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Conditions, allergies, reported medicines and referrals use review today. Sending them is covered in Conditions, Allergies, Medications and Referrals.
Some information is too important to let a program write straight into a patient’s chart. For those kinds of information the API does not change the chart when you send it. It places your item in the clinic’s review queue, and a person at the clinic decides.

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The three states you will see

An item you send can also be withdrawn (you took it back while it was still pending) or replaced by a newer item. A decision is final: a confirmed or rejected item is never reopened. If something needs changing after it is confirmed, you send a new item that asks for the change, and it is reviewed the same way. Nothing is ever deleted from a chart through the API.

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202 Accepted

When you send an item that needs review, the response status is 202 Accepted, not 200 or 201. It means “received, not yet applied”. The body shows the item as pending. Do not treat a 202 as a record that now exists on the chart. Treat it as a receipt. To find out what happened, read the item again later. A list can be filtered to what you sent and what is still waiting. You will see it move to confirmed or rejected, with the reason when it was rejected. You only ever see items sent with your own key or organization, never another party’s. Sending the same item twice, with the same Idempotency-Key, returns the first response again. See Retries and duplicates.

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Who decides

The clinic’s own staff decide, inside ClinikEHR:
  • Anything clinical (allergies, medications, conditions) needs a clinician, or the clinic’s manager or owner. For a condition, a clinician also needs permission to amend the problem list. An allergy or a reported medicine needs nothing more.
  • A referral can be added to the clinic’s list by any member of staff, and every later step (accept, decline, book, complete) is any member of staff’s decision too.
A reviewer sees that the item is from an outside system, what it says, who sent it and when. A patient the clinic has restricted is not visible to a reviewer who has no access to that patient, and an item for one is never shown to them.

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Example: an allergy

Sending an allergy works the same way: 202 Accepted, a Location header, a pending submission.
  1. Your system sends POST …/allergies for “Peanuts”. The patient’s allergy list at the clinic is unchanged.
  2. A clinician reviews it in Outside submissions and selects Accept. The allergy is on the chart.
  3. If the clinician declines it, you read rejected and the reason, and the chart is unchanged.
See Allergies for the full walk-through.

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Example: a reported medicine

Sending a reported medicine works the same way: 202 Accepted, a Location header, a pending submission.
  1. Your system sends POST …/medication-statements for “Metformin 500 mg”. The patient’s reported list at the clinic is unchanged, and no prescription is created.
  2. A clinician reviews it in Outside submissions and selects Accept. The medicine is on the chart as something the patient reports taking.
  3. If the clinician declines it, you read rejected and the reason, and the chart is unchanged.
See Medications for the full walk-through.

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Example: a referral

Sending a referral works the same way: 202 Accepted, a Location header, a pending submission.
  1. Your system sends POST …/referrals for a cardiology consultation. The clinic’s referral list is unchanged.
  2. A member of staff reviews it in Review outside data and selects Accept. It joins the clinic’s list as received. That does not accept the referral or book anything: the clinic decides that next.
  3. If staff decline it, you read rejected and the reason, and the list is unchanged.
See Referrals for the full walk-through.

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When a clinic accepts automatically

A clinic can choose, per key or per connected organization and per kind, to accept new items without review. You cannot request or detect that. When it is on, the answer to your send is still 202, but the body already shows review_status: "confirmed" and accepted_automatically: true, and the record carries accepted_by: "automatic" and verification_status: "unconfirmed" until a clinician reviews it. Updates, retractions and “no known allergies” are never accepted automatically, and unusual volume pauses it, so your items wait for review again. A rolled key or a new connection starts with it off. See Automatic acceptance.

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What this means for your integration

  • Do not tell a person an item is “on their record” until it is confirmed. Read review_status in the answer to your send: a clinic can accept automatically, so it may already be confirmed.
  • Expect a decision to take as long as the clinic takes. There is no time limit you can rely on.
  • Show a rejected item’s reason to whoever needs to fix it. Do not resend the same item unchanged.
  • Poll for the outcome. Notification of a decision by webhook is not available for these items yet.

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Example: a condition

Sending a condition returns 202 Accepted, a Location header pointing at the submission, and a body that shows the item as pending. A clinician has not seen it yet, so the chart is unchanged.
Read the submission later to see what happened to it. While it waits you will see "status": "pending". Once a clinician has decided you will see "confirmed", or "rejected" with the reason. See Conditions for the full walk-through.