2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

5.1 Resource Patient - Content

This resource maintained by the Patient Administration Work Group

Demographics and other administrative information about a person or animal receiving care or other health-related services.

5.1.1 Scope and Usage

This Resource covers data about persons and animals involved in a wide range of health-related activities, including:

  • Curative activities
  • Psychiatric care
  • Social services
  • Pregnancy care
  • Nursing and assisted living
  • Dietary services
  • Tracking of personal health and exercise data

The data in the Resource covers the "who" information about the patient: its attributes are focused on the demographic information necessary to support the administrative, financial and logistic procedures. A Patient record is generally created and maintained by each organization providing care for a patient. A person or animal receiving care at multiple organizations may therefore have its information present in multiple Patient Resources.

This resource is referenced by Alert, AllergyIntolerance, Appointment, AppointmentResponse, Basic, CarePlan, CarePlan2, ClinicalAssessment, Communication, CommunicationRequest, Composition, Condition, Contract, Contraindication, Coverage, Device, DeviceUseRequest, DeviceUseStatement, DiagnosticOrder, DiagnosticReport, DocumentManifest, DocumentReference, Encounter, EnrollmentRequest, EpisodeOfCare, FamilyHistory, Goal, Group, ImagingObjectSelection, ImagingStudy, Immunization, ImmunizationRecommendation, InstitutionalClaim, List, Media, MedicationAdministration, MedicationDispense, MedicationPrescription, MedicationStatement, NutritionOrder, Observation, OralHealthClaim, Order, Other, Person, PharmacyClaim, Procedure, ProcedureRequest, ProfessionalClaim, QuestionnaireAnswers, ReferralRequest, RelatedPerson, Reversal, RiskAssessment, SecurityEvent, Specimen, Supply, SupportingDocumentation, VisionClaim and VisionPrescription

5.1.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient DomainResourceInformation about a person or animal receiving health care services
... identifier Σ0..*IdentifierAn identifier for the person as this patient
... name Σ0..*HumanNameA name associated with the patient
... telecom Σ0..*ContactPointA contact detail for the individual
... gender Σ0..1codemale | female | other | unknown
AdministrativeGender (Required)
... birthDate Σ0..1dateThe date of birth for the individual
... birthTime Σ0..1timeThe time of birth for the individual
... deceased[x] M ΣIndicates if the individual is deceased or not
.... deceasedBoolean0..1boolean
.... deceasedDateTime0..1dateTime
... address Σ0..*AddressAddresses for the individual
... maritalStatus Σ0..1CodeableConceptMarital (civil) status of a person
MaritalStatus (Incomplete)
... multipleBirth[x] ΣWhether patient is part of a multiple birth
.... multipleBirthBoolean0..1boolean
.... multipleBirthInteger0..1integer
... photo 0..*AttachmentImage of the person
... contact I0..*ElementA contact party (e.g. guardian, partner, friend) for the patient
SHALL at least contain a contact's details or a reference to an organization
.... relationship 0..*CodeableConceptThe kind of relationship
ContactRelationship (Incomplete)
.... name 0..1HumanNameA name associated with the person
.... telecom 0..*ContactPointA contact detail for the person
.... address 0..1AddressAddress for the contact person
.... gender 0..1codemale | female | other | unknown
AdministrativeGender (Required)
.... organization I0..1OrganizationOrganization that is associated with the contact
.... period 0..1PeriodThe period during which this person or organization is valid to be contacted relating to this patient
... animal M Σ0..1ElementIf this patient is an animal (non-human)
.... species Σ1..1CodeableConceptE.g. Dog, Cow
AnimalSpecies (Example)
.... breed Σ0..1CodeableConceptE.g. Poodle, Angus
AnimalBreed (Example)
.... genderStatus Σ0..1CodeableConceptE.g. Neutered, Intact
AnimalGenderStatus (Example)
... communication 0..*CodeableConceptLanguages which may be used to communicate with the patient about his or her health
Language (Required)
... careProvider 0..*Organization | PractitionerPatient's nominated care provider
... managingOrganization Σ0..1OrganizationOrganization that is the custodian of the patient record
... link M Σ0..*ElementLink to another patient resource that concerns the same actual person
.... other M Σ1..1PatientThe other patient resource that the link refers to
.... type M Σ1..1codereplace | refer | seealso - type of link
LinkType (Required)
... active M Σ0..1booleanWhether this patient's record is in active use

