This page is part of the FHIR Specification (v0.01: Historical Archive Draft). The current version which supercedes this version is 4.0.1. For a full list of available versions, see the Directory of published versions

# Patient

A patient is a person or animal that is receiving care.

The relative url is /patients

## Content

    <Patient xmlns="http://www.hl7.org/fhir">
      <id> mand id Master Resource Id, always first in all resources</id>
      <link> mand Zero+ (Patient) Other patients linked to this resource</link>
      <active> mand boolean Whether this patient record is active (in use)</active>
      <person> cond (Person) The person who is the patient</person>
      <animal> cond (Animal) The animal which is the patient</animal>
      <provider> mand (Organization) Organization managing the patient</provider>
      <identifier> Zero+ HumanId An identifier for the person as this patient</identifier>
      <diet> opt CodeableConcept Dietary restrictions for the patient</diet>
      <confidentiality> opt CodeableConcept Confidentiality of the patient records</confidentiality>
      <recordLocation> opt CodeableConcept Where the paper record is</recordLocation>
      <extensions> opt See Extensions   See Extensions </extensions>
      <text> mand Narrative Text summary of person, for human interpretation</text>
    </Patient>

Schema for Patient and an example (or formatted for browser)

Terminology Bindings

- Patient.diet is bound to the concept domain PatientDiet: "casual dietary restrictions associated with this patient"
- Patient.confidentiality is bound to the concept domain PatientConfidentiality: "The confidentiality of the records associated with this patient"
- Patient.recordLocation is bound to the concept domain PaperRecordLocation: "A physical location for a record. (Usually site specific)"

Notes:

- Links: linking patient records is an assertion that they both are about the same actual person. If any patient record is linked to another, then the other must be linked back to the source record.
- The patient may be a person or an animal (in order to support vetinary medicine). Either a person or an animal resource link must be provided, but not both.
- The dietary restrictions are not for specifying medical diets, but for casual dietary restrictions such as vegetarian, diary-free, nut-free, etc

## Managing Patient Registration

Managing Patient registration is a well known difficult problem. Around 2% of registrations are in error, mostly duplicate records. Sometimes the duplicate record is caught fairly quickly and retired before much data is accumulated. In other cases, substantial amounts of data may accumulate. For these and other reasons, the identifiers associated with a patient may change over time.

The master identifier for the Patient Resource can never change. For this reason the identifiers with which humans are concerned (often called MRN - Medical Record Number, or UR - Unit Record) should not be used as the master identifier. Instead they should be represented in the Patient.identifier list where they can be managed. This is also useful for the case of institutions that have acquired multiple numbers because of mergers of patient record systems over time.

In this specification, patient records are never merged. If multiple patient records are found to be duplicates, they are linked. In a RESTful context, this is done using the "link patients" transaction described below. In other contexts, equivalent functionality will be needed. When patient resources are linked, one may be chosen as the "master" - the correct record. In this case, the active status of all the other resources is set to false, and all the content is moved to the active record by updating it directly.

Patient records may only be in one of two statuses: active and retired. A normal record is active - it is in use. The status retired is used when a record is created in error. Once the error is discovered, it can either be retired or deleted. A record does not need to be linked to be retired.

## RESTful Transactions

The patient resource type defines one special transaction provided by the patient manager: "Link" for linking resources. The reason is that linking records is effectively a transaction that involves at least two resources, and all or none must change. Since the transaction involves multiple resources, it is implemented on the resource manager as a POST to [todo]

There is no content model for the response, except for an HTTP status code.

## Searching Criteria

The following simple search/filter parameters are defined for person:

person | The identity of a person
provider | The identity of an organization
id | search id in any patient identifiers

The standard search parameters also apply (see Searching).

## Formal Definitions

The formal definitions for the elements above. Also available as an XML file.

Patient
Definition | A patient is a person or animal that is receiving care
Control | Mandatory, 1..1
Requirements | Tracking patient is the center of the healthcare process
RIM Mapping | Patient
Patient.id
Definition | Master Resource Id, always first in all resources
Control | Mandatory, 1..1
Type | id
To Do | .id(scope=OBJ)
Patient.link
Definition | A linked patient record is a record that concerns the same patient. Records are linked after it is realised that at least one was created in error.
Control | Mandatory, 0..*
Type | Resource(Patient)
Must Understand | true
Requirements | Due to the clerical errors associated with the difficulties of identifying humans consistently, duplicate patient records are frequently created in error
Comments | More then two patient records may be linked. Note that there is a special transaction for linking patient records in the RESTful context, as record linking consistency must be maintained
Patient.active
Definition | Whether the patient record is in use, or has been removed from active use
Control | Mandatory, 1..1
Type | boolean
Must Understand | true
Requirements | Need to be able to mark a patient record as not to be used because it was created in error
Comments | If a record is inactive, and linked to an active record, then future patient/person/record updates should occur on the other patient
Patient.person
Definition | The person that this patient record is about
Control | Conditional, 0..1: Either an animal or a person must be provided, but not both
Type | Resource(Person)
Must Understand | true
Requirements | Need to link this patient record to a known and identifiable person (or animal)
Patient.animal
Definition | The animal that this patient record is about
Control | Conditional, 0..1: Either an animal or a person must be provided, but not both
Type | Resource(Animal)
Requirements | Need to link this patient record to a known and identifiable animal (or person)
Patient.provider
Definition | The provider for whom this is a patient record
Control | Mandatory, 1..1
Type | Resource(Organization)
Must Understand | true
Requirements | Need to know who recognises this patient record
To Do | But is thie same as institution above?
Patient.identifier
Definition | An identifier that applies to this person as a patient
Control | 0..*
Type | HumanId
Must Understand | true
Requirements | Patients are almos always assigned specific numerical identifiers
Patient.diet
Definition | Dietary restrictions for the patient
Control | Optional, 0..1
Type | CodeableConcept from PatientDiet
Requirements | Track patients reported dietary restrictions to help with catering requirements
Comments | not for specifying medical diets, but for casual dietary restrictions such as vegetarian, diary-free, nut-free, etc
Patient.confidentiality
Definition | Confidentiality of the patient records
Control | Optional, 0..1
Type | CodeableConcept from PatientConfidentiality
Requirements | Need to be able to track which patient records are particularly sensitive
Comments | Confidentiality tracking also occurs at more detailed points in the medical record
Patient.recordLocation
Definition | The location of the paper record for the patient, if there is one
Control | Optional, 0..1
Type | CodeableConcept from PaperRecordLocation
Requirements | Track old paper records where these are still in use
Patient.extensions
Definition | See Extensions
Control | Optional, 0..1
Patient.text
Definition | Text summary of person, for human interpretation
Control | Mandatory, 1..1
Type | Narrative

This is an old version of FHIR retained for archive purposes. Do not use for anything else
Implementers are welcome to experiment with the content defined here, but should note that the contents are subject to change without prior notice.
© HL7.org 2011 - 2012. FHIR v0.01 generated on Mon, May 14, 2012 09:48+1000.