{
  "description": "Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]",
  "_filename": "example/ActivityDefinition-cc-cpg-activity-referral-nephrology.json",
  "package_name": "hl7.fhir.uv.cpg",
  "date": "2019-08-05T12:02:55-04:00",
  "publisher": "Elsevier Inc",
  "jurisdiction": [ {
    "coding": [ {
      "code": "001",
      "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "display": "World"
    } ]
  } ],
  "name": "ReferralNephrology",
  "type": null,
  "experimental": "true",
  "participant": [ {
    "type": "practitioner"
  } ],
  "resourceType": "ActivityDefinition",
  "title": "Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]",
  "package_version": "0.1.0",
  "timingTiming": {
    "_event": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
        "valueExpression": {
          "language": "text/cql",
          "expression": "Now()"
        }
      } ]
    } ]
  },
  "status": "active",
  "id": "cc86a6f4-3305-453f-896e-434691b0acbb",
  "kind": "ServiceRequest",
  "url": "http://hl7.org/fhir/uv/cpg/ActivityDefinition/cc-cpg-activity-referral-nephrology",
  "code": {
    "text": "Referral to nephrologist",
    "coding": [ {
      "code": "306286007",
      "system": "http://snomed.info/sct",
      "display": "Referral to nephrologist (procedure)"
    } ]
  },
  "version": "0.1.0",
  "relatedArtifact": [ {
    "url": "http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75DA0232E05352E3610A5325",
    "type": "justification",
    "display": "
Refer to nephrologist for co-management of treatment plan in cases of:
\n\n
\n\t
Unclear etiology of kidney disease
\n
\n\n
\n\t
Rapid progression of disease (GFR decline greater than 5 mL/minute/1.73 m²/year)
\n
\n\n
\n\t
Acute kidney injury or abrupt sustained fall in GFR
\n
\n\n
\n\t
GFR less than 30 mL/minute/1.73 m² (GFR categories G4-G5) to prepare for renal replacement therapy
\n
\n\n
\n\t
Consistent finding of significant albuminuria (albumin/creatinine ratio of 300 mg/g or more)
\n
\n\n
\n\t
Hypertension resistant to treatment with 4 or more antihypertensive agents
\n
\n\n
\n\t
Difficulty in decreasing the level of albuminuria despite institution of ACE inhibitor or angiotensin II receptor blocker therapy
\n
\n\n
\n\t
Persistent electrolyte abnormalities, including hyperkalemia or high serum phosphate
\n
\n\n
\n\t
Recurrent or extensive nephrolithiasis
\n
\n\n
\n\t
Hereditary kidney disease
\n
\n\n
 
\n\n
Nephrologist involvement is recommended when the cause of chronic kidney disease is not clear
\n\n
\n\t
Renal biopsy may be performed to determine the cause as well as to predict disease progression and response to therapy
\n
",
    "citation": "Chronic Kidney Disease Clinical Overview. ClinicalKey. Source"
  } ]
}