FHIR REST API capabilities for Azure Health Data Services FHIR service

In this article, we'll cover some of the nuances of the RESTful interactions of Azure Health Data Services FHIR service (hereby called FHIR service).

Conditional create/update

The FHIR service supports create, conditional create, update, and conditional update as defined by the FHIR specification. One useful header in these scenarios is the If-Match header. The If-Match header is used and will validate the version being updated before making the update. If the ETag doesn’t match the expected ETag, it will produce the error message 412 Precondition Failed.

Delete and Conditional Delete

FHIR service offers two delete types. There's Delete, which is also know as Hard + Soft Delete, and Conditional Delete.

Delete (Hard + Soft Delete)

Delete defined by the FHIR specification requires that after deleting a resource, subsequent non-version specific reads of a resource returns a 410 HTTP status code. Therefore, the resource is no longer found through searching. Additionally, the FHIR service enables you to fully delete (including all history) the resource. To fully delete the resource, you can pass a parameter settings hardDelete to true (DELETE {{FHIR_URL}}/{resource}/{id}?hardDelete=true). If you don't pass this parameter or set hardDelete to false, the historic versions of the resource will still be available.


If you only want to delete the history, FHIR service supports a custom operation called $purge-history. This operation allows you to delete the history off of a resource.

Conditional Delete

Conditional Delete allows you to pass search criteria to delete a resource. By default, the Conditional Delete allows you to delete one item at a time. You can also specify the _count parameter to delete up to 100 items at a time. Below are some examples of using Conditional Delete.

To delete a single item using Conditional Delete, you must specify search criteria that returns a single item.

DELETE https://{{FHIR_URL}}/Patient?identifier=1032704

You can do the same search but include hardDelete=true to also delete all history.

DELETE https://{{FHIR_URL}}/Patient?identifier=1032704&hardDelete=true

To delete multiple resources, include _count=100 parameter. This parameter will delete up to 100 resources that match the search criteria.

DELETE https://{{FHIR_URL}}/Patient?identifier=1032704&_count=100

Recovery of deleted files

If you don't use the hard delete parameter, then the record(s) in FHIR service should still exist. The record(s) can be found by doing a history search on the resource and looking for the last version with data.

If the ID of the resource that was deleted is known, use the following URL pattern:


For example: https://myworkspace-myfhirserver.fhir.azurehealthcareapis.com/Patient/123456789/_history

If the ID of the resource isn't known, do a history search on the entire resource type:


For example: https://myworkspace-myfhirserver.fhir.azurehealthcareapis.com/Patient/_history

After you've found the record you want to restore, use the PUT operation to recreate the resource with the same ID, or use the POST operation to make a new resource with the same information.


There is no time-based expiration for history/soft delete data. The only way to remove history/soft deleted data is with a hard delete or the purge history operation.

Patch and Conditional Patch

Patch is a valuable RESTful operation when you need to update only a portion of the FHIR resource. Using patch allows you to specify the element(s) that you want to update in the resource without having to update the entire record. FHIR defines three ways to patch resources: JSON Patch, XML Patch, and FHIRPath Patch. The FHIR Service support both JSON Patch and FHIRPath Patch along with Conditional JSON Patch and Conditional FHIRPath Patch (which allows you to patch a resource based on a search criteria instead of a resource ID). To walk through some examples, refer to the sample FHIRPath Patch REST file and the JSON Patch REST file for each approach. For additional details, read the HL7 documentation for patch operations with FHIR.


When using PATCH against STU3, and if you are requesting a History bundle, the patched resource's Bundle.entry.request.method is mapped to PUT. This is because STU3 doesn't contain a definition for the PATCH verb in the HTTPVerb value set.

Patch with FHIRPath Patch

This method of patch is the most powerful as it leverages FHIRPath for selecting which element to target. One common scenario is using FHIRPath Patch to update an element in a list without knowing the order of the list. For example, if you want to delete a patient’s home telecom information without knowing the index, you can use the example below.

PATCH http://{FHIR-SERVICE-HOST-NAME}/Patient/{PatientID}
Content-type: application/fhir+json

    "resourceType": "Parameters",
    "parameter": [
            "name": "operation",
            "part": [
                    "name": "type",
                    "valueCode": "delete"
                    "name": "path",
                    "valueString": "Patient.telecom.where(use = 'home')"

Any FHIRPath Patch operations must have the application/fhir+json Content-Type header set. FHIRPatch Patch supports add, insert, delete, remove, and move operations. FHIRPatch Patch operations also can be easily integrated into Bundles. For more examples, look at the sample FHIRPath Patch REST file.

Patch with JSON Patch

JSON Patch in the FHIR Service conforms to the well-used specification defined by the Internet Engineering Task Force. The payload format does not use FHIR resources and instead uses a JSON document leveraging JSON-Pointers for element selection. JSON Patch is more compact and has a test operation that allows you to validate that a condition is true before doing the patch. For example, if you want to set a patient as deceased only if they're not already marked as deceased, you can use the example below.

PATCH http://{FHIR-SERVICE-HOST-NAME}/Patient/{PatientID}
Content-type: application/json-patch+json

		"op": "test",
		"path": "/deceasedBoolean",
		"value": false
		"op": "replace",
		"path": "/deceasedBoolean",
		"value": true

Any JSON Patch operations must have the application/json-patch+json Content-Type header set. JSON Patch supports add, remove, replace, copy, move, and test operations. For more examples, look at the sample JSON Patch REST file.

JSON Patch in Bundles

By default, JSON Patch isn't supported in Bundle resources. This is because a Bundle only supports with FHIR resources and the JSON Patch payload isn't a FHIR resource. To work around this, we'll use Binary resources with a Content-Type of "application/json-patch+json" and the base64 encoding of the JSON payload inside of a Bundle. For information about this workaround, view this topic on the FHIR Chat Zulip.

In the example below, we want to change the gender on the patient to female. We've taken the JSON patch [{"op":"replace","path":"/gender","value":"female"}] and encoded it to base64.

Content-Type: application/json

	"resourceType": "Bundle",
	"id": "bundle-batch",
	"type": "batch",
	"entry": [
			"fullUrl": "Patient/{PatientID}",
			"resource": {
				"resourceType": "Binary",
				"contentType": "application/json-patch+json",
				"data": "W3sib3AiOiJyZXBsYWNlIiwicGF0aCI6Ii9nZW5kZXIiLCJ2YWx1ZSI6ImZlbWFsZSJ9XQ=="
			"request": { 
				"method": "PATCH",
				"url": "Patient/{PatientID}"

Next steps

In this article, you learned about some of the REST capabilities of the FHIR service. Next, you can learn more about the key aspects to searching resources in the FHIR service.

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