Update Service Request Message
Overview
The Update Service Request message enables updating previously submitted referrals in Netsmart Referral Manager. This message type allows healthcare organizations to modify existing service requests with updated patient information, clinical details, or administrative changes.
Before implementing, validate messaging capabilities in the CapabilityStatement:
GET {base-url}/metadata
Check the messaging section for supported message events and required parameters.
Message Schema
This message provides the required information to update previously submitted Service Request (a.k.a., Referral) in Netsmart Referral Manager.
{
// ...
"eventCoding": {
"system": "http://ntst.com/fhir/message-events",
"code": "update-service-request"
}
// ...
}
Authorization
This message will require the application obtain authorization using one of the following custom scopes based on SMART.
- v1:
[patient|user|system]/Messaging.[write|*] - v2: To be determined. (future)
Workflow
Payload
The payload for this message will consist of a Bundle with the type message and additional resources that make up the relevant information for the Service Request.
| Resource | Cardinality | Note |
|---|---|---|
| MessageHeader | 1..1 | Required for all FHIR messages and must be the first entry in the Bundle. |
| ServiceRequest | 1..1 | Details of the ServiceRequest. |
| Patient | 1..1 | Subject of the ServiceRequest. |
| Condition | 0..* | Associated conditions for this ServiceRequest. |
| Coverage | 0..* | Associated insurance coverage for this ServiceRequest. |
| Location | 0..* | Locations reference by the ServiceRequest or PractitionerRoles. |
| Observation | 0..* | Associated Observations for this ServiceRequest. |
| Organization | 0..* | Organizations referenced by the ServiceRequest or other resources. |
| Practitioner | 0..* | Practitioners referenced by the ServiceRequest or other resources. |
| PractitionerRole | 0..* | PractitionerRoles referenced by the ServiceRequest or other resources. |
| QuestionnaireResponse | 0..* | Supporting information for the ServiceRequest. These should be listed in MessageHeader.focus since they are not referenced elsewhere in the Bundle. |
Entity Relationship Diagram
Each resource included in the reference must be referenced by another resource within the Bundle. The diagram below illustrates the relationships and references.
Examples
Sample Request Payload
{
"resourceType": "Bundle",
"id": "607e4728-5d96-43a8-8be0-418313050140",
"type": "message",
"entry": [
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/MessageHeader/3641833",
"resource": {
"resourceType": "MessageHeader",
"eventCoding": {
"system": "http://ntst.com/fhir/message-events",
"code": "update-service-request"
},
"focus": [
{
"reference": "ServiceRequest/123456"
},
{
"reference": "QuestionnaireResponse/ABC-456789"
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/ServiceRequest/123456",
"resource": {
"resourceType": "ServiceRequest",
"id": "123456",
"extension": [
// We can support multiple extension data types via the message. However, these will only be read if configured in Referral Manager.
],
"identifier": [
// We can support the exchange of identifiers as well. Configure the Systems in Referral Manager to add to the Referral.
