A brand of a healthcare provider, such as a hospital, clinic, or practice

• value @ url

The unique identifier for the brand that apps can use to link this Brand across publishers or with external data sets. EHRs SHALL support customer-supplied identifiers (system and value).

• It is RECOMMENDED that each Brand include an identifier where system is urn:ietf:rfc: 3986 (meaning the identifier is a URL) and value is the HTTPS URL for the Brand's primary web presence, omitting any "www." prefix from the domain and omitting any path component. For example, since the main web presence of Boston Children's Hospital is https: //www.childrenshospital.org/, a recommended identifier would be:

  { "system": "urn:ietf:rfc:3986", "value": "https://childrenshospital.org" }

• value @ $this

The primary brand name to display on a card.

Aliases (e.g., former names like "Partners Healthcare") for filtering/search

telecom with system of url and value conveying the primary public website for the Brand. Note this is distinct from the patient access portal website.

Locations (e.g., zip codes and/or street addresses) associated with the Brand. The following combinations are allowed:

• State
• City, state
• City, state, zip code
• Street address, city, state, zip code
• zip code alone

Affiliated "parent brand", if this Brand is part of a larger health system. "Patient access provided by", to convey that an affiliated Brand hosts this Brand's API technology and patient portal. The hierarchy of "access provided by" links SHALL NOT exceed a depth of two (i.e., a Brand either includes portal details or links directly to a Brand that provides them).

References one or more PatientAccessEndpoints. Endpoints here will also be listed within the organization-portal extension, to indicate the specific portal they're associated with.

Relative URL to an Endpoint within the Patient Access Brands Bundle

A brand of a healthcare provider, such as a hospital, clinic, or practice

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

An Extension

• value @ url

Organization-level Brand information.

Organization-level portal information.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The unique identifier for the brand that apps can use to link this Brand across publishers or with external data sets. EHRs SHALL support customer-supplied identifiers (system and value).

• It is RECOMMENDED that each Brand include an identifier where system is urn:ietf:rfc: 3986 (meaning the identifier is a URL) and value is the HTTPS URL for the Brand's primary web presence, omitting any "www." prefix from the domain and omitting any path component. For example, since the main web presence of Boston Children's Hospital is https: //www.childrenshospital.org/, a recommended identifier would be:

  { "system": "urn:ietf:rfc:3986", "value": "https://childrenshospital.org" }

Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.

Whether the organization's record is still in active use.

This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used.

This element is labeled as a modifier because it may be used to mark that the resource was created in error.

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

The kind(s) of organization that this is.

Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes

When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center.

We expect that some jurisdictions will profile this optionality to be a single cardinality.

Used to categorize the organization.

Need to be able to track the kind of organization that this is - different organization types have different uses.

• value @ $this

The kind(s) of organization that this is.

Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes

When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center.

We expect that some jurisdictions will profile this optionality to be a single cardinality.

Need to be able to track the kind of organization that this is - different organization types have different uses.

The primary brand name to display on a card.

If the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches.

Need to use the name as the label of the organization.

Aliases (e.g., former names like "Partners Healthcare") for filtering/search

There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization.

Over time locations and organizations go through many changes and can be known by different names.

For searching knowing previous names that the organization was known by can be very useful.

telecom with system of url and value conveying the primary public website for the Brand. Note this is distinct from the patient access portal website.

The use code 'home' is not to be used. Note that these contacts are not the contact details of people who are employed by or represent the organization, but official contacts for the organization itself.

Human contact for the organization.

Locations (e.g., zip codes and/or street addresses) associated with the Brand. The following combinations are allowed:

• State
• City, state
• City, state, zip code
• Street address, city, state, zip code
• zip code alone

Organization may have multiple addresses with different uses or applicable periods. The use code 'home' is not to be used.

May need to keep track of the organization's addresses for contacting, billing or reporting requirements.

Affiliated "parent brand", if this Brand is part of a larger health system. "Patient access provided by", to convey that an affiliated Brand hosts this Brand's API technology and patient portal. The hierarchy of "access provided by" links SHALL NOT exceed a depth of two (i.e., a Brand either includes portal details or links directly to a Brand that provides them).

Need to be able to track the hierarchy of organizations within an organization.

References one or more PatientAccessEndpoints. Endpoints here will also be listed within the organization-portal extension, to indicate the specific portal they're associated with.

Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.

Relative URL to an Endpoint within the Patient Access Brands Bundle

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

A brand of a healthcare provider, such as a hospital, clinic, or practice

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

• value @ url

Organization-level Brand information.

Organization-level portal information.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The unique identifier for the brand that apps can use to link this Brand across publishers or with external data sets. EHRs SHALL support customer-supplied identifiers (system and value).

• It is RECOMMENDED that each Brand include an identifier where system is urn:ietf:rfc: 3986 (meaning the identifier is a URL) and value is the HTTPS URL for the Brand's primary web presence, omitting any "www." prefix from the domain and omitting any path component. For example, since the main web presence of Boston Children's Hospital is https: //www.childrenshospital.org/, a recommended identifier would be:

  { "system": "urn:ietf:rfc:3986", "value": "https://childrenshospital.org" }

Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.

Whether the organization's record is still in active use.

This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used.

This element is labeled as a modifier because it may be used to mark that the resource was created in error.

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

The kind(s) of organization that this is.

Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes

When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center.

We expect that some jurisdictions will profile this optionality to be a single cardinality.

Used to categorize the organization.

Need to be able to track the kind of organization that this is - different organization types have different uses.

• value @ $this

The kind(s) of organization that this is.

Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes

When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center.

We expect that some jurisdictions will profile this optionality to be a single cardinality.

Need to be able to track the kind of organization that this is - different organization types have different uses.

The primary brand name to display on a card.

If the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches.

Need to use the name as the label of the organization.

Aliases (e.g., former names like "Partners Healthcare") for filtering/search

There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization.

Over time locations and organizations go through many changes and can be known by different names.

For searching knowing previous names that the organization was known by can be very useful.

telecom with system of url and value conveying the primary public website for the Brand. Note this is distinct from the patient access portal website.

The use code 'home' is not to be used. Note that these contacts are not the contact details of people who are employed by or represent the organization, but official contacts for the organization itself.

Human contact for the organization.

Locations (e.g., zip codes and/or street addresses) associated with the Brand. The following combinations are allowed:

• State
• City, state
• City, state, zip code
• Street address, city, state, zip code
• zip code alone

Organization may have multiple addresses with different uses or applicable periods. The use code 'home' is not to be used.

May need to keep track of the organization's addresses for contacting, billing or reporting requirements.

Affiliated "parent brand", if this Brand is part of a larger health system. "Patient access provided by", to convey that an affiliated Brand hosts this Brand's API technology and patient portal. The hierarchy of "access provided by" links SHALL NOT exceed a depth of two (i.e., a Brand either includes portal details or links directly to a Brand that provides them).

Need to be able to track the hierarchy of organizations within an organization.

Contact for the organization for a certain purpose.

Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

Need to keep track of assigned contact points within bigger organization.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Indicates a purpose for which the contact can be reached.

The purpose for which you would contact a contact party.

Need to distinguish between multiple contact persons.

A name associated with the contact.

Need to be able to track the person by name.

A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.

People have (primary) ways to contact them in some way such as phone, email.

Visiting or postal addresses for the contact.

May need to keep track of a contact party's address for contacting, billing or reporting requirements.

References one or more PatientAccessEndpoints. Endpoints here will also be listed within the organization-portal extension, to indicate the specific portal they're associated with.

Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

Relative URL to an Endpoint within the Patient Access Brands Bundle

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.