Flag — Salient alert

A small attention flag intended to catch a caregiver's eye when opening the record: fall risk, severe allergy, VIP status, transfusion refusal, regulated care (minor at risk, prisoner).

Purpose of the resource

Flag is the FHIR equivalent of the "post-it on the first page of the chart". Placed by a caregiver or an administrative workflow, it stays visible until deactivated. Unlike DetectedIssue, which is computed continuously, Flag is a human or procedural assertion: "this patient is at fall risk", "this patient is under legal protection", "this patient refuses blood products".

Key fields

JSON example

Documented fall risk for an inpatient:

{
  "resourceType": "Flag",
  "id": "fall-risk-example",
  "identifier": [{ "system": "http://example.org/flags", "value": "FL-2026-0042" }],
  "status": "active",
  "category": [{
    "coding": [{
      "system": "http://terminology.hl7.org/CodeSystem/flag-category",
      "code": "safety",
      "display": "Safety"
    }]
  }],
  "code": {
    "coding": [{
      "system": "http://snomed.info/sct",
      "code": "129839007",
      "display": "Risk of fall"
    }]
  },
  "subject": { "reference": "Patient/example" },
  "period": { "start": "2026-05-14" },
  "encounter": { "reference": "Encounter/example-stay" },
  "author": { "reference": "Practitioner/nurse-coordinator" }
}

Typical use cases

• Patient safety: fall risk, pressure ulcer, restraint, isolation.
• Care refusal: transfusion refusal (Jehovah's Witnesses), DNR.
• Administrative status: VIP, involuntary commitment, prisoner.
• Behaviour: verbal violence, self-harm, elopement risk.
• Location: contaminated room (MDRO, XDR), out-of-service area.
• Identity: provisional identity, suspended identity vigilance.

Common pitfalls

• Flag left active after resolution: a "fall risk" flag from last year that has not been deactivated creates noise. Always close with status = inactive or period.end.
• Non-standardised clinical code: use SNOMED CT or a consistent local reference, not free text.
• Category omitted: without category, filtering by flag type is impossible.
• Flag / AllergyIntolerance / Condition confusion: an allergy is carried by AllergyIntolerance; a comorbidity by Condition. Flag is only an attention marker.
• Flag without subject: subject is 1..1. Without subject, the flag is unusable.

Related resources

• Patient — most frequent carrier.
• Condition — structured diagnosis (use it to carry the real clinical risk).
• AllergyIntolerance — structured allergy.
• DetectedIssue — dynamic CDS alert (vs static Flag).
• Communication — notification to the caregiver.

See also: Condition — diagnosis and AllergyIntolerance — declared allergy.