UML Diagram

Patient (DomainResource)An identifier that applies to this person as a patientidentifier : Identifier 0..*A name associated with the individualname : HumanName 0..*A contact detail (e.g. a telephone number or an email address) by which the individual may be contactedtelecom : ContactPoint 0..*Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposesgender : code 0..1 « The gender of a person used for administrative purposesAdministrativeGender »The date of birth for the individualbirthDate : date 0..1The time of birth for the individualbirthTime : time 0..1Indicates if the individual is deceased or not (this element modifies the meaning of other elements)deceased[x] : boolean|dateTime 0..1Addresses for the individualaddress : Address 0..*This field contains a patient's most recent marital (civil) statusmaritalStatus : CodeableConcept 0..1 « The domestic partnership status of a personMaritalStatus+ »Indicates whether the patient is part of a multiple or indicates the actual birth ordermultipleBirth[x] : boolean|integer 0..1Image of the personphoto : Attachment 0..*Languages which may be used to communicate with the patient about his or her healthcommunication : CodeableConcept 0..* « A human languageLanguage »Patient's nominated care providercareProvider : Reference(Organization|Practitioner) 0..*Organization that is the custodian of the patient recordmanagingOrganization : Reference(Organization) 0..1Whether this patient record is in active use (this element modifies the meaning of other elements)active : boolean 0..1ContactThe nature of the relationship between the patient and the contact personrelationship : CodeableConcept 0..* « The nature of the relationship between a patient and a contact person for that patientContactRelationship+ »A name associated with the personname : HumanName 0..1A contact detail for the person, e.g. a telephone number or an email addresstelecom : ContactPoint 0..*Address for the contact personaddress : Address 0..1Administrative Gender - the gender that the person is considered to have for administration and record keeping purposesgender : code 0..1 « The gender of a person used for administrative purposesAdministrativeGender »Organization on behalf of which the contact is acting or for which the contact is workingorganization : Reference(Organization) 0..1The period during which this person or organization is valid to be contacted relating to this patientperiod : Period 0..1AnimalIdentifies the high level categorization of the kind of animalspecies : CodeableConcept 1..1 « (The species of an animalAnimalSpecies) »Identifies the detailed categorization of the kind of animalbreed : CodeableConcept 0..1 « (The breed of an animalAnimalBreed) »Indicates the current state of the animal's reproductive organsgenderStatus : CodeableConcept 0..1 « (The state of the animal's reproductive organsAnimalGenderStatus) »LinkThe other patient resource that the link refers to (this element modifies the meaning of other elements)other : Reference(Patient) 1..1The type of link between this patient resource and another patient resource (this element modifies the meaning of other elements)type : code 1..1 « The type of link between this patient resource and another patient resource.LinkType »A contact party (e.g. guardian, partner, friend) for the patientcontact0..*This element has a value if the patient is an animal (this element modifies the meaning of other elements)animal0..1Link to another patient resource that concerns the same actual person (this element modifies the meaning of other elements)link0..*

