Status: Active: Approved (STU)

Introduction

This profile sets minimum expectations for the Encounter resource.

The Encounter is a key resource - as it explains the who, where, when, and why of care that has been provided. Not only is the Encounter resource valuable in itself, but it also acts as a point of reference for linking to other clinical resources.

Its main use in our region at present is for acute care, where it can be used to describe inpatient, outpatient and emergency encounters.

As of this writing Encounters are not being used by Social Care - which instead uses a model based around the Episode of Care. See the Episode of Care profile for further details.

The Encounter is a complex FHIR Resource – and one which offers significant flexibility to support different representations. The FHIR guidance on anticipated usage is helpful and should be read as background, see https://www.hl7.org/fhir/STU3/encounter.html. As this states: “The expectation is that for each domain of exchange, profiles are used to limit the flexibility of Encounter to meet the demands of the use case”. Before looking at the data items in detail, it is therefore necessary to establish some overall guidelines on how the Encounter resource type will be used

Encounter Start/End

Whilst there is an intuitive understanding of what constitutes the start / end of an Encounter, it is challenging to establish a rigorous definition. Nevertheless, the following guidelines cover key points discussed to date:

• An Encounter covers a period of continuous care

• A change in care-setting constitutes a change of Encounter. (This would include moving from Emergency to Inpatient to Outpatient within a hospital – as indicated by the “class”)

• A change in location within the same care setting does NOT constitute a change of Encounter. (For example moving between beds and/or wards within a hospital inpatient stay. This would instead be modelled using the “location” sub-structure of the Encounter)

• Involvement of additional clinicians does NOT constitute a separate Encounter. For example, suppose a hospital inpatient is visited by a dietician during their stay:

  • As a major contributor to the encounter the dietician would be referenced as one of the participants
  • As a minor contributor the dietician would be referenced as the author of a CarePlan, performer of an Observation, or assessor of a ClinicalImpression. These in turn would be linked to the Encounter.

Encounter Structure and hierarchy

Any discussion of Encounters inevitably has to consider the topic of how Encounters are structured and grouped.

• The FHIR Encounter Resource includes the “partOf” field, which allows Encounters to be linked into structures and hierarchies.
• It is also possible to link to an Episode of Care

There is a need to balance the desire to accurately model the complexity of real-life vs the need to provide a simple model which is easy for Data Consumers to understand and to reliably display. Experience suggests that offering a plethora of varying complex hierarchical structures from different care settings makes the task of a Data Consumer extremely challenging.

The core of the approach is therefore a simple flat list of Encounters. Two options are then offered to enrich this with different types of groupings:

• Core Model - Simple flat list of Encounters

  This is the basic model which all Data Providers and Consumers MUST support. It consists of a simple flat list of Encounters with no hierarchy whatsoever.

  • Much of the value comes from this list and, for Direct Care purposes at least, it is not difficult for a clinician to look at the times and locations and deduce what has occurred.
  • A important use-case is messaging-based consumers - eg Ambulance Transfer of Care and Subscription Notifications. These consumers see the world as a real-time stream of Encounter-based events. In this world-view it is difficult to comprehend hierarchy - and indeed the ultimate set of interrelationships may not even be known as the initial Encounter event unfolds. It is therefore extremely important that all of the necessary information can be conveyed as a “flat” stream of Encounter messages.

  The basic model is therefore of standalone Encounters which have a full set of information populated to give a complete picture of what occurred.

  A specific implication of this is in the use of the “hospitalization” structure which, despite the name, can be used to convey important admission and discharge information relevant to any care-setting:

  • If the Encounter includes an Admission event, then the relevant portion of the hospitalization structure MUST be populated
  • If the Encounter includes a Discharge event, then the relevant portion of the hospitalization structure MUST be populated
  • Portions of the hospitalization structure which are irrelevant to this Encounter may be omitted.
  • In other words, depending on circumstances, the hospitalization structure might be:
    • Fully populated (for a simple standalone Encounter)
    • Half populated (for an Encounter that is the first or last of a set)
    • Not populated at all (more rarely, for an Encounter that is “in the middle” of a set)

• Grouping Option 1 - Encounter Grouping (linking in time)

  Despite the appeal of a simple flat list of Encounters, the concept of a “visit”, “hospitalisation”, or “incident” is widely recognised and agreed to be useful as a way of grouping Encounters that are linked in time. For example:

  • An initial “emergency” visit to A&E is followed by admittance to the ward as an inpatient
  • An initial call to 111 is followed by a visit at home from a first-responder, and finally a conveyance to hospital in an ambulance

  A two-level hierarchy is therefore defined, based on the use of special type of Grouping Encounter to link together Encounters which comprise part of the same “visit”, “stay” or “incident”.