],
"status": "active",
"intent": "proposal",
"subject": {
"reference": "Patient/987654"
},
"requester": {
"reference": "PractitionerRole/45678"
},
"performer": [
{
"reference": "PractitionerRole/56789"
},
{
"reference": "Practitioner/888888888"
}
],
"locationReference": [
{
"reference": "Location/90456"
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/PractitionerRole/45678",
"resource": {
"resourceType": "PractitionerRole",
"id": "1176",
"practitioner": {
"reference": "Practitioner/444444444"
},
"organization": {
"reference": "Organization/90123"
}
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/PractitionerRole/56789",
"resource": {
"resourceType": "PractitionerRole",
"id": "56789",
"practitioner": {
"reference": "Practitioner/666666666"
},
"organization": {
"reference": "Organization/90123"
}
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Practitioner/444444444",
"resource": {
"resourceType": "Practitioner",
"id": "444444444",
"name": [
{
"family": "Family",
"given": [
"Given"
]
}
],
"telecom": [
{
"system": "phone",
"value": "5551234567"
},
{
"system": "email",
"value": "my.username@org.com"
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Practitioner/666666666",
"resource": {
"resourceType": "Practitioner",
"id": "900049",
"extension": [
// Supported
],
"identifier": [
// Supported
],
"name": [
{
"family": "Last",
"given": [
"First"
]
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Practitioner/888888888",
"resource": {
"resourceType": "Practitioner",
"id": "8236756",
"extension": [
// Supported
],
"name": [
{
"family": "Another",
"given": [
"Name"
]
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Organization/90123",
"resource": {
"resourceType": "Organization",
"id": "90123",
"extension": [
// Supported
],
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "2134567890"
},
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "Hospital Name",
"telecom": [
{
"system": "phone",
"value": "9998887777"
}
],
"address": [
{
"line": [
"123 Main Street",
"Apt B"
],
"city": "Springfield",
"state": "MO",
"postalCode": "65803",
"country": "USA"
}
]
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Patient/987654",
"resource": {
"resourceType": "Patient",
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "detailed",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "text",
"valueString": "White"
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
}
},
{
"url": "detailed",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
}
},
{
"url": "text",
"valueString": "Not Hispanic or Latino"
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "M"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-citizenship",
"extension": [
{
"url": "code",
"valueCodeableConcept": {
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US"
}
]
}
},
{
"url": "code",
"valuePeriod": {
"start": "2000-03-12T05:00:00+00:00",
"end": "2017-08-31T05:00:00+00:00"
}
}
]
}
],
"identifier": [
// Supported
],
"name": [
{
"text": "First MI Last",
"family": "Last",
"given": [
"First",
"MI"
],
"suffix": "JR"
}
],
"telecom": [
{
"use": "home",
"system": "phone",
"value": "5556667788",
"rank": 1
},
{
"use": "work",
"system": "phone",
"value": "5556321478"
},
{
"use": "home",
"system": "email",
"value": "myemail20004@gmail.com"
}
],
"gender": "male",
"birthDate": "1997-01-16",
"deceasedBoolean": false,
"address": [
{
"use": "home",
"line": [
"4950 College Blvd."
],
"city": "Overland Park",
"state": "KS",
"postalCode": "66211",
"country": "US",
"period": {
"start": "2015-06-22T05:00:00+00:00"
}
}
],
"maritalStatus": {
"coding": [
{
"system": "urn:oid:2.16.840.1.113883.4.642.3.29",
"code": "C",
"display": "Common Law"
}
]
},
"communication": [
{
"language": {
"coding": [
{
"system": "urn:oid:1.0.639.1",
"code": "en",
"display": "English"
}
]
},
"preferred": true
}
]
}
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/QuestionnaireResponse/ABC-456789",
"resource": {
"resourceType": "QuestionnaireResponse",
"identifier": {
"value": "MQ_3641833"
},
"basedOn": [
{
"reference": "ServiceRequest/123456"
}
],
"questionnaire": "Questionnaire/ABC",
"status": "in-progress",
"item": [
{
"linkId": "P-01",
"text": "Text of the first prompt?",
"answer": [
{
"valueString": "Free-text answer"
}
]
},
{
"linkId": "P-02",
"text": "Text the second prompt?",
"answer": [
{
"valueBoolean": false
}
]
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Location/90456",
"resource": {
"resourceType": "Location",
"id": "90456",
"extension": [
// Supported
],
"identifier": [
// Supported
],
"status": "active",
"name": "Facility Name",
"description": "Facility description.",
"mode": "instance",
"telecom": [
{
"use": "work",
"system": "phone",
"value": "2328"
},
{
"system": "email",
"value": "facility@domain.com"
}
],
"address": {
"use": "work",
"line": [
"Street 1",
"Street 2"
],
"city": "City",
