at the encounterpatient : Reference(Patient) 0..1Where a specific encounter should be classified as a part of a specific episode of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as govt reporting, or issue trackingepisodeOfCare : Reference(EpisodeOfCare) 0..1The referral request that this encounter is satisfies (incoming referral)incomingReferralRequest : Reference(ReferralRequest) 0..*The appointment that scheduled this encounterfulfills : Reference(Appointment) 0..1The start and end time of the encounterperiod : Period 0..1Quantity of time the encounter lasted. This excludes the time during leaves of absencelength : Duration 0..1Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosisreason : CodeableConcept 0..* « (Reason why the encounter takes placeEncounter Reason Codes) »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 Procedureindication : Reference(Any) 0..*Indicates the urgency of the encounterpriority : CodeableConcept 0..1 « (Indicates the urgency of the encounterEncounter Priority) »An organization that is in charge of maintaining the information of this Encounter (e.g., who maintains the report or the master service catalog item, etc.). This MAY be the same as the organization on the Patient record, however it could be different. This MAY not be not the Service Delivery Location's OrganizationserviceProvider : Reference(Organization) 0..1Another Encounter of which this encounter is a part of (administratively or in time)partOf : Reference(Encounter) 0..1StatusHistoryplanned | arrived | in-progress | onleave | finished | cancelledstatus : code 1..1 « Current state of the encounterEncounterState »The time that the episode was in the specified statusperiod : Period 1..1ParticipantRole of participant in encountertype : CodeableConcept 0..* « Role of participant in encounterParticipantType »The period of time that the specified participant was present during the encounter. These can overlap or be sub-sets of the overall encounters periodperiod : Period 0..1Persons involved in the encounter other than the patientindividual : Reference(Practitioner|RelatedPerson) 0..1HospitalizationPre-admission identifierpreAdmissionIdentifier : Identifier 0..1The location from which the patient came before admissionorigin : Reference(Location) 0..1From where patient was admitted (physician referral, transfer)admitSource : CodeableConcept 0..1 « From where the patient was admittedAdmitSource »Diet preferences reported by the patientdietPreference : CodeableConcept 0..1 « (Medical, cultural or ethical food preferences to help with catering requirementsDiet) »Special courtesies (VIP, board member)specialCourtesy : CodeableConcept 0..* « Special courtesiesSpecialCourtesy »Wheelchair, translator, stretcher, etcspecialArrangement : CodeableConcept 0..* « Special arrangementsSpecialArrangements »Location to which the patient is dischargeddestination : Reference(Location) 0..1Category or kind of location after dischargedischargeDisposition : CodeableConcept 0..1 « Discharge DispositionDischargeDisposition »The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are completedischargeDiagnosis : Reference(Any) 0..1Whether this hospitalization is a readmissionreAdmission : boolean 0..1LocationThe location where the encounter takes placelocation : Reference(Location) 1..1The status of the participants presence at the specified location during the period specified. If the participant is is no longer at the location, then the period will have an end date/timestatus : code 0..1 « The status of the locationEncounterLocationStatus »Time period during which the patient was present at the locationperiod : Period 0..1The current status is always found in the current version of the resource. This status history permits the encounter resource to contain the status history without the needing to read through the historical versions of the resource, or even have the server store themstatusHistory0..*The main practitioner responsible for providing the serviceparticipant0..*Details about an admission to a clinichospitalization0..1List of locations at which the patient has beenlocation0..*