  • A separate Encounter Grouping profile is provided to support this.
  • Data Providers who feel it is relevant MAY provide this additional grouping information
  • Data Consumers who are able MAY make use of this additional grouping information to provide a richer and more meaningful display to their users

  In practical terms:

  • The “partOf” field on the base Encounters is populated to point at a Grouping Encounter
  • Only a SINGLE level of Encounter hierarchy is supported. The “partOf” field of a base Encounter must point ONLY at a single Grouping Encounter. Other more complex structures are NOT supported
  • It is perfectly acceptable to have a Grouping Encounter which contains only a single base Encounter. In fact this is likely to be common - as when the initial encounter occurs it is not known how events will unfold. The simplest approach for a Maturity Level 2 Data Provider will therefore be to always create a Grouping Encounter in anticipation. With the grouping structure already in place, it becomes straightforward to add additional Encounters as-and-if they occur.
  • It is, of course, also acceptable to have a standalone Encounter with no Grouping Encounter - for example where an Encounter is not going to be part of any grouping and this is known from the start.
  • The Grouping Encounter is essentially an empty shell. Its purpose is purely to group. All of the important information is held in the base Encounters.
  • The Grouping Encounter does however add value by capturing the overall period and the full set of “hospitalization” information about admission and discharge. Whilst this could be deduced from the base encounters, it is helpful and logical to also provide in one place here.

• Grouping Option 2 - Episode of Care (linking by condition)

  Another way of grouping Encounters goes beyond modelling a single visit or incident and links together a care pathway based on a Condition. This linkage is provided by the Episode of Care.

  At first glance it can be difficult to distinguish an Encounter Grouping from an Episode of Care - however the FHIR specification provides helpful guidance, and in fact there are some clear differentiating features:

  • An Episode of Care continues over a longer period of time. Specifically it can be used to link together multiple separate visits over a period of months or even years. For example an initial in-patient stay, and then several related out patient appointments, and then maybe another in-patient stay if there is a relapse.

  • An Episode of Care is based around a “condition” and is thus used to join-up a care pathway. Specifically, a patient with multiple conditions could have multiple Episodes of Care running concurrently. The Episode of Care is used to “pick out” from the mass of activity those Encounters relating to a particular care pathway. Therefore the Episode of Care MUST have its Condition field populated when using it to group Encounters in this way.

  • The FHIR Specification states that an Episode of Care relates to a single organisation, and this is how we envisage it being used initially.

  Longer term the definition of “organisation” might be considered a point of controversy, specifically is an Integrated Care System an “organisation”? This would provide a valuable mechanism to link up a cross-care-setting care pathway - noting that there is currently no obvious mechanism to identify and link encounters at this whole-system level. Extending an Episode of Care across multiple care settings in this way is therefore currently seen as aspiriational and unlikely to be implemented immediately. Please get in touch for further discussion if you believe you may be a first-of-type.

The diagram below summarises the above discussion - ie core Encounters, plus options for a single Grouping Encounter, and/or one or more Episodes of Care.

​

Encounters vs Appointments

Whilst the terms “Encounter” and “Appointment” might be used interchangeably in everyday speech, in FHIR they have specific meanings:

• An Appointment describes a plan for the future
• An Encounter generally describes something that is happening now, or has occurred in the past

In general therefore:

• An Appointment will lead to an Encounter - when the patient attends
• An Encounter may or may not come from an Appointment (ie scheduled vs unscheduled care)

The picture is further complicated as FHIR does allow an Encounter to be created with status “planned”, however this is not recommended here and should normally be represented instead with an Appointment.

Further useful guidance can be found on the FHIR website, here:

https://www.hl7.org/fhir/STU3/encounter.html#bnr

https://www.hl7.org/fhir/STU3/appointment.html#statuses

https://www.hl7.org/fhir/STU3/appointment.html#status-flow

Mandatory fields

A significant set of mandatory fields are defined in order to properly describe an Encounter:

1. Status - this is already mandatory in FHIR. As noted above the use of “planned” is discouraged - use Appointment instead for this.

2. Class - this provides a categorisation, ie Emergency, Inpatient, Ambulatory. This should always be known, and vital for meaningful display purposes. We have defined a custom code list which replicates the standard list provided by Care Connect, and adds a codes to identify an “Encounter Grouping”, and various types of ambulance/emergency service encounters. However it also enables the possibility of extending the list to cover a wider range of care settings if this is found to be necessary (please get in touch).

3. Subject - every encounter must be linked to a Patient (not a Group)

4. Participant - it is required to include EXACTLY ONE practitioner who has the “type” of “Primary Performer”. This should be the main person responsible - someone who it would be useful to contact if further information is desired. (If this person changed during the course of the encounter then please pick just ONE to finally hold this key role, and demote the others to “participant”)

   Also included in the list of participants might be:

   • Admitter and Discharger - should be included if known and relevant.
   • Participant - FHIR offers a wealth of other participant type codes, however it is suggested that simply classifying others as “participant” is likely to be adequate in most cases.

