STU 2 Ballot

This page is part of the Data Access Framework (v1.6.0: STU 2 Ballot 1) based on FHIR v1.6.0. . For a full list of available versions, see the Directory of published versions

D.4.1.4 StructureDefinition: DAF-Patient - Detailed Descriptions

Definitions for the daf-patient Profile.

Patient(DAFPatient)
Definition

Demographics and other administrative information about an individual or animal receiving care or other health-related services.

Control0..*
Alternate NamesSubjectOfCare Client Resident
InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (xpath: not(parent::f:contained and f:text))
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (xpath: not(parent::f:contained and f:contained))
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (xpath: not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))])))
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (xpath: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated)))
Patient.id
Definition

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

Control0..1
Typeid
Comments

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

Patient.meta
Definition

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

Control0..1
TypeMeta
Patient.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Comments

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 as much as possible.

Patient.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Typecode
Comments

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).

Patient.text
Definition

A human-readable narrative that contains a summary of the resource, and may 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.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

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 in formation is added later.

Patient.contained
Definition

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.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

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.

Patient.extension
Definition

An Extension

Control0..*
TypeExtension
Patient.extension (http://hl7.org/fhir/StructureDefinition/us-core-race)
Definition

A code classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality.

Control0..* This element is affected by the following invariants: ele-1
Type (Extension Type: CodeableConcept)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
ext-1: Must have either extensions or value[x], not both (xpath: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')]))
Patient.extension.id
Definition

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

Control0..1
Typestring
Patient.extension.extension(extension)
Definition

An Extension

Control0..0
TypeExtension
Patient.extension.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Valuehttp://hl7.org/fhir/StructureDefinition/us-core-race
Patient.extension.valueCodeableConcept
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control1..1
BindingA code classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality.
The codes SHALL be taken from v3 Code System Race
TypeCodeableConcept
Must Supporttrue
Patient.extension.valueCodeableConcept.id
Definition

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

Control0..1
Typestring
Patient.extension.valueCodeableConcept.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.extension.valueCodeableConcept.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Patient.extension.valueCodeableConcept.coding(race-code)
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Patient.extension.valueCodeableConcept.coding
Definition

A reference to a code defined by a terminology system.

Control1..1
BindingRace of the patient
The codes SHALL be taken from OMB Race Categories
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Patient.extension.valueCodeableConcept.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
BindingGranular race of the patient, which can be rolled up to the higher level OMB categories, specified in the race element.
The codes SHALL be taken from v3 Code System Race; other codes may be used where these codes are not suitable
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Patient.extension.valueCodeableConcept.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Patient.extension (http://hl7.org/fhir/StructureDefinition/us-core-ethnicity)
Definition

A code classifying the person into a named category of humans sharing a common real or presumed heritage.

Control0..1 This element is affected by the following invariants: ele-1
Type (Extension Type: CodeableConcept)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
ext-1: Must have either extensions or value[x], not both (xpath: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')]))
Patient.extension (http://hl7.org/fhir/StructureDefinition/us-core-birthsex)
Definition

A code classifying the person's sex assigned at birth as specified by the Office of the National Coordinator for Health IT (ONC).

Control0..1 This element is affected by the following invariants: ele-1
Type (Extension Type: code)
Comments

The codes required are intended to present birth sex (i.e., the sex recorded on the patient’s birth certificate) and not gender identity or reassigned sex.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
ext-1: Must have either extensions or value[x], not both (xpath: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')]))
Patient.extension (http://hl7.org/fhir/StructureDefinition/us-core-religion)
Definition

A code classifying a person's professed religion.

Control0..1 This element is affected by the following invariants: ele-1
Type (Extension Type: CodeableConcept)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
ext-1: Must have either extensions or value[x], not both (xpath: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')]))
Patient.extension (http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName)
Definition

Mother's maiden (unmarried) name, commonly collected to help verify patient identity.

Control0..1 This element is affected by the following invariants: ele-1
Type (Extension Type: string)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
ext-1: Must have either extensions or value[x], not both (xpath: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')]))
Patient.extension (http://hl7.org/fhir/StructureDefinition/birthPlace)
Definition

The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements.

Control0..1 This element is affected by the following invariants: ele-1
Type (Extension Type: Address)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
ext-1: Must have either extensions or value[x], not both (xpath: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')]))
Patient.modifierExtension
Definition

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. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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.

Patient.identifier
Definition

An identifier for this patient.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control1..*
TypeIdentifier
Must Supporttrue
Requirements

Patients are almost always assigned specific numerical identifiers.

Patient.identifier.id
Definition

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

Control0..1
Typestring
Patient.identifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.identifier.use
Definition

The purpose of this identifier.

