Reasonable Adjustments - Removing Consent

Please can the intent of requirements RAU010 and RAU019 be clarified.

MUST not be able to remove a consent option from an existing Reasonable Adjustment Flag record.
It MUST not be possible to remove / delete the consent status from an existing Reasonable Adjustment Flag record.

Cannot delete consent status from an existing Reasonable Adjustment Flag record
It MUST not be possible for a user to delete the consent status associated with an existing Reasonable Adjustment Flag record

One of the example use cases from the API documentation describes the removal of consent (see below), so I am confused what the above requirement is attempting to enforce/ensure

Update Use Cases | FHIR® Reasonable Adjustments API (

Hi @stuart.ross

Thanks for reaching out to us!

The RAF product team is working hard to get back to you as soon as possible. We’ll be in touch shortly with a response.

Kind regards,

Thanks Ernest - do you have an update?


Apologies for the delay this is due to staff annual leave. I have been informed you will be emailed shortly and this thread will updated accordingly.


Hi Stuart,

The API documentation is linked to the old specification. With the old specification removing consent was effectively the same thing as removing the RA record as there is no actual RA Flag in the STU3 version of the API.
With the R4 version we won’t allow the consent resource to be deleted, the guidance will be that if the patient is no longer providing their consent for their RA record to be shared then the entire record should be deleted.
Where a patient provides consent for a record to be shared via their GP and then removes consent via another setting, e.g. Community or Secondary Care, we don’t have a requirement to enforce any logic related to where a RA record originated from, if an Application has access to the National RA record it is authorised to add or remove any part of it.