   Participants can be given a “period” and this is optional. For regional sharing the most important thing is to see who has been involved with the patient, rather than to construct a forensic timeline of involvements. However this information might be useful in the case of a long Encounter with many brief involvements, and so may be provided if desired.

5. Period When the encounter occurred is vital to know. The start date/time is always mandatory, but as per the FHIR specification, the end date/time may be omitted if the encounter is ongoing

Must Support fields

In addition the following fields are “Must Support” - ie they must be populated if relevant and known. These largely relate to providing additional “clinical” detail about the Encounter - including links to related FHIR Resources such as the originating Appointment, the Condition, etc. These build up the rich dataset around an Encounter and are important to provide, but may not yet be available for an initial Encounter implementation.

1. Identifier - a Local Id should be provided, such that could be quoted if manually getting in touch to find out more

2. Type - categorises the type of place where the encounter took place. CareConnect modifies FHIR by providing a much more relevant list covering:
   • Indirect encounters - eg phone, video, letter, etc
   • In an establishment - a short list of top-level codes which cover a good range of care settings eg “Seen in clinic”, “Seen in own home”, “Seen in supervised accomodation”, etc.
   • On the street

     NB: The code for “Seen in Clinic” offers the ability to drill down into a long list of specific clinic types. However this overlaps to some extent with the purpose of the “Service Type” field - so it is sufficient here to populate simply “Seen in Clinic”.

3. Service Type (Extension) - this is perhaps one of the most important and useful fields about an Encounter as it describes the type of service - ie what the Encounter was “for”.

   However this field is missing in FHIR STU3! This is corrected in FHIR R4, and so we pre-adopt it here as an extension.

   We also pre-adopt the UKCore value set (based on SNOMED refset 1127531000000102: Services Simple Reference Set), which is more relevant than the default FHIR example and also covers social care

4. Priority: This provides useful information about whether it was emergency, routine, elective, etc

5. Location - the location provides essential information about where the encounter took place. Exactly what is appropriate here will depend on the care setting:
   • For a hospital information should be provided down to the “ward” level. Thus enabling a visitor to find the patient, as well as potentially giving some insight into the type of treatment being provided.
   • For other (smaller) locations then the “site” level may be sufficient
   • Other types of care (eg community, emergency) may take place at home or in a vehicle

   It is useful to understand the history of where the patient has been seen, so the status and period MUST be populated, and a history SHOULD be provided. (As noted above, a change of location does not in itself constitute a new Encounter, simply append to this list).

6. Appointment: Link to the originating Appointment, if relevant

7. Reason: A long list of SNOMED codes to describe different reasons which may have led to the Encounter. (Note that this may duplicate to some extent information provided in a linked Appointment and/or Referral, but is seen as useful to pull through onto the Encounter itself also).

   We pre-adopt the value set used in R4. This builds on the existing STU3 list covering SNOMED codes for “Clinical Finding” and “Procedure”, and adds codes for “Context-dependent categories” (Social Care) and “Events” (A&E)

8. Diagnosis: Link to a Condition diagnosed as a result of the Encounter. Can obviously be provided only if the Condition FHIR Resource is also being offered. If populated then it is required to rank the Conditions, and to assign one the “role” of “Chief Complaint”

9. Outcome fields: Care Connect defines three extension fields which cover aspects of the encounter outcome:
   • Outcome of Attendance - relevant to outpatient encounters
   • Emergency Care Discharge Status - relevant to emergency encounters
   • Discharge Method - found in the “hospitalization”, and relevant to inpatient encounters

   These provide valuable information which is important to populate. However it is expected that only one of the three will be populated, as relevant for the type of encounter

   • Emergency Care Discharge Destination - This extension has been added to record the discharge destination of patients which have attended ED. (based on SNOMED refset 999003011000000105: Emergency care discharge destination simple reference set)

10. Hospitalization: To provide details of admission and discharge. As described above then, depending on circumstances, it might be actually populated fully, partially, or not at all. See below for further details of the fields contained

11. Status History - this is seen as important - to understand the timeline of the Encounter.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Points of note include:

• Part Of - as described above, this may be used to point to an overarching “EncounterGrouping” Encounter. No other complex structures or nesting are permitted.

• Episode of Care - again as described above, this may be used to link up a care pathway by pointing to an Episode of Care.