XML Template

<Encounter xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this encounter is known --></identifier>
 <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled -->
 <statusHistory>  <!-- 0..* List of Encounter statuses -->
  <status value="[code]"/><!-- 1..1 planned | arrived | in-progress | onleave | finished | cancelled -->
  <period><!-- 1..1 Period The time that the episode was in the specified status --></period>
 </statusHistory>
 <class value="[code]"/><!-- 0..1 inpatient | outpatient | ambulatory | emergency + -->
 <type><!-- 0..* CodeableConcept Specific type of encounter --></type>
 <patient><!-- 0..1 Reference(Patient) The patient present at the encounter --></patient>
 <episodeOfCare><!-- 0..1 Reference(EpisodeOfCare) An episode of care that this encounter should be recorded against --></episodeOfCare>
 <incomingReferralRequest><!-- 0..* Reference(ReferralRequest) Incoming Referral Request --></incomingReferralRequest>
 <participant>  <!-- 0..* List of participants involved in the encounter -->
  <type><!-- 0..* CodeableConcept Role of participant in encounter --></type>
  <period><!-- 0..1 Period Period of time during the encounter participant was present --></period>
  <individual><!-- 0..1 Reference(Practitioner|RelatedPerson) Persons involved in the encounter other than the patient --></individual>
 </participant>
 <fulfills><!-- 0..1 Reference(Appointment) The appointment that scheduled this encounter --></fulfills>
 <period><!-- 0..1 Period The start and end time of the encounter --></period>
 <length><!-- 0..1 Duration Quantity of time the encounter lasted (less time absent) --></length>
 <reason><!-- 0..* CodeableConcept Reason the encounter takes place (code) --></reason>
 <indication><!-- 0..* Reference(Any) Reason the encounter takes place (resource) --></indication>
 <priority><!-- 0..1 CodeableConcept Indicates the urgency of the encounter --></priority>
 <hospitalization>  <!-- 0..1 Details about an admission to a clinic -->
  <preAdmissionIdentifier><!-- 0..1 Identifier Pre-admission identifier --></preAdmissionIdentifier>
  <origin><!-- 0..1 Reference(Location) The location from which the patient came before admission --></origin>
  <admitSource><!-- 0..1 CodeableConcept From where patient was admitted (physician referral, transfer) --></admitSource>
  <dietPreference><!-- 0..1 CodeableConcept Diet preferences reported by the patient --></dietPreference>
  <specialCourtesy><!-- 0..* CodeableConcept Special courtesies (VIP, board member) --></specialCourtesy>
  <specialArrangement><!-- 0..* CodeableConcept Wheelchair, translator, stretcher, etc --></specialArrangement>
  <destination><!-- 0..1 Reference(Location) Location to which the patient is discharged --></destination>
  <dischargeDisposition><!-- 0..1 CodeableConcept Category or kind of location after discharge --></dischargeDisposition>
  <dischargeDiagnosis><!-- 0..1 Reference(Any) The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete --></dischargeDiagnosis>
  <reAdmission value="[boolean]"/><!-- 0..1 Is this hospitalization a readmission? -->
 </hospitalization>
 <location>  <!-- 0..* List of locations the patient has been at -->
  <location><!-- 1..1 Reference(Location) Location the encounter takes place --></location>
  <status value="[code]"/><!-- 0..1 planned | present | reserved -->
  <period><!-- 0..1 Period Time period during which the patient was present at the location --></period>
 </location>
 <serviceProvider><!-- 0..1 Reference(Organization) The custodian organization of this Encounter record --></serviceProvider>
 <partOf><!-- 0..1 Reference(Encounter) Another Encounter this encounter is part of --></partOf>
</Encounter>

JSON Template

{doco
  "resourceType" : "Encounter",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this encounter is known
  "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled
  "statusHistory" : [{ // List of Encounter statuses
    "status" : "<code>", // R!  planned | arrived | in-progress | onleave | finished | cancelled
    "period" : { Period } // R!  The time that the episode was in the specified status
  }],
  "class" : "<code>", // inpatient | outpatient | ambulatory | emergency +
  "type" : [{ CodeableConcept }], // Specific type of encounter
  "patient" : { Reference(Patient) }, // The patient present at the encounter
  "episodeOfCare" : { Reference(EpisodeOfCare) }, // An episode of care that this encounter should be recorded against
  "incomingReferralRequest" : [{ Reference(ReferralRequest) }], // Incoming Referral Request
  "participant" : [{ // List of participants involved in the encounter
    "type" : [{ CodeableConcept }], // Role of participant in encounter
    "period" : { Period }, // Period of time during the encounter participant was present
    "individual" : { Reference(Practitioner|RelatedPerson) } // Persons involved in the encounter other than the patient
  }],
  "fulfills" : { Reference(Appointment) }, // The appointment that scheduled this encounter
  "period" : { Period }, // The start and end time of the encounter
  "length" : { Duration }, // Quantity of time the encounter lasted (less time absent)
  "reason" : [{ CodeableConcept }], // Reason the encounter takes place (code)
  "indication" : [{ Reference(Any) }], // Reason the encounter takes place (resource)
  "priority" : { CodeableConcept }, // Indicates the urgency of the encounter
  "hospitalization" : { // Details about an admission to a clinic
    "preAdmissionIdentifier" : { Identifier }, // Pre-admission identifier
    "origin" : { Reference(Location) }, // The location from which the patient came before admission
    "admitSource" : { CodeableConcept }, // From where patient was admitted (physician referral, transfer)
    "dietPreference" : { CodeableConcept }, // Diet preferences reported by the patient
    "specialCourtesy" : [{ CodeableConcept }], // Special courtesies (VIP, board member)
    "specialArrangement" : [{ CodeableConcept }], // Wheelchair, translator, stretcher, etc
    "destination" : { Reference(Location) }, // Location to which the patient is discharged
    "dischargeDisposition" : { CodeableConcept }, // Category or kind of location after discharge
    "dischargeDiagnosis" : { Reference(Any) }, // The final diagnosis given a patient before release from the hospital after all testing, surgery, and workup are complete
    "reAdmission" : <boolean> // Is this hospitalization a readmission?
  },
  "location" : [{ // List of locations the patient has been at
    "location" : { Reference(Location) }, // R!  Location the encounter takes place
    "status" : "<code>", // planned | present | reserved
    "period" : { Period } // Time period during which the patient was present at the location
  }],
  "serviceProvider" : { Reference(Organization) }, // The custodian organization of this Encounter record
  "partOf" : { Reference(Encounter) } // Another Encounter this encounter is part of
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON)

