Release 4B Ballot #1
Clinical SummaryThis page is part of the FHIR Specification v4.1.0: R4B Ballot. About the R4B version of FHIR. 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
| Patient Care Work Group | Maturity Level: 2 | Trial Use | Security Category: Patient | Compartments: Patient |
Significant health conditions for a person related to the patient relevant in the context of care for the patient.
FamilyMemberHistory is one of the event resources in the FHIR workflow specification.
This resource records significant health conditions for a particular individual related to the subject. This information can be known to different levels of accuracy. Sometimes the exact condition ('asthma') is known, and sometimes it is less precise ('some sort of cancer'). Equally, sometimes the person can be identified ('my aunt Agatha') and sometimes all that is known is that the person was an uncle.
This resource represents a simple structure used to capture an 'elementary' family history for a particular family member. However, it can also be the basis for capturing a more rigorous history useful for genetic and other analysis - refer to the Genetic Pedigree profile for an example.
The entire family history for an individual can be represented by combining references to FamilyMemberHistory instances into a List resource instance.
This resource is referenced by AdverseEvent and ClinicalImpression.
This resource implements the Event pattern.
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  FamilyMemberHistory | TU | DomainResource | Information about patient's relatives, relevant for patient + Rule: Can have age[x] or born[x], but not both + Rule: Can only have estimatedAge if age[x] is present Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
  identifier | Σ | 0..* | Identifier | External Id(s) for this record |
 instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | Questionnaire | ActivityDefinition | Measure | OperationDefinition) | Instantiates FHIR protocol or definition |
 instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition |
| status | ?!Σ | 1..1 | code | partial | completed | entered-in-error | health-unknown FamilyHistoryStatus (Required) |
| dataAbsentReason | Σ | 0..1 | CodeableConcept | subject-unknown | withheld | unable-to-obtain | deferred FamilyHistoryAbsentReason (Example) |
| patient | Σ | 1..1 | Reference(Patient) | Patient history is about |
| date | Σ | 0..1 | dateTime | When history was recorded or last updated |
| name | Σ | 0..1 | string | The family member described |
| relationship | Σ | 1..1 | CodeableConcept | Relationship to the subject FamilyMember (Example) |
| sex | Σ | 0..1 | CodeableConcept | male | female | other | unknown AdministrativeGender (Extensible) |
  born[x] | I | 0..1 | (approximate) date of birth | |
 bornPeriod | Period | |||
| bornDate | date | |||
 bornString | string | |||
| age[x] | ΣI | 0..1 | (approximate) age | |
| ageAge | Age | |||
| ageRange | Range | |||
| ageString | string | |||
| estimatedAge | ΣI | 0..1 | boolean | Age is estimated? |
| deceased[x] | Σ | 0..1 | Dead? How old/when? | |
| deceasedBoolean | boolean | |||
| deceasedAge | Age | |||
| deceasedRange | Range | |||
| deceasedDate | date | |||
| deceasedString | string | |||
| reasonCode | Σ | 0..* | CodeableConcept | Why was family member history performed? SNOMED CT Clinical Findings (Example) |
| reasonReference | Σ | 0..* | Reference(Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference) | Why was family member history performed? |
| note | 0..* | Annotation | General note about related person | |
  condition | 0..* | BackboneElement | Condition that the related person had | |
 code | 1..1 | CodeableConcept | Condition suffered by relation Condition/Problem/Diagnosis Codes (Example) | |
| outcome | 0..1 | CodeableConcept | deceased | permanent disability | etc. Condition Outcome Codes (Example) | |