• Incoming Referral: Link to the originating Referral, if relevant and implemented. This could be very useful information. However FHIR makes significant changes from the STU3 “ReferralRequest” to the R4 “ServiceRequest”, and so we are reluctant to mandate implementation at this stage

• Length - the period is already provided, so this may appear to be duplication. However it is encouraged to populate if possible as it is useful for analytic purposes. If provided then the duration SHOULD be in minutes, and should reflect the time the patient is receiving direct care - eg not including the time the patient is waiting to be seen in clinic. (This provides a further distinction and greater analytical accuracy over-and-above the “period”)

• Encounter Transport - may be useful if relevant and known (however noting that it no longer exists in UK Core)

Discouraged or Removed fields

• Class History - as described in the introduction, a change of care setting would constitute a new Encounter. Therefore by definition an Encounter will only ever have a single Class.
• Account - for billing purposes, not relevant.
• Service Provider - duplicates information already available in the provenance tags

Hospitalization Structure

Within the Encounter sits the “Hospitalization” structure. This structure provides information about the admission and discharge. Therefore it is particularly important for a regional shared record - as this defines the touchpoints with other care providers.

Fields in the Hospitalization structure are as follows:

• Must Support
  • Admission Method - this CareConnect extension provides a useful list of codes about the method of admission (eg Planned, A&E, transfer, etc)
  • Discharge Method - this CareConnect extension provides a useful list of codes about the method of discharge relevant to an inpatient stay (eg clinical discharge, self-discharge, deceased, etc). It is one of three alternatives for providing outcome information, depending on the type of encounter - see above under the main encounter “must support” heading for further details.
  • Origin - Information about the location which the patient arrived from (if relevant / known)
    • Required at the “site” level if arriving from another institution
    • Optional if arriving from a residential address
  • Admit Source - Useful information about the type of place the patient came from (eg home, other NHS hospital, care home, etc)
  • Destination - Information about the location which the patient is discharged to (if relevant / known)
    • Required at the “site” level if discharged to another institution
    • Optional if discharged to a residential address
  • Discharge Disposition - Useful information about the type of place the patient has been discharged to (eg home, other NHS hospital, care home, etc)). (We use a value set which updates that provided by CareConnect with the latest improved list from the NHS Data Dictionary)
  • Medically Safe For Discharge - This extension has been added to capture important information to assist with discharge planning and analysis. It contains a status code (ready, not ready, or unknown), plus the predicted and actual date when the patient is medically safe for discharge.

  Note that Origin and Destination are likely to be external locations - please refer to guidance on the Location profile about use of References. For example the use of a Contained Resource may be appropriate.

• Optional
  • Readmission - flag may be provided if known and relevant
• Discouraged
  • Diet Preferences, Special Courtesy, Special Arrangement - additional details that are relevant internally for planning the patient’s stay, but not so relevant for external sharing.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from CareConnect-Encounter-1

