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There are several distinct steps in the process from requesting a referral to a skilled nursing facility to getting the patient to the best possible facility for their care. The following diagram shows the transaction flow from the point of view of the requester. (Note: this is work in progress, and not all transactions have been represented yet)

The following diagram shows an example of the possible sequences of messages from the initiator to multiple recipients:

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2.1 Sending the request

The referral request to a skilled nursing facility may be sent to multiple facilities. In order to enable the appropriate matching of the responses and allow for automation whenever possible, this implementation guide requires that each referral request contains a different unique referral ID. There are different ways to accomplish this in the initiator's system (e.g. parent referral order with multiple child orders, single referral order with a table correlating the IDs and the facilities, etc.) and different implementations can chose what is best for their purposes.

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