| contributedToDeath | 0..1 | boolean | Whether the condition contributed to the cause of death | |
| onset[x] | 0..1 | When condition first manifested | ||
| onsetAge | Age | |||
| onsetRange | Range | |||
| onsetPeriod | Period | |||
| onsetString | string | |||
| note | 0..* | Annotation | Extra information about condition | |
| Documentation for this format | ||||
UML Diagram (Legend)
XML Template
<FamilyMemberHistory xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier External Id(s) for this record --></identifier> <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure| OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical> <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition --> <status value="[code]"/><!-- 1..1 partial | completed | entered-in-error | health-unknown --> <dataAbsentReason><!-- 0..1 CodeableConcept subject-unknown | withheld | unable-to-obtain | deferred --></dataAbsentReason> <patient><!-- 1..1 Reference(Patient) Patient history is about --></patient> <date value="[dateTime]"/><!-- 0..1 When history was recorded or last updated --> <name value="[string]"/><!-- 0..1 The family member described --> <relationship><!-- 1..1 CodeableConcept Relationship to the subject
0..1 Period|date|string (approximate) date of birth --></born[x]> <age[x]><!--
JSON Template
{
"resourceType" : "FamilyMemberHistory",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // External Id(s) for this record
"instantiatesCanonical" : [{ canonical(ActivityDefinition|Measure|
OperationDefinition|PlanDefinition|Questionnaire) }], // Instantiates FHIR protocol or definition
"instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
"status" : "<code>", // R! partial | completed | entered-in-error | health-unknown
"dataAbsentReason" : { CodeableConcept }, // subject-unknown | withheld | unable-to-obtain | deferred
"patient" : { Reference(Patient) }, // R! Patient history is about
"date" : "<dateTime>", // When history was recorded or last updated
"name" : "<string>", // The family member described
"relationship" : { CodeableConcept }, // R! Relationship to the subject
"sex" : { CodeableConcept }, // male | female | other | unknown
// born[x]: (approximate) date of birth. One of these 3:
"bornPeriod" : { Period },
"bornDate" : "<date>",
"bornString" : "<string>",
// age[x]: (approximate) age. One of these 3:
"ageAge" : { Age },
"ageRange" : { Range },
"ageString" : "<string>",
"estimatedAge" : <boolean>, // C? Age is estimated?
// deceased[x]: Dead? How old/when?. One of these 5:
"deceasedBoolean" : <boolean>,
"deceasedAge" : { Age },
"deceasedRange" : { Range },
"deceasedDate" : "<date>",
"deceasedString" : "<string>",
"reasonCode" : [{ CodeableConcept }], // Why was family member history performed?
"reasonReference" : [{ Reference(AllergyIntolerance|Condition|
DiagnosticReport|DocumentReference|Observation|QuestionnaireResponse) }], // Why was family member history performed?
"note" : [{ Annotation }], // General note about related person
"condition" : [{ // Condition that the related person had
"code" : { CodeableConcept }, // R! Condition suffered by relation
"outcome" : { CodeableConcept }, // deceased | permanent disability | etc.
"contributedToDeath" : <boolean>, // Whether the condition contributed to the cause of death
// onset[x]: When condition first manifested. One of these 4:
"onsetAge" : { Age },
"onsetRange" : { Range },
"onsetPeriod" : { Period },
"onsetString" : "<string>",
"note" : [{ Annotation }] // Extra information about condition
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since R3
| FamilyMemberHistory | |
| FamilyMemberHistory.status |
|
| FamilyMemberHistory.sex |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. All tests pass round-trip testing and 1 r3 resources are invalid (0 errors).)
