HL7 FHIR Implementation Guide: SHR Core, Release 0.6 - US Realm (Draft for Comment 1)

HL7 FHIR Implementation Guide: SHR Core, Release 0.6 - US Realm (Draft for Comment 1) FHIR Profiles - Local Development build (v0.6.0). See the Directory of published versions

Primary extensions defined as part of this Implementation Guide

Name Definition

The action taken as a result of the adverse reaction. May include changing or discontinuing medication, reducing dose, etc.


A list of alternate names the subject is or was known as.


An added or follow-up note, often after the fact, that contains metadata about who made the statement and when.


Reason the appointment is to take place (resource)


Preconditions for service, either ‘true’ indicating to be performed if needed, or a code indicating the pre-condition for performing the service. For example ‘pain’, ‘on flare-up’, etc.


The actor who created the item and it responsible for the content (regardless of the information source or who recorded it). If only the author is given, it is assumed the author is the information source and the recorder.


A description of when the locations opening ours are different to normal, e.g. public holiday availability. Succinctly describing all possible exceptions to normal site availability as detailed in the opening hours Times.


The size of cuff used, if applicable.


A location or structure in the body, including tissues, regions, cavities, and spaces; for example, right elbow, or left ventricle of the heart. Body location is a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

  • Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
  • Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
  • Relation to landmark: The location relative to a landmark is specified by:
  • Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
  • Specifying the direction and distance from the landmark to the body location. Note that BodyLocation is a data type, a reusable structure, not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR’s stand-alone BodySite (aka BodyStructure in r4) which ‘is not … intended for describing the type of anatomical location but rather a specific body site on a specific patient’ (FHIR 3.5).

The position or physical attitude of the body.

A URI that refers to a resource by its canonical URL (resources with a url property). The canonical type differs from a uri in that it has special meaning in this specification, and in that it may have a version appended, separated by a vertical bar ( ).

The encounter or episode of care


The general type or class of this item.


The main type identifier for a lab, procedure, condition, etc., usually drawn from a controlled vocabulary.


A text note containing additional details, explanation, description, comment, or summarization.


Language used for communication by a human, either the subject of record, parent, or other involved person.


The condition that is the focus of the study. For example, In a study to examine risk factors for Lupus, might have as an inclusion criterion ‘healthy volunteer’, but the target condition code would be a Lupus SNOMED code.


A contact party (e.g. guardian, partner, friend) for the person


A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card. Alternate names include co-pay, deductible, exceptions.


The description of the overall pattern of the administration of the medication to the patient.


A suite of underwriter specific classifiers.


The date the disease was first clinically recognized with sufficient certainty, regardless of whether it was fully characterized at that time.


The date on which the existence of the AdverseEvent first become known or was first observed.


A name of the device as given by the manufacturer, along with a type of name.


The name of the device.


The distinct identification string as required by regulation for a human cell, tissue, or cellular and tissue-based product.


A flag, when set to true, indicates that the service/procedure should NOT be performed.


Reason the encounter is taking place.


When an action should be done. If the action is a series or recurs (e.g. daily blood sugar testing in the morning) then a Timing can be used to describe the periodicity.


Who this request is being addressed to.


What type of party should carry out the testing.


The person or entity that the information in this resource relates to, if different than the person of record. The subject of information can be a reference or a code, the latter when the subject is described generically, for example, in terms of a relationship to the subject of record (e.g., wife).


A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.


Cautions on the handling of this specimen.


What days/times during a week is this location usually open.


Business identifier or external id for this resource.


Substance used for this imaging procedure such as a contrast agent.


A set of rules under which this content was created


Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.


Whether this is intended to be used with an extensible binding


A human language, spoken or written.


Services and space and equipment provided for a particular purpose; a building or place that provides a particular service or is used for a particular industry. Could be a clinical site, community site, or a mobile facility.


The preferred type of location(s) where the service should happen, in coded or free text form, e.g. at home or nursing day care center.


Entity responsible for defining and maintaining Group characteristics and/or registered members.


A type of prescription drug or over-the-counter drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition, but excluding vaccines. In FHIR DSTU2 and STU3, Medication lacks the identifier attribute, which is included in SHR as an extension. DSTU2 lacks the status attribute, which is required by US-Core. Batch is 0..1 in FHIR R4, and accordingly is restricted here.


A choice of a medication code or reference.


Reason that patient did not adhere to a medication regimen.


Elements that belong to all information items.


The technique used to carry out an action, for example, the specific imaging technical or assessment vehicle.


A human-readable narrative, potentially including images, that contains a summary of the resource, and may be used to represent the content of the resource to a human.


The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.


A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.


Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).


The larger entity that the asserted item is a portion of. For example, an organization part of a larger organization, or an encounter with a hospitalist might be part of a larger hospitalization encounter.


Patient or consumer-oriented instructions.


A human author, patient, practitioner, or related person, as opposed to an organization or device.


The person who provided the information, not necessarily the patient.


A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.


Description of the intent or use of the item.


The Questionnaire that defines and organizes the questions for which answers are being provided.


The total number of treatment sessions (fractions) administered during a course of radiation therapy therapy. A fraction is a portion of the total radiation dose, delivered as a series of treatments that make up the full course of radiotherapy. (source: LOINC)


The total number of treatment sessions (fractions) administered during a course of radiation therapy therapy. A fraction is a portion of the total radiation dose, delivered as a series of treatments that make up the full course of radiotherapy. (source: LOINC)


Request(s) replaced by this request


Indicates if this record was captured as a secondary ‘reported’ record rather than as an original primary source-of-truth record. It may also indicate the source of the report.


An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).


The stage in the progression of a therapy from initial experimental use in humans in clinical trials to post-market evaluation.


The practitioner or organization that is responsible for the report’s conclusions and interpretations.


Serial number assigned by the manufacturer.


The original or initiating plan, proposal, or request.


A service requested or performed. Additional details and instructions about the service requested or performed. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.


Degree of harshness or extent of a symptom, disorder, or condition.


Information about the proper handling of the specimen.


A specimen is a substance, physical object, or collection of objects, that the laboratory considers a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory workflow. A specimen may include multiple physical pieces as long as they are considered a single unit within the laboratory workflow. A specimen results from one to many specimen collection procedures, and may be contained in multiple specimen containers. Specimen may have one or more processing activities.


Additives added to the specimen.


The point in time when the statement was created.


A state that relates to the workflow or interpretation of this resource. Certain status values can modify the meaning of the resource, for example, entered-in-error. When a boolean value is used, Status of true indicates the record is active, false means inactive.


Captures the reason for the current state of the procedure.


A goal that the study is aiming to achieve in terms of a scientific question to be answered by the analysis of data collected during the study.


The subject of a clinical statement, often called the Patient or the Subject. The SubjectOfRecord typically identifies the clinical record in which this statement is contained. If the statement should be in John Doe’s patient record, then John Doe is the subject of record. When there is no patient, the SubjectOfRecord can also be a location, group, or other entity that statement pertains to. For example, observations concerning a hospital ward would have a Location as the SubjectOfRecord.

Note that the word ‘Subject’ is used here in the sense of a person or entity subjected to observations or actions, not subject as in a conceptual topic, like heart disease.


Resource that can be subject of QuestionnaireResponse


Reimbursement to insurer. When ‘subrogation=true’ this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.


Additional information to support this request.


A code explaining unplanned or premature termination of a plan of treatment, course of medication, or research study.


The total amount of radiation dose delivered for the course of therapy. (source: SNOMED, ASTRO)


The purpose of a treatment.