Control0..1
BindingIdentifies the purpose for this identifier, if known .
The codes SHALL be taken from IdentifierUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Patient.identifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingA coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Patient.identifier.system
Definition

Establishes the namespace in which set of possible id values is unique.

Control1..1
Typeuri
Must Supporttrue
Requirements

There are many sequences of identifiers. To perform matching, we need to know what sequence we're dealing with. The system identifies a particular sequence or set of unique identifiers.

Examplehttp://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Patient.identifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Must Supporttrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Example123456
Patient.identifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
Patient.identifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Patient.active
Definition

Whether this patient record is in active use.

Control0..1
Typeboolean
Is Modifiertrue
Must Supporttrue
Requirements

Need to be able to mark a patient record as not to be used because it was created in error.

Comments

Default is true. If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

Default Valuetrue
Patient.name
Definition

A name associated with the individual.

Control1..*
TypeHumanName
Must Supporttrue
Requirements

Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

Comments

A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

Patient.name.id
Definition

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

Control0..1
Typestring
Patient.name.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.name.use
Definition

Identifies the purpose for this name.

Control0..1
BindingThe use of a human name
The codes SHALL be taken from NameUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate name for a particular context of use to be selected from among a set of names.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

Patient.name.text
Definition

A full text representation of the name.

Control0..1
Typestring
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and structured parts.

Patient.name.family
Definition

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

Control1..*
Typestring
Must Supporttrue
Alternate Namessurname
Comments

For family name, hyphenated names such as "Smith-Jones" are a single name, but names with spaces such as "Smith Jones" are broken into multiple parts.

Patient.name.given
Definition

Given name.

Control1..*
Typestring
Must Supporttrue
Alternate Namesfirst name, middle name
Comments

If only initials are recorded, they may be used in place of the full name. Not called "first name" since given names do not always come first.

Patient.name.prefix
Definition

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

Control0..*
Typestring
Patient.name.suffix
Definition

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

Control0..*
Typestring
Patient.name.period
Definition

Indicates the period of time when this name was valid for the named person.

Control0..1
TypePeriod
Requirements

Allows names to be placed in historical context.

Patient.telecom
Definition

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

Control0..*
TypeContactPoint
Must Supporttrue
Requirements

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

Comments

A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address may not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

Patient.telecom.id
Definition

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

Control0..1
Typestring
Patient.telecom.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.telecom.system
Definition

Telecommunications form for contact point - what communications system is required to make use of the contact.

Control1..1 This element is affected by the following invariants: cpt-2
BindingTelecommunications form for contact point
The codes SHALL be taken from ContactPointSystem
Typecode
Must Supporttrue
Patient.telecom.value
Definition

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

Control1..1
Typestring
Must Supporttrue
Requirements

Need to support legacy numbers that are not in a tightly controlled format.

Comments

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

Patient.telecom.use
Definition

Identifies the purpose for the contact point.

Control0..1
BindingUse of contact point
The codes SHALL be taken from ContactPointUse
Typecode
Is Modifiertrue
Must Supporttrue
Requirements

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one. Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Patient.telecom.rank
Definition

Specifies a preferred order in which to use a set of contacts. Contacts are ranked with lower values coming before higher values.

Control0..1
TypepositiveInt
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

Patient.telecom.period
Definition

Time period when the contact point was/is in use.

Control0..1
TypePeriod
Patient.gender
Definition

Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

Control1..1
Bindingnull
The codes SHALL be taken from AdministrativeGender
Typecode
Must Supporttrue
Requirements

Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.

Comments

The gender may not match the biological sex as determined by genetics, or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error.

Patient.birthDate
Definition

The date of birth for the individual.

Control0..1
Typedate
Must Supporttrue
Requirements

Age of the individual drives many clinical processes.

Comments

At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternaty/infant care systems).

LOINC Code21112-8
Patient.deceased[x]
Definition

Indicates if the individual is deceased or not.

Control0..1
TypeChoice of: boolean, dateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifiertrue
Must Supporttrue
Requirements

The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

Comments

If there's no value in the instance it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

Patient.address
Definition

Addresses for the individual.

Control0..*
TypeAddress
Must Supporttrue
Requirements

May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

Comments

Patient may have multiple addresses with different uses or applicable periods.

Patient.address.id
Definition

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

Control0..1
Typestring
Patient.address.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.address.use
Definition

The purpose of this address.

Control0..1
BindingThe use of an address
The codes SHALL be taken from AddressUse
Typecode
Is Modifiertrue
Requirements

Allows an appropriate address to be chosen from a list of many.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one. Applications can assume that an address is current unless it explicitly says that it is temporary or old.