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| FamilyMemberHistory | TU | DomainResource | Information about patient's relatives, relevant for patient + Rule: Can have age[x] or born[x], but not both + Rule: Can only have estimatedAge if age[x] is present Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
| identifier | Σ | 0..* | Identifier | External Id(s) for this record |
| instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | Questionnaire | ActivityDefinition | Measure | OperationDefinition) | Instantiates FHIR protocol or definition |
| instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition |
| status | ?!Σ | 1..1 | code | partial | completed | entered-in-error | health-unknown FamilyHistoryStatus (Required) |
| dataAbsentReason | Σ | 0..1 | CodeableConcept | subject-unknown | withheld | unable-to-obtain | deferred FamilyHistoryAbsentReason (Example) |
| patient | Σ | 1..1 | Reference(Patient) | Patient history is about |
| date | Σ | 0..1 | dateTime | When history was recorded or last updated |
| name | Σ | 0..1 | string | The family member described |
| relationship | Σ | 1..1 | CodeableConcept | Relationship to the subject FamilyMember (Example) |
| sex | Σ | 0..1 | CodeableConcept | male | female | other | unknown AdministrativeGender (Extensible) |
| born[x] | I | 0..1 | (approximate) date of birth | |
| bornPeriod | Period | |||
| bornDate | date | |||
| bornString | string | |||
| age[x] | ΣI | 0..1 | (approximate) age | |
| ageAge | Age | |||
| ageRange | Range | |||
| ageString | string | |||
| estimatedAge | ΣI | 0..1 | boolean | Age is estimated? |
| deceased[x] | Σ | 0..1 | Dead? How old/when? | |
| deceasedBoolean | boolean | |||
| deceasedAge | Age | |||
| deceasedRange | Range | |||
| deceasedDate | date | |||
| deceasedString | string | |||
| reasonCode | Σ | 0..* | CodeableConcept | Why was family member history performed? SNOMED CT Clinical Findings (Example) |
| reasonReference | Σ | 0..* | Reference(Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference) | Why was family member history performed? |
| note | 0..* | Annotation | General note about related person | |
| condition | 0..* | BackboneElement | Condition that the related person had | |
| code | 1..1 | CodeableConcept | Condition suffered by relation Condition/Problem/Diagnosis Codes (Example) | |
| outcome | 0..1 | CodeableConcept | deceased | permanent disability | etc. Condition Outcome Codes (Example) | |
| contributedToDeath | 0..1 | boolean | Whether the condition contributed to the cause of death | |
| onset[x] | 0..1 | When condition first manifested | ||
| onsetAge | Age | |||
| onsetRange | Range | |||
| onsetPeriod | Period | |||
| onsetString | string | |||
| note | 0..* | Annotation | Extra information about condition | |
| Documentation for this format | ||||
XML Template
<FamilyMemberHistory xmlns="http://hl7.org/fhir">
JSON Template
{
"resourceType" : "FamilyMemberHistory",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // External Id(s) for this record
"instantiatesCanonical" : [{ canonical(ActivityDefinition|Measure|
OperationDefinition|PlanDefinition|Questionnaire) }], // Instantiates FHIR protocol or definition
"instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
"status" : "<code>", // R! partial | completed | entered-in-error | health-unknown
"dataAbsentReason" : { CodeableConcept }, // subject-unknown | withheld | unable-to-obtain | deferred
"patient" : { Reference(Patient) }, // R! Patient history is about
"date" : "<dateTime>", // When history was recorded or last updated
"name" : "<string>", // The family member described
"relationship" : { CodeableConcept }, // R! Relationship to the subject
"sex" : { CodeableConcept }, // male | female | other | unknown
// born[x]: (approximate) date of birth. One of these 3:
"bornPeriod" : { Period },
"bornDate" : "<date>",
"bornString" : "<string>",
// age[x]: (approximate) age. One of these 3:
"ageAge" : { Age },
"ageRange" : { Range },
"ageString" : "<string>",
"estimatedAge" : <boolean>, // C? Age is estimated?
// deceased[x]: Dead? How old/when?. One of these 5:
"deceasedBoolean" : <boolean>,
"deceasedAge" : { Age },
"deceasedRange" : { Range },
"deceasedDate" : "<date>",
"deceasedString" : "<string>",
"reasonCode" : [{ CodeableConcept }], // Why was family member history performed?
"reasonReference" : [{ Reference(AllergyIntolerance|Condition|
DiagnosticReport|DocumentReference|Observation|QuestionnaireResponse) }], // Why was family member history performed?
"note" : [{ Annotation }], // General note about related person
"condition" : [{ // Condition that the related person had
"code" : { CodeableConcept }, // R! Condition suffered by relation
"outcome" : { CodeableConcept }, // deceased | permanent disability | etc.