XML Template

<Patient xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier An identifier for the person as this patient --></identifier>
 <name><!-- 0..* HumanName A name associated with the patient --></name>
 <telecom><!-- 0..* ContactPoint A contact detail for the individual --></telecom>
 <gender value="[code]"/><!-- 0..1 male | female | other | unknown -->
 <birthDate value="[date]"/><!-- 0..1 The date of birth for the individual -->
 <birthTime value="[time]"/><!-- 0..1 The time of birth for the individual -->
 <deceased[x]><!-- 0..1 boolean|dateTime Indicates if the individual is deceased or not --></deceased[x]>
 <address><!-- 0..* Address Addresses for the individual --></address>
 <maritalStatus><!-- 0..1 CodeableConcept Marital (civil) status of a person --></maritalStatus>
 <multipleBirth[x]><!-- 0..1 boolean|integer 
     Whether patient is part of a multiple birth --></multipleBirth[x]>
 <photo><!-- 0..* Attachment Image of the person --></photo>
 <contact>  <!-- 0..* A contact party (e.g. guardian, partner, friend) for the patient -->
  <relationship><!-- 0..* CodeableConcept The kind of relationship --></relationship>
  <name><!-- 0..1 HumanName A name associated with the person --></name>
  <telecom><!-- 0..* ContactPoint A contact detail for the person --></telecom>
  <address><!-- 0..1 Address Address for the contact person --></address>
  <gender value="[code]"/><!-- 0..1 male | female | other | unknown -->
  <organization><!-- ?? 0..1 Reference(Organization) 
      Organization that is associated with the contact --></organization>
  <period><!-- 0..1 Period 
      The period during which this person or organization is valid to be contacted relating to this patient --></period>
 </contact>
 <animal>  <!-- 0..1 If this patient is an animal (non-human) -->
  <species><!-- 1..1 CodeableConcept E.g. Dog, Cow --></species>
  <breed><!-- 0..1 CodeableConcept E.g. Poodle, Angus --></breed>
  <genderStatus><!-- 0..1 CodeableConcept E.g. Neutered, Intact --></genderStatus>
 </animal>
 <communication><!-- 0..* CodeableConcept Languages which may be used to communicate with the patient about his or her health --></communication>
 <careProvider><!-- 0..* Reference(Organization|Practitioner) 
     Patient's nominated care provider --></careProvider>
 <managingOrganization><!-- 0..1 Reference(Organization) 
     Organization that is the custodian of the patient record --></managingOrganization>
 <link>  <!-- 0..* Link to another patient resource that concerns the same actual person -->
  <other><!-- 1..1 Reference(Patient) The other patient resource that the link refers to --></other>
  <type value="[code]"/><!-- 1..1 replace | refer | seealso - type of link -->
 </link>
 <active value="[boolean]"/><!-- 0..1 Whether this patient's record is in active use -->
</Patient>

JSON Template

{doco
  "resourceType" : "Patient",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // An identifier for the person as this patient
  "name" : [{ HumanName }], // A name associated with the patient
  "telecom" : [{ ContactPoint }], // A contact detail for the individual
  "gender" : "<code>", // male | female | other | unknown
  "birthDate" : "<date>", // The date of birth for the individual
  "birthTime" : "<time>", // The time of birth for the individual
  // deceased[x]: Indicates if the individual is deceased or not. One of these 2:
  "deceasedBoolean" : <boolean>,
  "deceasedDateTime" : "<dateTime>",
  "address" : [{ Address }], // Addresses for the individual
  "maritalStatus" : { CodeableConcept }, // Marital (civil) status of a person
  // multipleBirth[x]: Whether patient is part of a multiple birth. One of these 2:
  "multipleBirthBoolean" : <boolean>,
  "multipleBirthInteger" : <integer>,
  "photo" : [{ Attachment }], // Image of the person
  "contact" : [{ // A contact party (e.g. guardian, partner, friend) for the patient
    "relationship" : [{ CodeableConcept }], // The kind of relationship
    "name" : { HumanName }, // A name associated with the person
    "telecom" : [{ ContactPoint }], // A contact detail for the person
    "address" : { Address }, // Address for the contact person
    "gender" : "<code>", // male | female | other | unknown
    "organization" : { Reference(Organization) }, // C? 
      Organization that is associated with the contact
    "period" : { Period } // 
      The period during which this person or organization is valid to be contacted relating to this patient
  }],
  "animal" : { // If this patient is an animal (non-human)
    "species" : { CodeableConcept }, // R! E.g. Dog, Cow
    "breed" : { CodeableConcept }, // E.g. Poodle, Angus
    "genderStatus" : { CodeableConcept } // E.g. Neutered, Intact
  },
  "communication" : [{ CodeableConcept }], // Languages which may be used to communicate with the patient about his or her health
  "careProvider" : [{ Reference(Organization|Practitioner) }], // 
     Patient's nominated care provider
  "managingOrganization" : { Reference(Organization) }, // 
     Organization that is the custodian of the patient record
  "link" : [{ // Link to another patient resource that concerns the same actual person
    "other" : { Reference(Patient) }, // R! The other patient resource that the link refers to
    "type" : "<code>" // R! replace | refer | seealso - type of link
  }],
  "active" : <boolean> // Whether this patient's record is in active use
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient DomainResourceInformation about a person or animal receiving health care services
... identifier Σ0..*IdentifierAn identifier for the person as this patient
... name Σ0..*HumanNameA name associated with the patient
... telecom Σ0..*ContactPointA contact detail for the individual
... gender Σ0..1codemale | female | other | unknown
AdministrativeGender (Required)
... birthDate Σ0..1dateThe date of birth for the individual
... birthTime Σ0..1timeThe time of birth for the individual
... deceased[x] M ΣIndicates if the individual is deceased or not
.... deceasedBoolean0..1boolean
.... deceasedDateTime0..1dateTime
... address Σ0..*AddressAddresses for the individual
... maritalStatus Σ0..1CodeableConceptMarital (civil) status of a person
MaritalStatus (Incomplete)
... multipleBirth[x] ΣWhether patient is part of a multiple birth
.... multipleBirthBoolean0..1boolean
.... multipleBirthInteger0..1integer
... photo 0..*AttachmentImage of the person
... contact I0..*ElementA contact party (e.g. guardian, partner, friend) for the patient
SHALL at least contain a contact's details or a reference to an organization
.... relationship 0..*CodeableConceptThe kind of relationship
ContactRelationship (Incomplete)
.... name 0..1HumanNameA name associated with the person
.... telecom 0..*ContactPointA contact detail for the person
.... address 0..1AddressAddress for the contact person
.... gender 0..1codemale | female | other | unknown
AdministrativeGender (Required)
.... organization I0..1OrganizationOrganization that is associated with the contact
.... period 0..1PeriodThe period during which this person or organization is valid to be contacted relating to this patient
... animal M Σ0..1ElementIf this patient is an animal (non-human)
.... species Σ1..1CodeableConceptE.g. Dog, Cow
AnimalSpecies (Example)
.... breed Σ0..1CodeableConceptE.g. Poodle, Angus
AnimalBreed (Example)
.... genderStatus Σ0..1CodeableConceptE.g. Neutered, Intact
AnimalGenderStatus (Example)
... communication 0..*CodeableConceptLanguages which may be used to communicate with the patient about his or her health
Language (Required)
... careProvider 0..*Organization | PractitionerPatient's nominated care provider
... managingOrganization Σ0..1OrganizationOrganization that is the custodian of the patient record
... link M Σ0..*ElementLink to another patient resource that concerns the same actual person
.... other M Σ1..1PatientThe other patient resource that the link refers to
.... type M Σ1..1codereplace | refer | seealso - type of link
LinkType (Required)
... active M Σ0..1booleanWhether this patient's record is in active use