5.19.3.1 Terminology Bindings

PathDefinitionTypeReference
Encounter.status
Encounter.statusHistory.status
Current state of the encounterRequiredhttp://hl7.org/fhir/encounter-state
Encounter.class Classification of the encounterRequiredhttp://hl7.org/fhir/encounter-class
Encounter.type The type of encounterExamplehttp://hl7.org/fhir/vs/encounter-type
Encounter.participant.type Role of participant in encounterRequiredhttp://hl7.org/fhir/vs/encounter-participant-type
Encounter.reason Reason why the encounter takes placeExamplehttp://hl7.org/fhir/vs/encounter-reason
Encounter.priority Indicates the urgency of the encounterExamplehttp://hl7.org/fhir/vs/encounter-priority
Encounter.hospitalization.admitSource From where the patient was admittedRequiredhttp://hl7.org/fhir/vs/encounter-admit-source
Encounter.hospitalization.dietPreference Medical, cultural or ethical food preferences to help with catering requirementsExamplehttp://hl7.org/fhir/vs/encounter-diet
Encounter.hospitalization.specialCourtesy Special courtesiesRequiredhttp://hl7.org/fhir/vs/encounter-special-courtesy
Encounter.hospitalization.specialArrangement Special arrangementsRequiredhttp://hl7.org/fhir/vs/encounter-special-arrangements
Encounter.hospitalization.dischargeDisposition Discharge DispositionRequiredhttp://hl7.org/fhir/vs/encounter-discharge-disposition
Encounter.location.status The status of the locationRequiredhttp://hl7.org/fhir/encounter-location-status

5.19.4 Notes

  • The class element describes the setting (in/outpatient etc.) in which the Encounter took place. Since this is important for interpreting the context of the encounter, choosing the appropriate business rules to enforce and for the management of the process, this element is required.
  • In future versions of FHIR, some kind of charge posting vehicle (e.g. Account) will be added.

5.19.5 Example usage

As stated, Encounter allows a flexible nesting of Encounters using the partOf element. For example:

  • A patient is admitted for two weeks - This could be modeled using a single Encounter instance, in which the start and length are given for the duration of the whole stay. The admitting doctor and the responsible doctor during the stay are specified using the Participant component.
  • During the encounter, the patient moves from the admitting department to the Intensive Care unit and back - Three more detailed additional Encounters can be created, one for each location in which the patient stayed. Each of these Encounters has a single location (twice the admitting department and once the Intensive Care unit) and one or more participants at that location. These Encounters may use the partOf relationship to indicate these movements occurred during the longer overarching Encounter.
  • During the last part of the stay, the patient is visited by the members of the multi-disciplinary team that treated him for final evaluation - If relevant, for each of these short visits, an Encounter may be created with a single participant. Since these took place during the last part of the stay, the partOf element can be used to associate these short visits with either the third patient movement or the bigger overall encounter.

Exactly how the Encounter is used depends on information available in the source system, the relevance of exchange of each level of Encounter and demands specific to the communicating partners. The expectation is that for each domain of exchange, Profiles are used to limit the flexibility of Encounter to meet the demands of the usecase.

5.19.6 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
datedateA date within the period the Encounter lastedEncounter.period
episodeofcarereferenceAn episode of care that this encounter should be recorded againstEncounter.episodeOfCare
(EpisodeOfCare)
fulfillsreferenceThe appointment that scheduled this encounterEncounter.fulfills
(Appointment)
identifiertokenIdentifier(s) by which this encounter is knownEncounter.identifier
incomingreferralreferenceIncoming Referral RequestEncounter.incomingReferralRequest
(ReferralRequest)
indicationreferenceReason the encounter takes place (resource)Encounter.indication
(Any)
lengthnumberLength of encounter in daysEncounter.length
locationreferenceLocation the encounter takes placeEncounter.location.location
(Location)
location-perioddateTime period during which the patient was present at the locationEncounter.location.period
part-ofreferenceAnother Encounter this encounter is part ofEncounter.partOf
(Encounter)
participantreferencePersons involved in the encounter other than the patientEncounter.participant.individual
(Practitioner, RelatedPerson)
participant-typetokenRole of participant in encounterEncounter.participant.type
patientreferenceThe patient present at the encounterEncounter.patient
(Patient)
practitionerreferencePersons involved in the encounter other than the patientEncounter.participant.individual
(Practitioner)
reasontokenReason the encounter takes place (code)Encounter.reason
special-arrangementtokenWheelchair, translator, stretcher, etcEncounter.hospitalization.specialArrangement
statustokenplanned | arrived | in-progress | onleave | finished | cancelledEncounter.status
typetokenSpecific type of encounterEncounter.type