Examplehome
Patient.address.type
Definition

Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

Control0..1
BindingThe type of an address (physical / postal)
The codes SHALL be taken from AddressType
Typecode
Exampleboth
Patient.address.text
Definition

A full text representation of the address.

Control0..1
Typestring
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and parts.

Example137 Nowhere Street, Erewhon 9132
Patient.address.line
Definition

This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

Control1..*
Typestring
Must Supporttrue
Requirements

home | work | temp | old - purpose of this address.

Example137 Nowhere Street
Patient.address.city
Definition

The name of the city, town, village or other community or delivery center.

Control1..1
Typestring
Must Supporttrue
Alternate NamesMunicpality
ExampleErewhon
Patient.address.district
Definition

The name of the administrative area (county).

Control0..1
Typestring
Alternate NamesCounty
Comments

District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

ExampleMadison
Patient.address.state
Definition

Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (i.e. US 2 letter state codes).

Control1..1
Binding2 letter state list
The codes SHALL be taken from USPS Two Letter Alphabetic Codes
Typestring
Must Supporttrue
Alternate NamesProvince, Territory
Patient.address.postalCode
Definition

A postal code designating a region defined by the postal service.

Control1..1
Typestring
Must Supporttrue
Alternate NamesZip
Example9132
InvariantsDefined on this element
1: (Zip or Postal Code) SHALL be formatted as 99999[-9999] for US Zip or ZIP +4 codes or as A9A9A9 for Canadian postal codes. (xpath: f:matches(issued,[0-9]{5}(-[0-9]{4}){0,1} ))
Patient.address.country
Definition

Country - a nation as commonly understood or generally accepted.

Control1..1
Typestring
Must Supporttrue
Comments

ISO 3166 3 letter codes can be used in place of a full country name.

Patient.address.period
Definition

Time period when address was/is in use.

Control0..1
TypePeriod
Requirements

Allows addresses to be placed in historical context.

Example&lt;valuePeriod&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;start&nbsp;value=&quot;2010-03-23&quot;/&gt;<br/>&nbsp;&nbsp;&lt;end&nbsp;value=&quot;2010-07-01&quot;/&gt;<br/>&lt;/valuePeriod&gt;<br/>
Patient.maritalStatus
Definition

This field contains a patient's most recent marital (civil) status.

Control0..1
BindingThe domestic partnership status of a person.
The codes SHALL be taken from Marital Status Codes
TypeCodeableConcept
Must Supporttrue
Requirements

Most, if not all systems capture it.

Patient.multipleBirth[x]
Definition

Indicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer).

Control0..1
TypeChoice of: boolean, integer
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Requirements

For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

Comments

Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in tripplets would be valueInteger=2 and the third born would have valueInteger=3 If a bool value was provided for this tripplets examle, then all 3 patient records would have valueBool=true (the ordering is not indicated).

Patient.photo
Definition

Image of the patient.

Control0..*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

Patient.contact
Definition

A contact party (e.g. guardian, partner, friend) for the patient.

Control0..*
TypeBackboneElement
Must Supporttrue
Requirements

Need to track people you can contact about the patient.

Comments

Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

InvariantsDefined on this element
pat-1: SHALL at least contain a contact's details or a reference to an organization (xpath: exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization))
Patient.contact.id
Definition

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

Control0..1
Typestring
Patient.contact.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.contact.modifierExtension
Definition

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Patient.contact.relationship
Definition

The nature of the relationship between the patient and the contact person.

Control0..*
BindingType of relationship
The codes SHALL be taken from http://hl7.org/fhir/ValueSet/patient-contact-relationship
TypeCodeableConcept
Must Supporttrue
Requirements

Used to determine which contact person is the most relevant to approach, depending on circumstances.

Patient.contact.name
Definition

A name associated with the contact person.

Control0..1
TypeHumanName
Must Supporttrue
Requirements

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

Patient.contact.telecom
Definition

A contact detail for the person, e.g. a telephone number or an email address.

Control0..*
TypeContactPoint
Must Supporttrue
Requirements

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

Comments

Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

Patient.contact.address
Definition

Address for the contact person.

Control0..1
TypeAddress
Must Supporttrue
Requirements

Need to keep track where the contact person can be contacted per postal mail or visited.

Patient.contact.address.id
Definition

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

Control0..1
Typestring
Patient.contact.address.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.contact.address.use
Definition

The purpose of this address.

Control0..1
BindingThe use of an address
The codes SHALL be taken from AddressUse
Typecode
Is Modifiertrue
Must Supporttrue
Requirements

Allows an appropriate address to be chosen from a list of many.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one. Applications can assume that an address is current unless it explicitly says that it is temporary or old.