UML Diagram

Patient (DomainResource)An identifier that applies to this person as a patientidentifier : Identifier 0..*A name associated with the individualname : HumanName 0..*A contact detail (e.g. a telephone number or an email address) by which the individual may be contactedtelecom : ContactPoint 0..*Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposesgender : code 0..1 « The gender of a person used for administrative purposesAdministrativeGender »The date of birth for the individualbirthDate : date 0..1The time of birth for the individualbirthTime : time 0..1Indicates if the individual is deceased or not (this element modifies the meaning of other elements)deceased[x] : boolean|dateTime 0..1Addresses for the individualaddress : Address 0..*This field contains a patient's most recent marital (civil) statusmaritalStatus : CodeableConcept 0..1 « The domestic partnership status of a personMaritalStatus+ »Indicates whether the patient is part of a multiple or indicates the actual birth ordermultipleBirth[x] : boolean|integer 0..1Image of the personphoto : Attachment 0..*Languages which may be used to communicate with the patient about his or her healthcommunication : CodeableConcept 0..* « A human languageLanguage »Patient's nominated care providercareProvider : Reference(Organization|Practitioner) 0..*Organization that is the custodian of the patient recordmanagingOrganization : Reference(Organization) 0..1Whether this patient record is in active use (this element modifies the meaning of other elements)active : boolean 0..1ContactThe nature of the relationship between the patient and the contact personrelationship : CodeableConcept 0..* « The nature of the relationship between a patient and a contact person for that patientContactRelationship+ »A name associated with the personname : HumanName 0..1A contact detail for the person, e.g. a telephone number or an email addresstelecom : ContactPoint 0..*Address for the contact personaddress : Address 0..1Administrative Gender - the gender that the person is considered to have for administration and record keeping purposesgender : code 0..1 « The gender of a person used for administrative purposesAdministrativeGender »Organization on behalf of which the contact is acting or for which the contact is workingorganization : Reference(Organization) 0..1The period during which this person or organization is valid to be contacted relating to this patientperiod : Period 0..1AnimalIdentifies the high level categorization of the kind of animalspecies : CodeableConcept 1..1 « (The species of an animalAnimalSpecies) »Identifies the detailed categorization of the kind of animalbreed : CodeableConcept 0..1 « (The breed of an animalAnimalBreed) »Indicates the current state of the animal's reproductive organsgenderStatus : CodeableConcept 0..1 « (The state of the animal's reproductive organsAnimalGenderStatus) »LinkThe other patient resource that the link refers to (this element modifies the meaning of other elements)other : Reference(Patient) 1..1The type of link between this patient resource and another patient resource (this element modifies the meaning of other elements)type : code 1..1 « The type of link between this patient resource and another patient resource.LinkType »A contact party (e.g. guardian, partner, friend) for the patientcontact0..*This element has a value if the patient is an animal (this element modifies the meaning of other elements)animal0..1Link to another patient resource that concerns the same actual person (this element modifies the meaning of other elements)link0..*

