Encounter

An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient. Refer to the US Core Encounter Profile and the US Core Condition Encounter profile.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Identifier(s) by which this encounter is known Details Identifier(s) by which this encounter is known.
status	✓	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Details planned | arrived | triaged | in-progress | onleave | finished | cancelled +. Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).
statusHistory		EncounterStatusHistory[]	List of past encounter statuses Details The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them. The current status is always found in the current version of the resource, not the status history.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
status	✓	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Details planned | arrived | triaged | in-progress | onleave | finished | cancelled +.
period	✓	Period	The time that the episode was in the specified status Details The time that the episode was in the specified status.
class	✓	Coding	Classification of patient encounter Details Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
classHistory		EncounterClassHistory[]	List of past encounter classes Details The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
class	✓	Coding	inpatient | outpatient | ambulatory | emergency + Details inpatient | outpatient | ambulatory | emergency +.
period	✓	Period	The time that the episode was in the specified class Details The time that the episode was in the specified class.
type		CodeableConcept[]	Specific type of encounter Details Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation). Since there are many ways to further classify encounters, this element is 0..*.
serviceType		CodeableConcept	Specific type of service Details Broad categorization of the service that is to be provided (e.g. cardiology).
priority		CodeableConcept	Indicates the urgency of the encounter Details Indicates the urgency of the encounter.
subject		Reference<Patient | Group>	The patient or group present at the encounter Details The patient or group present at the encounter. While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).
episodeOfCare		Reference<EpisodeOfCare>[]	Episode(s) of care that this encounter should be recorded against Details Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).
basedOn		Reference<ServiceRequest>[]	The ServiceRequest that initiated this encounter Details The request this encounter satisfies (e.g. incoming referral or procedure request).
participant		EncounterParticipant[]	List of participants involved in the encounter Details The list of people responsible for providing the service.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
type		CodeableConcept[]	Role of participant in encounter Details Role of participant in encounter. The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.
period		Period	Period of time during the encounter that the participant participated Details The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
individual		Reference< Practitioner | PractitionerRole | RelatedPerson >	Persons involved in the encounter other than the patient Details Persons involved in the encounter other than the patient.
appointment		Reference<Appointment>[]	The appointment that scheduled this encounter Details The appointment that scheduled this encounter.
period		Period	The start and end time of the encounter Details The start and end time of the encounter. If not (yet) known, the end of the Period may be omitted.
length		Duration	Quantity of time the encounter lasted (less time absent) Details Quantity of time the encounter lasted. This excludes the time during leaves of absence. May differ from the time the Encounter.period lasted because of leave of absence.
reasonCode		CodeableConcept[]	Coded reason the encounter takes place Details Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis. For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
reasonReference		Reference< Condition | Procedure | Observation | ImmunizationRecommendation >[]	Reason the encounter takes place (reference) Details Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis. For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
diagnosis		EncounterDiagnosis[]	The list of diagnosis relevant to this encounter Details The list of diagnosis relevant to this encounter.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
condition	✓	Reference<Condition | Procedure>	The diagnosis or procedure relevant to the encounter Details Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure. For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
use		CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Details Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).
rank		positiveInt	Ranking of the diagnosis (for each role type) Details Ranking of the diagnosis (for each role type).
account		Reference<Account>[]	The set of accounts that may be used for billing for this Encounter Details The set of accounts that may be used for billing for this Encounter. The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
hospitalization		EncounterHospitalization	Details about the admission to a healthcare service Details Details about the admission to a healthcare service. An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
preAdmissionIdentifier		Identifier	Pre-admission identifier Details Pre-admission identifier.
origin		Reference<Location | Organization>	The location/organization from which the patient came before admission Details The location/organization from which the patient came before admission.
admitSource		CodeableConcept	From where patient was admitted (physician referral, transfer) Details From where patient was admitted (physician referral, transfer).
reAdmission		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 Details Whether this hospitalization is a readmission and why if known.
dietPreference		CodeableConcept[]	Diet preferences reported by the patient Details Diet preferences reported by the patient. For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
specialCourtesy		CodeableConcept[]	Special courtesies (VIP, board member) Details Special courtesies (VIP, board member).
specialArrangement		CodeableConcept[]	Wheelchair, translator, stretcher, etc. Details Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
destination		Reference<Location | Organization>	Location/organization to which the patient is discharged Details Location/organization to which the patient is discharged.
dischargeDisposition		CodeableConcept	Category or kind of location after discharge Details Category or kind of location after discharge.
location		EncounterLocation[]	List of locations where the patient has been Details List of locations where the patient has been during this encounter. Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
location	✓	Reference<Location>	Location the encounter takes place Details The location where the encounter takes place.
status		code	planned | active | reserved | completed Details The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time. When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.
physicalType		CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Details This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query. This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query. There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.
period		Period	Time period during which the patient was present at the location Details Time period during which the patient was present at the location.
serviceProvider		Reference<Organization>	The organization (facility) responsible for this encounter Details The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.
partOf		Reference<Encounter>	Another Encounter this encounter is part of Details Another Encounter of which this encounter is a part of (administratively or in time). This is also used for associating a child's encounter back to the mother's encounter. Refer to the Notes section in the Patient resource for further details.

