German Practice Management FHIR Profiles (R4)
Version 0.99.1 - release

Request and Result Semantics

Request and Result Semantics

This page defines the current resource contracts for laboratory and cervical screening requests, referrals, and episodic service orders. The profiles reuse standard FHIR workflow elements and introduce no generic local request parent.

Laboratory and cervical screening

PraxisLabServiceRequestDE is the reusable laboratory-order model. PraxisCervicalScreeningServiceRequestDE narrows that model for cervical screening.

Concern Contract
Stable order identity identifier[placerOrderId] is required, typed as V2-0203 PLAC, and carries both system and value
Patient and ordering party subject and requester
Intended laboratory performer
Requested test code, using LOINC or an issuer-controlled, versioned laboratory catalog
Indication and insurance optional Must Support reasonReference and insurance
Specimen optional ServiceRequest.specimen; screening narrows the target when present
Result correlation standard DiagnosticReport.basedOn and Observation.basedOn
Specimen correlation standard Specimen.request

The order identifier namespace is controlled by its issuer. FHIR identity is the (Identifier.system, Identifier.value) pair; PLAC identifies the role of the identifier and is not a namespace.

The laboratory and screening proof Bundles are non-normative collection examples. They demonstrate closed reference graphs and do not define document, message, rendering, signature, or transport semantics.

Screening terminology

The screening profiles use extensible bindings to selected LOINC codes and a required SNOMED CT specimen coding. The public package carries codes and canonical references without publishing restricted displays. Issuer-controlled local laboratory codes remain permitted by the extensible bindings.

Referrals and episodic orders

PraxisReferralDE supports reusable incoming and outgoing referral records. PraxisSociotherapyIndicationReferralDE derives from it because the record is an indication referral. Hospital admission and patient transport use separate thin ServiceRequest profiles because their performer targets and clinical meaning differ.

Shared element Current rule
Order identity required identifier[placerOrderId] with PLAC, system, and value; additional identifiers are allowed
Lifecycle status is required and Must Support; intent is fixed to order for episodic orders
Ordered service code is required; the binding remains open when no distributable authoritative catalog exists
Patient subject is a required Patient reference
Ordering party requester is required and targets PractitionerRole, Practitioner, or Organization
Intended performer performer is required; each profile narrows the target set to its domain
Timing authoredOn is required; occurrence[x] and priority are optional Must Support
Clinical context reasonReference and supportingInfo carry structured indication, findings, documents, and medication context
Coverage insurance is optional Must Support and targets Coverage

PraxisHospitalAdmissionServiceRequestDE and PraxisPatientTransportServiceRequestDE insert the same PraxisServiceRequestCore RuleSet. PraxisSociotherapyIndicationReferralDE inherits the same contract through PraxisReferralDE. A shared RuleSet is an authoring consistency mechanism, not a new public profile.

The exact performer targets are intentional:

  • hospital admission: Organization or HealthcareService;
  • patient transport: Organization or HealthcareService;
  • referral and sociotherapy indication: professional, organization, or HealthcareService targets permitted by PraxisReferralDE.

Terminology and envelope boundary

Form-specific semantics use a named public source when a distributable terminology exists. Otherwise the relevant element stays open for an authoritative or versioned local catalog. The IG does not infer national codes from paper labels and does not mirror unavailable issuer catalogs. Public terminology contracts are carried by this IG or referenced through public issuer packages. Protected displays and catalogs are installed separately by authorized runtime compositions.

The referral and episodic-order profiles are reusable record contracts. They do not claim conformance to an official Annex 2b transport, form rendering, attestation, signature, or payer-authorization envelope. Their proof Bundles are collection examples only.

Validation

scripts/check-request-result-semantics.sh verifies the generated differentials, cardinalities, Must Support flags, reference target sets, shared RuleSet behavior, and proof-graph correlations. Negative validation cases are in test/Profile/request-result-semantics.http.