XML Template

<Patient xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier An identifier for the person as this patient --></identifier>
 <name><!-- 0..* HumanName A name associated with the patient --></name>
 <telecom><!-- 0..* ContactPoint A contact detail for the individual --></telecom>
 <gender value="[code]"/><!-- 0..1 male | female | other | unknown -->
 <birthDate value="[date]"/><!-- 0..1 The date of birth for the individual -->
 <birthTime value="[time]"/><!-- 0..1 The time of birth for the individual -->
 <deceased[x]><!-- 0..1 boolean|dateTime Indicates if the individual is deceased or not --></deceased[x]>
 <address><!-- 0..* Address Addresses for the individual --></address>
 <maritalStatus><!-- 0..1 CodeableConcept Marital (civil) status of a person --></maritalStatus>
 <multipleBirth[x]><!-- 0..1 boolean|integer 
     Whether patient is part of a multiple birth --></multipleBirth[x]>
 <photo><!-- 0..* Attachment Image of the person --></photo>
 <contact>  <!-- 0..* A contact party (e.g. guardian, partner, friend) for the patient -->
  <relationship><!-- 0..* CodeableConcept The kind of relationship --></relationship>
  <name><!-- 0..1 HumanName A name associated with the person --></name>
  <telecom><!-- 0..* ContactPoint A contact detail for the person --></telecom>
  <address><!-- 0..1 Address Address for the contact person --></address>
  <gender value="[code]"/><!-- 0..1 male | female | other | unknown -->
  <organization><!-- ?? 0..1 Reference(Organization) 
      Organization that is associated with the contact --></organization>
  <period><!-- 0..1 Period 
      The period during which this person or organization is valid to be contacted relating to this patient --></period>
 </contact>
 <animal>  <!-- 0..1 If this patient is an animal (non-human) -->
  <species><!-- 1..1 CodeableConcept E.g. Dog, Cow --></species>
  <breed><!-- 0..1 CodeableConcept E.g. Poodle, Angus --></breed>
  <genderStatus><!-- 0..1 CodeableConcept E.g. Neutered, Intact --></genderStatus>
 </animal>
 <communication><!-- 0..* CodeableConcept Languages which may be used to communicate with the patient about his or her health --></communication>
 <careProvider><!-- 0..* Reference(Organization|Practitioner) 
     Patient's nominated care provider --></careProvider>
 <managingOrganization><!-- 0..1 Reference(Organization) 
     Organization that is the custodian of the patient record --></managingOrganization>
 <link>  <!-- 0..* Link to another patient resource that concerns the same actual person -->
  <other><!-- 1..1 Reference(Patient) The other patient resource that the link refers to --></other>
  <type value="[code]"/><!-- 1..1 replace | refer | seealso - type of link -->
 </link>
 <active value="[boolean]"/><!-- 0..1 Whether this patient's record is in active use -->
</Patient>