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	CareConnect-Encounter-1	An interaction during which services are provided to the patient
id	S	0..1	id	Logical id of this artifact
meta
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
extension:outcomeOfAttendance	S	0..1	Extension-CareConnect-OutcomeOfAttendance-1	An extension to the Encounter resource to record the outcome of an Out-Patient attendance.
extension:emergencyCareDischargeStatus	S	0..1	Extension-CareConnect-EmergencyCareDischargeStatus-1	An extension to the Encounter resource which is used indicate the status of the Patient on discharge from an Emergency Care Department.
emergencyCareDischargeDestination	S	0..1	CodeableConcept	Discharge destination of patients which have attended ED. URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-EDDischargeDestination Binding: Interweave ED Discharge Destination (preferred)
serviceType	S	0..1	CodeableConcept	Specific type of service (pre-adopted from R4) URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-R4EncounterServiceType Binding: Interweave UkCore Care Setting Type (preferred)
Slices for identifier		0..*	Identifier	Identifier(s) by which this encounter is known Slice: Unordered, Open by value:system
identifier:localIdentifier	S	0..1	Identifier	Identifier(s) by which this encounter is known
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-encounter-identifier
value	S	1..1	string	The Local encounter Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
status	S	1..1	code	arrived | triaged | in-progress | onleave | finished | cancelled + (Note: 'planned' is also possible, but normally represented instead as an Appointment)
statusHistory	S	0..*	BackboneElement	List of past encounter statuses
class	S	1..1	Coding	Classification of the encounter. EXTENSIBLE on request, eg to cover other care settings Binding: InterweaveEncounterClass (required)
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
classHistory		0..0
type	S	0..1	CodeableConcept	Specific type of encounter Binding: Care Connect Encounter Type (required)
coding		1..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:snomedCT	S	1..*	Coding	Code defined by a terminology system Binding: Care Connect Encounter Type (required)
priority	S	0..1	CodeableConcept	Indicates the urgency of the encounter Binding: InterweaveEncounterPriority (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
subject	S	1..1	Reference(CareConnectPatient1)	The patient (NOT group) present at the encounter
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
incomingReferral
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
participant	S	1..*	BackboneElement	List of participants involved in the encounter
type	S	1..1	CodeableConcept	Role of participant in encounter Binding: ParticipantType (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
individual	S	1..1	Reference(CareConnect-Practitioner-1)	Persons involved in the encounter other than the patient
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
appointment	S	0..1	Reference(Appointment)	The appointment that scheduled this encounter
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
period	S	1..1	Period	The start and end time of the encounter
start	S	1..1	dateTime	Starting time with inclusive boundary
end	S	0..1	dateTime	End time with inclusive boundary, if not ongoing
length		0..1	Duration	Quantity of time the encounter lasted (less time absent). Please use minutes.
reason	S	0..*	CodeableConcept	Reason the encounter takes place (code) Binding: Interweave R4 Encounter Reason (preferred)
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
Slices for diagnosis	S	0..*	BackboneElement	The list of diagnosis relevant to this encounter Slice: Unordered, Open by value:role
diagnosis:All Slices				Content/Rules for all slices
condition	S	1..1	Reference(CareConnect-Condition-1)	Reason the encounter takes place (resource)
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
role	S	1..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
rank	S	1..1	positiveInt	Ranking of the diagnosis (for each role type)
diagnosis:chiefComplaint	S	0..1	BackboneElement	The list of diagnosis relevant to this encounter
role		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Fixed Value: As shown
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/diagnosis-role
code		1..1	code	Symbol in syntax defined by the system Fixed Value: CC
display		1..1	string	Representation defined by the system Fixed Value: Chief complaint
account		0..0
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service
extension:admissionMethod	S	0..1	Extension-CareConnect-AdmissionMethod-1	An extension to the Encounter resource to record how a Patient was admitted to hospital.
extension:dischargeMethod	S	0..1	Extension-CareConnect-DischargeMethod-1	An extension to the Encounter resource to record the method of discharge from hospital.
medicallySafeForDischarge	S	0..1	(Complex)	Medically Safe for Discharge URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-MedicallySafeForDischarge
origin		0..1	Reference(CareConnect-Location-1)	The location from which the patient came before admission. Useful to provide if possible, in particular to reference a 'site' if transfered from another institution.
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
admitSource	S	0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: NHS Data Model and Dictionary Source Of Admission (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
dietPreference		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
specialCourtesy		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
specialArrangement		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
destination	S	0..1	Reference(CareConnect-Location-1)	Location to which the patient is discharged. Important to provide if known to support discharge planning, and/or to reference a 'site' if transfered to another institution.
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
dischargeDisposition	S	0..1	CodeableConcept	Category or kind of location after discharge Binding: Interweave Discharge Destination codes (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
location	S	0..*	BackboneElement	Location the encounter takes place (at Ward level)
location	S	1..1	Reference(CareConnect-Location-1)	Location the encounter takes place
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
status	S	1..1	code	planned | active | reserved | completed
period	S	1..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(CareConnect-Organization-1)	DISCOURAGED: This is instead covered via the provenance tags
partOf		0..1	Reference(InterweaveEncounterGrouping)	Another Encounter this encounter is part of
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Encounter.class	required	InterweaveEncounterClass
Encounter.type	required	Care Connect Encounter Type
Encounter.type.coding:snomedCT	required	Care Connect Encounter Type
Encounter.priority	required	InterweaveEncounterPriority
Encounter.participant.type	required	ParticipantType
Encounter.reason	preferred	Interweave R4 Encounter Reason
Encounter.diagnosis.role	required	DiagnosisRole
Encounter.hospitalization.admitSource	required	NHS Data Model and Dictionary Source Of Admission
Encounter.hospitalization.dischargeDisposition	required	Interweave Discharge Destination codes

