NHS North West Genomics
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NHS North West Genomics - Local Development build (v2.2.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Referral Decline [PCC-56] (Future Use)

Referral Decline [PCC-56] - the Referral Recipient declines a Genetic Clinical Referral or a laboratory order (Genomic Test Order) after it has accepted it (for example when the patient declines genetic counselling, or the sample turns out to be unsuitable). It ends the referral or order. The example is for a laboratory order.

References

Interaction

sequenceDiagram
    participant RI as Referral Initiator
    participant RR as Referral Recipient<br/>(Clinical Genetics)
    Note over RI,RR: Referral already accepted [PCC-55]
    RR ->> RI: Referral Decline<br/>OSU^O51 UA/CA / Task rejected
    RI -->> RI: Show decline, end referral
Actor Optionality
Referral Initiator R - must handle a decline at any point of the workflow
Referral Recipient O - but must send a decline as the first response if it cannot accept (PCC-55)

Where the referral is managed by GOMS, the decline is a Task update that the RIE receives via MNS and converts to OSU^O51 - see Status Updates from GOMS via MNS.

Content

The message is the same as the Referral Decline in PCC-55:

Data item HL7 v2 (OSU^O51) FHIR (Task)
Order control ORC-1 UA status rejected (Task was accepted or in-progress)
Referral ID ORC-2 basedOn.identifier, focus
Order status ORC-5 CA businessStatus declined
Reason ORC-16 (at least text) statusReason, e.g. sample-unsuitable, patient-declined, not-eligible

A clinical document is not required. If the patient was seen before the decline, the Referral Recipient SHOULD send what it found as an interim consultation note, or use a Referral Outcome [PCC-57] instead.

Example

The North West GLH accepted Octavia CHISLETT's R240.1 order (ServiceRequest Coded Entries Example) [PCC-55]. DNA extraction then failed, so the laboratory declines the order and asks for a new sample.

MSH|^~\&|RIE|699X0|EPIC|R0A|20250205100000+0000||OSU^O51^OSU_O51|GLH-MSG-250205001|P|2.8|||AL|NE
PID|1||633^^^R0A^MR~9449305552^^^^NH||CHISLETT^Octavia||20080920|F|||1 RAVENSFIELD GARDENS^^EPSOM^SURREY^KT19 0ST
ORC|UA|1601737^R0A|R25012345^699X0||CA||||20250205100000+0000|||C3456789^Darwin^Samuel^^^Dr^^^GMC||||sample-unsuitable^Insufficient DNA extracted from the sample. Please send a new blood sample with a new order.^L|||||MANCHESTER UNIVERSITY NHS FOUNDATION TRUST^^R0A^^^ODS

FHIR Message: Bundle Message - Order Status (O51), declined after acceptance (focus Task Genomic Test Declined after acceptance: status rejected, businessStatus declined, statusReason sample-unsuitable with the text).

Expected Actions

  • The Referral Initiator SHALL record that the referral has ended without being completed and show the reason, so the clinician can decide whether to refer again (with a new Referral ID).