JSON Template

{doco
  "resourceType" : "Patient",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // An identifier for the person as this patient
  "name" : [{ HumanName }], // A name associated with the patient
  "telecom" : [{ ContactPoint }], // A contact detail for the individual
  "gender" : "<code>", // male | female | other | unknown
  "birthDate" : "<date>", // The date of birth for the individual
  "birthTime" : "<time>", // The time of birth for the individual
  // deceased[x]: Indicates if the individual is deceased or not. One of these 2:
  "deceasedBoolean" : <boolean>,
  "deceasedDateTime" : "<dateTime>",
  "address" : [{ Address }], // Addresses for the individual
  "maritalStatus" : { CodeableConcept }, // Marital (civil) status of a person
  // multipleBirth[x]: Whether patient is part of a multiple birth. One of these 2:
  "multipleBirthBoolean" : <boolean>,
  "multipleBirthInteger" : <integer>,
  "photo" : [{ Attachment }], // Image of the person
  "contact" : [{ // A contact party (e.g. guardian, partner, friend) for the patient
    "relationship" : [{ CodeableConcept }], // The kind of relationship
    "name" : { HumanName }, // A name associated with the person
    "telecom" : [{ ContactPoint }], // A contact detail for the person
    "address" : { Address }, // Address for the contact person
    "gender" : "<code>", // male | female | other | unknown
    "organization" : { Reference(Organization) }, // C? 
      Organization that is associated with the contact
    "period" : { Period } // 
      The period during which this person or organization is valid to be contacted relating to this patient
  }],
  "animal" : { // If this patient is an animal (non-human)
    "species" : { CodeableConcept }, // R! E.g. Dog, Cow
    "breed" : { CodeableConcept }, // E.g. Poodle, Angus
    "genderStatus" : { CodeableConcept } // E.g. Neutered, Intact
  },
  "communication" : [{ CodeableConcept }], // Languages which may be used to communicate with the patient about his or her health
  "careProvider" : [{ Reference(Organization|Practitioner) }], // 
     Patient's nominated care provider
  "managingOrganization" : { Reference(Organization) }, // 
     Organization that is the custodian of the patient record
  "link" : [{ // Link to another patient resource that concerns the same actual person
    "other" : { Reference(Patient) }, // R! The other patient resource that the link refers to
    "type" : "<code>" // R! replace | refer | seealso - type of link
  }],
  "active" : <boolean> // Whether this patient's record is in active use
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

5.1.2.1 Terminology Bindings

PathDefinitionTypeReference
Patient.gender
Patient.contact.gender 		The gender of a person used for administrative purposesFixedhttp://hl7.org/fhir/administrative-gender
Patient.maritalStatus The domestic partnership status of a personIncompletehttp://hl7.org/fhir/vs/marital-status
Patient.contact.relationship The nature of the relationship between a patient and a contact person for that patientIncompletehttp://hl7.org/fhir/vs/patient-contact-relationship
Patient.animal.species The species of an animalExamplehttp://hl7.org/fhir/vs/animal-species
Patient.animal.breed The breed of an animalExamplehttp://hl7.org/fhir/vs/animal-breeds
Patient.animal.genderStatus The state of the animal's reproductive organsExamplehttp://hl7.org/fhir/vs/animal-genderstatus
Patient.communication A human languageFixedIETF language tag
Patient.link.type The type of link between this patient resource and another patient resource.Fixedhttp://hl7.org/fhir/link-type

5.1.2.2 Constraints

  • pat-1: On Patient.contact: SHALL at least contain a contact's details or a reference to an organization (xpath on f:Patient/f:contact: f:name or f:telecom or f:address or f:organization)

Notes:

  • multipleBirth can be either expressed as a boolean (just indicating whether the patient is part of a multiple birth) or as an integer, indicating the actual birth order.
  • Patient records may only be in one of two statuses: in use (active=true) and not in use (active=false). A normal record is active, i.e. it is in use. Active is set to 'false' when a record is created as a duplicate or in error. A record does not need to be linked to be inactivated.
  • The link element is used to assert that two or more Patient resources are both about the same actual person. See below for further discussion
  • There should be only one preferred language (Language.preference = true) per mode of expression.
  • The Contact for a Patient has an element organization, this is for use with guardians or business related contacts where just the organization is relevant.

5.1.3 Patient id's and Patient resource id's

A Patient record's Resource Id 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 for the resource's id, since MRN's may change, i.e. as a result of having duplicate records of the same person. 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.