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	CareConnect-Encounter-1	An interaction during which services are provided to the patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
encounterTransport		0..1	(Complex)	Encounter transport URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EncounterTransport-1
outcomeOfAttendance	S	0..1	CodeableConcept	An extension to the Encounter resource to record the outcome of an Out-Patient attendance. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-OutcomeOfAttendance-1 Binding: NHS Data Model and Dictionary Outcome Of Attendance (required): This records the outcome of an Out-Patient Attendance Consultant.
emergencyCareDischargeStatus	S	0..1	CodeableConcept	An extension to the Encounter resource which is used indicate the status of the Patient on discharge from an Emergency Care Department. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EmergencyCareDischargeStatus-1 Binding: Care Connect Emergency Care Discharge Status (required): The status of the Patient on discharge from an Emergency Care Department.
emergencyCareDischargeDestination	S	0..1	CodeableConcept	Discharge destination of patients which have attended ED. URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-EDDischargeDestination Binding: Interweave ED Discharge Destination (preferred)
serviceType	S	0..1	CodeableConcept	Specific type of service (pre-adopted from R4) URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-R4EncounterServiceType Binding: Interweave UkCore Care Setting Type (preferred)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
identifier:localIdentifier	SΣ	0..1	Identifier	Identifier(s) by which this encounter is known
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-encounter-identifier
value	SΣ	1..1	string	The Local encounter Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	arrived | triaged | in-progress | onleave | finished | cancelled + (Note: 'planned' is also possible, but normally represented instead as an Appointment) Binding: EncounterStatus (required): Current state of the encounter
statusHistory	S	0..*	BackboneElement	List of past encounter statuses
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter
period		1..1	Period	The time that the episode was in the specified status
class	SΣ	1..1	Coding	Classification of the encounter. EXTENSIBLE on request, eg to cover other care settings Binding: InterweaveEncounterClass (required)
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
type	SΣ	0..1	CodeableConcept	Specific type of encounter Binding: Care Connect Encounter Type (required)
Slices for coding	Σ	1..1	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	SΣ	1..*	Coding	Code defined by a terminology system Binding: Care Connect Encounter Type (required)
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
priority	S	0..1	CodeableConcept	Indicates the urgency of the encounter Binding: InterweaveEncounterPriority (required)
subject	SΣ	1..1	Reference(CareConnectPatient1)	The patient (NOT group) present at the encounter
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
participant	SΣ	1..*	BackboneElement	List of participants involved in the encounter
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	SΣ	1..1	CodeableConcept	Role of participant in encounter Binding: ParticipantType (required)
individual	SΣ	1..1	Reference(CareConnect-Practitioner-1)	Persons involved in the encounter other than the patient
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
appointment	SΣ	0..1	Reference(Appointment)	The appointment that scheduled this encounter
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
period	S	1..1	Period	The start and end time of the encounter
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
length		0..1	Duration	Quantity of time the encounter lasted (less time absent). Please use minutes.
reason	SΣ	0..*	CodeableConcept	Reason the encounter takes place (code) Binding: Interweave R4 Encounter Reason (preferred)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
Slices for diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this encounter Slice: Unordered, Open by value:role
diagnosis:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
condition	S	1..1	Reference(CareConnect-Condition-1)	Reason the encounter takes place (resource)
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
role	S	1..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (required)
rank	S	1..1	positiveInt	Ranking of the diagnosis (for each role type)
diagnosis:chiefComplaint	SΣ	0..1	BackboneElement	The list of diagnosis relevant to this encounter
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
condition		1..1	Reference(CareConnect-Procedure-1 | CareConnect-Condition-1)	Reason the encounter takes place (resource)
role		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents Fixed Value: As shown
id		0..0	string	xml:id (or equivalent in JSON)
extension		0..0	Extension	Additional Content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	xml:id (or equivalent in JSON)
extension		0..0	Extension	Additional Content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/diagnosis-role
version		0..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: CC
display		1..1	string	Representation defined by the system Fixed Value: Chief complaint
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service
admissionMethod	S	0..1	CodeableConcept	An extension to the Encounter resource to record how a Patient was admitted to hospital. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-AdmissionMethod-1 Binding: NHS Data Model and Dictionary Admission Method (required): The method of admission to a Hospital Provider Spell.
dischargeMethod	S	0..1	CodeableConcept	An extension to the Encounter resource to record the method of discharge from hospital. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-DischargeMethod-1 Binding: NHS Data Model and Dictionary Discharge Method (required): The method of discharge from a Hospital Provider Spell.
medicallySafeForDischarge	S	0..1	(Complex)	Medically Safe for Discharge URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-MedicallySafeForDischarge
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
origin		0..1	Reference(CareConnect-Location-1)	The location from which the patient came before admission. Useful to provide if possible, in particular to reference a 'site' if transfered from another institution.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
admitSource	S	0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: NHS Data Model and Dictionary Source Of Admission (required)
dietPreference		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing Binding: Diet (extensible)
specialCourtesy		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing Binding: SpecialCourtesy (preferred): Special courtesies
specialArrangement		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing Binding: SpecialArrangements (preferred): Special arrangements
destination	S	0..1	Reference(CareConnect-Location-1)	Location to which the patient is discharged. Important to provide if known to support discharge planning, and/or to reference a 'site' if transfered to another institution.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
dischargeDisposition	S	0..1	CodeableConcept	Category or kind of location after discharge Binding: Interweave Discharge Destination codes (required)
location	S	0..*	BackboneElement	Location the encounter takes place (at Ward level)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
location	S	1..1	Reference(CareConnect-Location-1)	Location the encounter takes place
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
status	S	1..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
period	S	1..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(CareConnect-Organization-1)	DISCOURAGED: This is instead covered via the provenance tags
partOf		0..1	Reference(InterweaveEncounterGrouping)	Another Encounter this encounter is part of
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Encounter.meta.security	extensible	All Security Labels
Encounter.meta.tag	example	Common Tags
Encounter.meta.tag:Source	example	Common Tags
Encounter.meta.tag:Provenance	example	Common Tags
Encounter.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Encounter.identifier.use	required	IdentifierUse
Encounter.identifier:localIdentifier.use	required	IdentifierUse
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	required	InterweaveEncounterClass
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	required	Care Connect Encounter Type
Encounter.type.coding:snomedCT	required	Care Connect Encounter Type
Encounter.priority	required	InterweaveEncounterPriority
Encounter.participant.type	required	ParticipantType
Encounter.reason	preferred	Interweave R4 Encounter Reason
Encounter.diagnosis.role	required	DiagnosisRole
Encounter.diagnosis:chiefComplaint.role	preferred	Fixed Value: CC("Chief complaint")
Encounter.hospitalization.admitSource	required	NHS Data Model and Dictionary Source Of Admission
Encounter.hospitalization.dietPreference	extensible	Diet
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	required	Interweave Discharge Destination codes
Encounter.location.status	required	EncounterLocationStatus