"postalCode": "12345+6789",
"country": "US"
},
"position": {
"longitude": -83.6945691,
"latitude": 42.25475478,
"altitude": 0
},
"managingOrganization": {
"reference": "Organization/90123"
},
"hoursOfOperation": [
{
"daysOfWeek": [
"mon",
"tue",
"wed",
"thu",
"fri"
],
"allDay": false,
"openingTime": "07:00:00",
"closingTime": "19:00:00"
},
{
"daysOfWeek": [
"sat"
],
"allDay": false,
"openingTime": "09:00:00",
"closingTime": "16:00:00"
}
]
}
},
]
}
Sample Response Payload
{
"resourceType": "Bundle",
"id": "1a124350-e357-4b29-b780-1a4c9064c024",
"type": "message",
"entry": [
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/MessageHeader/3641833",
"resource": {
"resourceType": "MessageHeader",
"eventCoding": {
"system": "http://ntst.com/fhir/message-events",
"code": "update-service-request"
},
"response": {
"identifier": "607e4728-5d96-43a8-8be0-418313050140",
"code": "ok"
},
"focus": [
{
"reference": "ServiceRequest/123456"
},
{
"reference": "QuestionnaireResponse/ABC-456789"
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/ServiceRequest/123456",
"resource": {
"resourceType": "ServiceRequest",
"id": "123456",
"extension": [
// We can support multiple extension data types via the message. However, these will only be read if configured in Referral Manager.
],
"identifier": [
// We can support the exchange of identifiers as well. Configure the Systems in Referral Manager to add to the Referral.
],
"status": "active",
"intent": "proposal",
"subject": {
"reference": "Patient/987654"
},
"requester": {
"reference": "PractitionerRole/45678"
},
"performer": [
{
"reference": "PractitionerRole/56789"
},
{
"reference": "Practitioner/888888888"
}
],
"locationReference": [
{
"reference": "Location/90456"
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/PractitionerRole/45678",
"resource": {
"resourceType": "PractitionerRole",
"id": "1176",
"practitioner": {
"reference": "Practitioner/444444444"
},
"organization": {
"reference": "Organization/90123"
}
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/PractitionerRole/56789",
"resource": {
"resourceType": "PractitionerRole",
"id": "56789",
"practitioner": {
"reference": "Practitioner/666666666"
},
"organization": {
"reference": "Organization/90123"
}
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Practitioner/444444444",
"resource": {
"resourceType": "Practitioner",
"id": "444444444",
"name": [
{
"family": "Family",
"given": [
"Given"
]
}
],
"telecom": [
{
"system": "phone",
"value": "5551234567"
},
{
"system": "email",
"value": "my.username@org.com"
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Practitioner/666666666",
"resource": {
"resourceType": "Practitioner",
"id": "900049",
"extension": [
// Supported
],
"identifier": [
// Supported
],
"name": [
{
"family": "Last",
"given": [
"First"
]
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Practitioner/888888888",
"resource": {
"resourceType": "Practitioner",
"id": "8236756",
"extension": [
// Supported
],
"name": [
{
"family": "Another",
"given": [
"Name"
]
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Organization/90123",
"resource": {
"resourceType": "Organization",
"id": "90123",
"extension": [
// Supported
],
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "2134567890"
},
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "Hospital Name",
"telecom": [
{
"system": "phone",
"value": "9998887777"
}
],
"address": [
{
"line": [
"123 Main Street",
"Apt B"
],
"city": "Springfield",
"state": "MO",
"postalCode": "65803",
"country": "USA"
}
]
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Patient/987654",
"resource": {
"resourceType": "Patient",
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "detailed",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "text",
"valueString": "White"
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
}
},
{
"url": "detailed",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
}
},
{
"url": "text",
"valueString": "Not Hispanic or Latino"
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "M"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-citizenship",
"extension": [
{
"url": "code",
"valueCodeableConcept": {
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US"
}
]
}
},
{
"url": "code",
"valuePeriod": {
"start": "2000-03-12T05:00:00+00:00",
"end": "2017-08-31T05:00:00+00:00"
}
}
]
}
],
"identifier": [
// Supported
],
"name": [
{
"text": "First MI Last",
"family": "Last",
"given": [
"First",
"MI"
],
"suffix": "JR"
}
],
"telecom": [
{
"use": "home",
"system": "phone",
"value": "5556667788",
"rank": 1
},
{
"use": "work",
"system": "phone",
"value": "5556321478"
},
{
"use": "home",
"system": "email",
"value": "myemail20004@gmail.com"
}
],
"gender": "male",
"birthDate": "1997-01-16",
"deceasedBoolean": false,
"address": [
{
"use": "home",
"line": [
"4950 College Blvd."