"contributedToDeath" : <boolean>, // Whether the condition contributed to the cause of death
// onset[x]: When condition first manifested. One of these 4:
"onsetAge" : { Age },
"onsetRange" : { Range },
"onsetPeriod" : { Period },
"onsetString" : "<string>",
"note" : [{ Annotation }] // Extra information about condition
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since Release 3
| FamilyMemberHistory | |
| FamilyMemberHistory.status |
|
| FamilyMemberHistory.sex |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. All tests pass round-trip testing and 1 r3 resources are invalid (0 errors).)
See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis
| Path | Definition | Type | Reference |
|---|---|---|---|
| FamilyMemberHistory.status | A code that identifies the status of the family history record. | Required | FamilyHistoryStatus |
| FamilyMemberHistory.dataAbsentReason | Codes describing the reason why a family member's history is not available. | Example | FamilyHistoryAbsentReason |
| FamilyMemberHistory.relationship | The nature of the relationship between the patient and the related person being described in the family member history. | Example | FamilyMember |
| FamilyMemberHistory.sex | Codes describing the sex assigned at birth as documented on the birth registration. | Extensible | AdministrativeGender |
| FamilyMemberHistory.reasonCode | Codes indicating why the family member history was done. | Example | SNOMEDCTClinicalFindings |
| FamilyMemberHistory.condition.code | Identification of the Condition or diagnosis. | Example | Condition/Problem/DiagnosisCodes |
| FamilyMemberHistory.condition.outcome | The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc. | Example | ConditionOutcomeCodes |
| id | Level | Location | Description | Expression |
| fhs-1 | Rule | (base) | Can have age[x] or born[x], but not both | age.empty() or born.empty() |
| fhs-2 | Rule | (base) | Can only have estimatedAge if age[x] is present | age.exists() or estimatedAge.empty() |
The Family Member History List may contain other than FamilyMemberHistory resources. For example, a full Family History could be a List that might include a mixture of FamilyMemberHistory records as well as Observation records of things like "maternal family history of breast cancer", "number of siblings", "number of female family members with breast cancer" etc.
The List representing a patient's "family history" can include Condition and Observation records that capture "family-history" relevant assertions about the patient themselves that would typically be captured as part of a family history.
Not Reviewed, Not Asked
When a sending system does not have family history about any family members or the statement is about family history not yet being asked, then the List resource should be used to indicate the List.emptyReason="notasked".
Reviewed, None Identified for Family
After reasonable investigation that there are no known items for the family member history list, then the List resource should be used to indicate the List.emptyReason="nilknown". The List.emptyReason represents a statement about the full scope of the list (i.e. the patient or patient's agent/guardian has asserted that there are no conditions or significant events for any family members to record).
Reviewed, None Identified for a Family Member
When an individual family member's history is not available, FamilyMemberHistory.dataAbsentReason can be used to indicate why that family member's history is not available (e.g. subject unknown).
Reviewed, No Known Problems or Negated Condition for a Family Member
The FamilyMemberHistory.condition.code can be used to capture "No Known Problems" or negated conditions, such as "No history of malignant tumor of breast", for an individual family member.
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| code | token | A search by a condition code | FamilyMemberHistory.condition.code | |
| date | date | When history was recorded or last updated | FamilyMemberHistory.date | |
| identifier | token | A search by a record identifier | FamilyMemberHistory.identifier | |
| instantiates-canonical | reference | Instantiates FHIR protocol or definition | FamilyMemberHistory.instantiatesCanonical (Questionnaire, Measure, PlanDefinition, OperationDefinition, ActivityDefinition) | |
| instantiates-uri | uri | Instantiates external protocol or definition | FamilyMemberHistory.instantiatesUri | |
| patient | reference | The identity of a subject to list family member history items for | FamilyMemberHistory.patient (Patient) | |
| relationship | token | A search by a relationship type | FamilyMemberHistory.relationship | |
| sex | token | A search by a sex code of a family member | FamilyMemberHistory.sex | |
| status | token | partial | completed | entered-in-error | health-unknown | FamilyMemberHistory.status |
FHIR ®© HL7.org 2011+. FHIR R4B Ballot #1 hl7.fhir.core#4.1.0 generated on Thu, Mar 11, 2021 17:10+1100.
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