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	Encounter	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()
ele-1	error	Encounter.extension:encounterTransport, Encounter.extension:outcomeOfAttendance, Encounter.extension:emergencyCareDischargeStatus, Encounter.statusHistory, Encounter.participant, Encounter.diagnosis, Encounter.diagnosis:chiefComplaint, Encounter.hospitalization, Encounter.hospitalization.extension:admissionMethod, Encounter.hospitalization.extension:dischargeMethod, Encounter.location	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	Encounter.extension:encounterTransport, Encounter.extension:outcomeOfAttendance, Encounter.extension:emergencyCareDischargeStatus, Encounter.hospitalization.extension:admissionMethod, Encounter.hospitalization.extension:dischargeMethod	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	CareConnect-Encounter-1	An interaction during which services are provided to the patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
encounterTransport		0..1	(Complex)	Encounter transport URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EncounterTransport-1
outcomeOfAttendance	S	0..1	CodeableConcept	An extension to the Encounter resource to record the outcome of an Out-Patient attendance. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-OutcomeOfAttendance-1 Binding: NHS Data Model and Dictionary Outcome Of Attendance (required): This records the outcome of an Out-Patient Attendance Consultant.
emergencyCareDischargeStatus	S	0..1	CodeableConcept	An extension to the Encounter resource which is used indicate the status of the Patient on discharge from an Emergency Care Department. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EmergencyCareDischargeStatus-1 Binding: Care Connect Emergency Care Discharge Status (required): The status of the Patient on discharge from an Emergency Care Department.
emergencyCareDischargeDestination	S	0..1	CodeableConcept	Discharge destination of patients which have attended ED. URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-EDDischargeDestination Binding: Interweave ED Discharge Destination (preferred)
serviceType	S	0..1	CodeableConcept	Specific type of service (pre-adopted from R4) URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-R4EncounterServiceType Binding: Interweave UkCore Care Setting Type (preferred)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	Identifier(s) by which this encounter is known
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-encounter-identifier
value	SΣ	1..1	string	The Local encounter Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	arrived | triaged | in-progress | onleave | finished | cancelled + (Note: 'planned' is also possible, but normally represented instead as an Appointment) Binding: EncounterStatus (required): Current state of the encounter
statusHistory	S	0..*	BackboneElement	List of past encounter statuses
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter
period		1..1	Period	The time that the episode was in the specified status
class	SΣ	1..1	Coding	Classification of the encounter. EXTENSIBLE on request, eg to cover other care settings Binding: InterweaveEncounterClass (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
type	SΣ	0..1	CodeableConcept	Specific type of encounter Binding: Care Connect Encounter Type (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..1	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	SΣ	1..*	Coding	Code defined by a terminology system Binding: Care Connect Encounter Type (required)
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
priority	S	0..1	CodeableConcept	Indicates the urgency of the encounter Binding: InterweaveEncounterPriority (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(CareConnectPatient1)	The patient (NOT group) present at the encounter
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
incomingReferral		0..*	Reference(ReferralRequest)	The ReferralRequest that initiated this encounter
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
participant	SΣ	1..*	BackboneElement	List of participants involved in the encounter
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	SΣ	1..1	CodeableConcept	Role of participant in encounter Binding: ParticipantType (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
period		0..1	Period	Period of time during the encounter that the participant participated
individual	SΣ	1..1	Reference(CareConnect-Practitioner-1)	Persons involved in the encounter other than the patient
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
appointment	SΣ	0..1	Reference(Appointment)	The appointment that scheduled this encounter
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
period	S	1..1	Period	The start and end time of the encounter
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
length		0..1	Duration	Quantity of time the encounter lasted (less time absent). Please use minutes.
reason	SΣ	0..*	CodeableConcept	Reason the encounter takes place (code) Binding: Interweave R4 Encounter Reason (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
Slices for diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this encounter Slice: Unordered, Open by value:role
diagnosis:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
condition	S	1..1	Reference(CareConnect-Condition-1)	Reason the encounter takes place (resource)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
role	S	1..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
rank	S	1..1	positiveInt	Ranking of the diagnosis (for each role type)
diagnosis:chiefComplaint	SΣ	0..1	BackboneElement	The list of diagnosis relevant to this encounter
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
condition		1..1	Reference(CareConnect-Procedure-1 | CareConnect-Condition-1)	Reason the encounter takes place (resource)
role		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents Fixed Value: As shown
id		0..0	string	xml:id (or equivalent in JSON)