],
"city": "Overland Park",
"state": "KS",
"postalCode": "66211",
"country": "US",
"period": {
"start": "2015-06-22T05:00:00+00:00"
}
}
],
"maritalStatus": {
"coding": [
{
"system": "urn:oid:2.16.840.1.113883.4.642.3.29",
"code": "C",
"display": "Common Law"
}
]
},
"communication": [
{
"language": {
"coding": [
{
"system": "urn:oid:1.0.639.1",
"code": "en",
"display": "English"
}
]
},
"preferred": true
}
]
}
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/QuestionnaireResponse/ABC-456789",
"resource": {
"resourceType": "QuestionnaireResponse",
"identifier": {
"value": "MQ_3641833"
},
"basedOn": [
{
"reference": "ServiceRequest/123456"
}
],
"questionnaire": "Questionnaire/ABC",
"status": "in-progress",
"item": [
{
"linkId": "P-01",
"text": "Text of the first prompt?",
"answer": [
{
"valueString": "Free-text answer"
}
]
},
{
"linkId": "P-02",
"text": "Text the second prompt?",
"answer": [
{
"valueBoolean": false
}
]
}
]
}
},
{
"fullUrl": "https://fhir.netsmartcloud.com/v4/Location/90456",
"resource": {
"resourceType": "Location",
"id": "90456",
"extension": [
// Supported
],
"identifier": [
// Supported
],
"status": "active",
"name": "Facility Name",
"description": "Facility description.",
"mode": "instance",
"telecom": [
{
"use": "work",
"system": "phone",
"value": "2328"
},
{
"system": "email",
"value": "facility@domain.com"
}
],
"address": {
"use": "work",
"line": [
"Street 1",
"Street 2"
],
"city": "City",
"postalCode": "12345+6789",
"country": "US"
},
"position": {
"longitude": -83.6945691,
"latitude": 42.25475478,
"altitude": 0
},
"managingOrganization": {
"reference": "Organization/90123"
},
"hoursOfOperation": [
{
"daysOfWeek": [
"mon",
"tue",
"wed",
"thu",
"fri"
],
"allDay": false,
"openingTime": "07:00:00",
"closingTime": "19:00:00"
},
{
"daysOfWeek": [
"sat"
],
"allDay": false,
"openingTime": "09:00:00",
"closingTime": "16:00:00"
}
]
}
},
]
}
Integration Patterns
Update Workflow
-
Identify Existing Service Request
- Use ServiceRequest ID from original submission
- Include all required identifiers
- Maintain resource relationships
-
Prepare Update Bundle
- Include MessageHeader with update event
- Reference existing ServiceRequest by ID
- Include updated resource data
-
Submit Update Message
- POST to
/$process-messageendpoint - Handle response and confirmation
- Process any validation errors
- POST to
Best Practices
- Always include complete resource data in updates
- Maintain referential integrity between resources
- Use consistent identifiers across messages
- Validate message structure before submission
Relationships to Other Resources
- Submit Service Request Message - Initial referral submission
- Process Message Operation - Core messaging operation
- ServiceRequest Resource - Primary resource structure
- MessageHeader Resource - Message header format
Error Handling
For comprehensive error handling information, see Common Errors.
Support
For technical support with Update Service Request messages:
- Contact: Netsmart Technologies, Inc.
- Documentation: FHIR Messaging
- Integration: Referral Manager Documentation