Search Parameters

Name	Type	Description	Expression
date	date	A date within the period the Encounter lasted	Encounter.period
identifier	token	Identifier(s) by which this encounter is known	Encounter.identifier
patient	reference	The patient or group present at the encounter	Encounter.subject.where(resolve() is Patient)
type	token	Specific type of encounter	Encounter.type
account	reference	The set of accounts that may be used for billing for this Encounter	Encounter.account
appointment	reference	The appointment that scheduled this encounter	Encounter.appointment
based-on	reference	The ServiceRequest that initiated this encounter	Encounter.basedOn
class	token	Classification of patient encounter	Encounter.class
diagnosis	reference	The diagnosis or procedure relevant to the encounter	Encounter.diagnosis.condition
episode-of-care	reference	Episode(s) of care that this encounter should be recorded against	Encounter.episodeOfCare
length	quantity	Length of encounter in days	Encounter.length
location	reference	Location the encounter takes place	Encounter.location.location
location-period	date	Time period during which the patient was present at the location	Encounter.location.period
part-of	reference	Another Encounter this encounter is part of	Encounter.partOf
participant	reference	Persons involved in the encounter other than the patient	Encounter.participant.individual
participant-type	token	Role of participant in encounter	Encounter.participant.type
practitioner	reference	Persons involved in the encounter other than the patient	Encounter.participant.individual.where(resolve() is Practitioner)
reason-code	token	Coded reason the encounter takes place	Encounter.reasonCode
reason-reference	reference	Reason the encounter takes place (reference)	Encounter.reasonReference
service-provider	reference	The organization (facility) responsible for this encounter	Encounter.serviceProvider
special-arrangement	token	Wheelchair, translator, stretcher, etc.	Encounter.hospitalization.specialArrangement
status	token	planned | arrived | triaged | in-progress | onleave | finished | cancelled +	Encounter.status
subject	reference	The patient or group present at the encounter	Encounter.subject

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
text		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
contained		Resource[]	Contained, inline Resources Details These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored Details May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Usage

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

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

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

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

The Hospitalization component is intended to store the extended information relating to a hospitalization event. It is always expected to be the same period as the encounter itself. Where the period is different, another encounter instance should be used to capture this information as a partOf this encounter instance.

The Procedure and encounter have references to each other, and these should be to different procedures; one for the procedure that was performed during the encounter (stored in Procedure.encounter), and another for cases where an encounter is a result of another procedure (stored in Encounter.indication) such as a follow-up encounter to resolve complications from an earlier procedure.

Status Management

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

There is no direct indication purely by the status field as to whether an encounter is considered "admitted".
The context of the encounter and business practices/policies/workflows/types can influence this definition. (e.g., acute care facility, aged care center, outpatient clinic, emergency department, community-based clinic).
Statuses of "arrived", "triaged" or "in progress" could be considered the start of the admission, and also have the presence of the hospitalization sub-component entered.

The "on leave" status might or might not be a part of the admission, for example if the patient was permitted to go home for a weekend or some other form of external event.
The location is also likely to be filled in with a location status of "present".
For other examples such as an outpatient visit (day procedure - colonoscopy), the patient could also be considered to be admitted, hence the encounter doesn't have a fixed definition of admitted. At a minimum, we do believe that a patient IS admitted when the status is in-progress.

Relationships

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

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

Communication resources are used for a simultaneous interaction between a practitioner and a patient where there is no direct contact. Examples include a phone message, or transmission of some correspondence documentation.
There is no duration recorded for a communication resource, but it could contain sent and received times.

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

Referenced By

• AdverseEvent
• AllergyIntolerance
• CarePlan
• CareTeam
• ChargeItem
• Claim
• ClinicalImpression
• Communication
• CommunicationRequest
• Composition
• Condition
• Contract
• DeviceRequest
• DiagnosticReport
• DocumentReference
• ExplanationOfBenefit
• Flag
• GuidanceResponse
• ImagingStudy
• Immunization
• List
• Media
• MedicationAdministration
• MedicationDispense
• MedicationRequest
• MedicationStatement
• NutritionOrder
• Observation
• Procedure
• QuestionnaireResponse
• RequestGroup
• RiskAssessment
• ServiceRequest
• Task
• VisionPrescription