extension		0..0	Extension	Additional Content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	xml:id (or equivalent in JSON)
extension		0..0	Extension	Additional Content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/diagnosis-role
version		0..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: CC
display		1..1	string	Representation defined by the system Fixed Value: Chief complaint
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
rank		0..1	positiveInt	Ranking of the diagnosis (for each role type)
hospitalization	S	0..1	BackboneElement	Details about the admission to a healthcare service
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
admissionMethod	S	0..1	CodeableConcept	An extension to the Encounter resource to record how a Patient was admitted to hospital. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-AdmissionMethod-1 Binding: NHS Data Model and Dictionary Admission Method (required): The method of admission to a Hospital Provider Spell.
dischargeMethod	S	0..1	CodeableConcept	An extension to the Encounter resource to record the method of discharge from hospital. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-DischargeMethod-1 Binding: NHS Data Model and Dictionary Discharge Method (required): The method of discharge from a Hospital Provider Spell.
medicallySafeForDischarge	S	0..1	(Complex)	Medically Safe for Discharge URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-MedicallySafeForDischarge
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
origin		0..1	Reference(CareConnect-Location-1)	The location from which the patient came before admission. Useful to provide if possible, in particular to reference a 'site' if transfered from another institution.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
admitSource	S	0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: NHS Data Model and Dictionary Source Of Admission (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: v2 Re-Admission Indicator (example): The reason for re-admission of this hospitalization encounter.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
dietPreference		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing Binding: Diet (extensible)
specialCourtesy		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing Binding: SpecialCourtesy (preferred): Special courtesies
specialArrangement		0..*	CodeableConcept	DISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing Binding: SpecialArrangements (preferred): Special arrangements
destination	S	0..1	Reference(CareConnect-Location-1)	Location to which the patient is discharged. Important to provide if known to support discharge planning, and/or to reference a 'site' if transfered to another institution.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
dischargeDisposition	S	0..1	CodeableConcept	Category or kind of location after discharge Binding: Interweave Discharge Destination codes (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
location	S	0..*	BackboneElement	Location the encounter takes place (at Ward level)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
location	S	1..1	Reference(CareConnect-Location-1)	Location the encounter takes place
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
status	S	1..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
period	S	1..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(CareConnect-Organization-1)	DISCOURAGED: This is instead covered via the provenance tags
partOf		0..1	Reference(InterweaveEncounterGrouping)	Another Encounter this encounter is part of
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Encounter.meta.security	extensible	All Security Labels
Encounter.meta.tag	example	Common Tags
Encounter.meta.tag:Source	example	Common Tags
Encounter.meta.tag:Provenance	example	Common Tags
Encounter.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Encounter.identifier.use	required	IdentifierUse
Encounter.identifier.type	extensible	Identifier Type Codes
Encounter.identifier:localIdentifier.use	required	IdentifierUse
Encounter.identifier:localIdentifier.type	extensible	Identifier Type Codes
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	required	InterweaveEncounterClass
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	required	Care Connect Encounter Type
Encounter.type.coding:snomedCT	required	Care Connect Encounter Type
Encounter.priority	required	InterweaveEncounterPriority
Encounter.participant.type	required	ParticipantType
Encounter.reason	preferred	Interweave R4 Encounter Reason
Encounter.diagnosis.role	required	DiagnosisRole
Encounter.diagnosis:chiefComplaint.role	preferred	Fixed Value: CC("Chief complaint")
Encounter.hospitalization.preAdmissionIdentifier.use	required	IdentifierUse
Encounter.hospitalization.preAdmissionIdentifier.type	extensible	Identifier Type Codes
Encounter.hospitalization.admitSource	required	NHS Data Model and Dictionary Source Of Admission
Encounter.hospitalization.reAdmission	example	v2 Re-Admission Indicator
Encounter.hospitalization.dietPreference	extensible	Diet
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	required	Interweave Discharge Destination codes
Encounter.location.status	required	EncounterLocationStatus

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	Encounter.extension:encounterTransport, Encounter.extension:outcomeOfAttendance, Encounter.extension:emergencyCareDischargeStatus, Encounter.statusHistory, Encounter.participant, Encounter.diagnosis, Encounter.diagnosis:chiefComplaint, Encounter.hospitalization, Encounter.hospitalization.extension:admissionMethod, Encounter.hospitalization.extension:dischargeMethod, Encounter.location	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	Encounter.extension:encounterTransport, Encounter.extension:outcomeOfAttendance, Encounter.extension:emergencyCareDischargeStatus, Encounter.hospitalization.extension:admissionMethod, Encounter.hospitalization.extension:dischargeMethod	Must have either extensions or value[x], not both : extension.exists() != value.exists()