5.1.4 Linking Patients

The link element is used to assert that patient resources refer to the same person. This element is used to support three distinct scenario's where multiple records of the same person exist:

5.1.4.1 Duplicate Patient records

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. By using a link of type 'replace', the record containing such a link is marked as a duplicate and the link points forward to a record that should be used instead. Note that the record pointed to may in its turn have been identified as created in error and forward to yet another Patient resource. Records that replace another record, do not point back to the replaced record.

5.1.4.2 Patient record in a Patient index

A Patient record may be present in a system that acts as a Patient Index: it maintains a (summary of) patient data and a list of one or more servers that it are known to hold a more comprehensive and/or authorative record of the same patient. The link type 'refer' is used denote such a link. Note that linked records may contain contradictory information. The record referred to does not point back to the referring record.

5.1.4.3 Distributed Patient record

In a distributed architecture, multiple systems keep separate patient records concerning the same person. These records are not considered duplicates, but contain a distributed, potentially overlapping view of the patient's data. Each such record may have its own focus or maintaining organization and there need not be a sense of one record being more complete or more authorative than another. In such cases, links of type 'seealso' can be used to point to other patient records. It is not a requirement that such links are bilateral.

5.1.4.4 Patient vs Person vs Patient.Link

The Person resource on the surface appears to be very similar to the Patient resource, and the usage for it is very similar to using the Patient.Link capability.
The intention of the Person resource is to be able to link instances of resources together that are believed to be the same individual. This includes across resource types, such as RelatedPerson, Practitioner, Patient and even other Person resources.
The Patient Link however is only intended to be used for Patient resources.

The primary use case for the Person resource is to be able to support Person registries that do not necessarily have a healthcare context, and are able to identify and quantify confidence levels that this is the same person.
This could include consumer portals where the actual maintainer of the Person information is the actual person themselves.
A system could use the Person entry to cross check changes to information applied to one part of a record to values in another system. e.g. A Consumer updates his contact numbers and address when moving in his Person record, and then a Patient Administation system is able to see that this data is changed, and prompt the organization to follow up with the patient that was linked to the person record if they want their details updated, or if they no longer need services and they should be cancelled, as they've moved from the area.

5.1.4.5 Patient.Contact vs RelatedPerson

The contact component on the Patient Resource should be used for storing persons to contact information. Where a system has a separate record for other people for purposes other than just the contact details, The RelatedPerson resource should be used.
This includes cases where these related people are actually contributing to the record, and need to be referenced individually (e.g. CarePlan.Participant, Encounter, DocumentReference, Appointment) where the Patient.Contact component cannot be used.

It is not expected that these records will be used for primary care provider, this information should be stored in the Patient.careProvider field.

5.1.5 Merging records

This specification does not specify merge functionality: if multiple patient records are found to be duplicates, they can be linked together, as described above. These links merely express the relationship between records, and in the case of a replacement link, indicate a "master" record. This specification does not mandate that FHIR servers migrate information between such records on finding such a link. Note:

  • Health information administrators may call the process "merging", but it is often implemented as "linking" at the record level
  • Servers are allowed to implement merging/record migration even though it is not mandated.

5.1.6 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
activetokenWhether the patient record is activePatient.active
addressstringAn address in any kind of address/part of the patientPatient.address
animal-breedtokenThe breed for animal patientsPatient.animal.breed
animal-speciestokenThe species for animal patientsPatient.animal.species
birthdatedateThe patient's date of birthPatient.birthDate
careproviderreferencePatient's nominated care provider, could be a care manager, not the organization that manages the recordPatient.careProvider
(Organization, Practitioner)
familystringA portion of the family name of the patientPatient.name.family
gendertokenGender of the patientPatient.gender
givenstringA portion of the given name of the patientPatient.name.given
identifiertokenA patient identifierPatient.identifier
languagetokenLanguage code (irrespective of use value)Patient.communication
linkreferenceAll patients linked to the given patientPatient.link.other
(Patient)
namestringA portion of either family or given name of the patientPatient.name
organizationreferenceThe organization at which this person is a patientPatient.managingOrganization
(Organization)
phoneticstringA portion of either family or given name using some kind of phonetic matching algorithm
telecomstringThe value in any kind of telecom details of the patientPatient.telecom