Examplehome
Patient.contact.address.type
Definition

Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

Control0..1
BindingThe type of an address (physical / postal)
The codes SHALL be taken from AddressType
Typecode
Exampleboth
Patient.contact.address.text
Definition

A full text representation of the address.

Control0..1
Typestring
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and parts.

Example137 Nowhere Street, Erewhon 9132
Patient.contact.address.line
Definition

This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

Control0..*
Typestring
Must Supporttrue
Requirements

home | work | temp | old - purpose of this address.

Example137 Nowhere Street
Patient.contact.address.city
Definition

The name of the city, town, village or other community or delivery center.

Control0..1
Typestring
Must Supporttrue
Alternate NamesMunicpality
ExampleErewhon
Patient.contact.address.district
Definition

The name of the administrative area (county).

Control0..1
Typestring
Alternate NamesCounty
Comments

District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

ExampleMadison
Patient.contact.address.state
Definition

Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (i.e. US 2 letter state codes).

Control0..1
Binding2 letter state list
The codes SHALL be taken from USPS Two Letter Alphabetic Codes
Typestring
Must Supporttrue
Alternate NamesProvince, Territory
Patient.contact.address.postalCode
Definition

A postal code designating a region defined by the postal service.

Control0..1
Typestring
Must Supporttrue
Alternate NamesZip
Example9132
InvariantsDefined on this element
2: (Zip or Postal Code) SHALL be formatted as 99999[-9999] for US Zip or ZIP +4 codes or as A9A9A9 for Canadian postal codes. (xpath: f:matches(issued,[0-9]{5}(-[0-9]{4}){0,1} ))
Patient.contact.address.country
Definition

Country - a nation as commonly understood or generally accepted.

Control0..1
BindingISO 2 letter country codes.
The codes SHALL be taken from http://www.iso.org/iso/country_codes.htm
Typestring
Must Supporttrue
Comments

ISO 3166 3 letter codes can be used in place of a full country name.

Patient.contact.address.period
Definition

Time period when address was/is in use.

Control0..1
TypePeriod
Requirements

Allows addresses to be placed in historical context.

Example&lt;valuePeriod&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;start&nbsp;value=&quot;2010-03-23&quot;/&gt;<br/>&nbsp;&nbsp;&lt;end&nbsp;value=&quot;2010-07-01&quot;/&gt;<br/>&lt;/valuePeriod&gt;<br/>
Patient.contact.gender
Definition

Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.

Control0..1
BindingThe gender of a person used for administrative purposes.
The codes SHALL be taken from AdministrativeGender
Typecode
Requirements

Needed to address the person correctly.

Patient.contact.organization
Definition

Organization on behalf of which the contact is acting or for which the contact is working.

Control0..1 This element is affected by the following invariants: pat-1
TypeReference(Organization)
Requirements

For guardians or business related contacts, the organization is relevant.

Patient.contact.period
Definition

The period during which this contact person or organization is valid to be contacted relating to this patient.

Control0..1
TypePeriod
Patient.animal
Definition

This patient is known to be an animal.

Control0..0
TypeBackboneElement
Is Modifiertrue
Requirements

Many clinical systems are extended to care for animal patients as well as human.

Comments

The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

Patient.animal.id
Definition

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

Control0..1
Typestring
Patient.animal.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.animal.modifierExtension
Definition

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Patient.animal.species
Definition

Identifies the high level taxonomic categorization of the kind of animal.

Control1..1
BindingThe species of an animal.
For example codes, see AnimalSpecies
TypeCodeableConcept
Requirements

Need to know what kind of animal.

Comments

If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).

Patient.animal.breed
Definition

Identifies the detailed categorization of the kind of animal.

Control0..1
BindingThe breed of an animal.
For example codes, see AnimalBreeds
TypeCodeableConcept
Requirements

May need to know the specific kind within the species.

Comments

Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.

Patient.animal.genderStatus
Definition

Indicates the current state of the animal's reproductive organs.

Control0..1
BindingThe state of the animal's reproductive organs.
For example codes, see GenderStatus
TypeCodeableConcept
Requirements

Gender status can affect housing and animal behavior.

Patient.communication
Definition

Languages which may be used to communicate with the patient about his or her health.

Control0..*
TypeBackboneElement
Must Supporttrue
Requirements

If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.

Comments

If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

Patient.communication.id
Definition

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

Control0..1
Typestring
Patient.communication.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.communication.modifierExtension
Definition

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Patient.communication.language
Definition

The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.

Control1..1
Bindingnull
The codes SHALL be taken from Common Languages
TypeCodeableConcept
Must Supporttrue
Requirements

Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

Patient.communication.preferred
Definition

Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

Control0..1
Typeboolean
Requirements

People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

Comments

This language is specifically identified for communicating healthcare information.

Patient.generalPractitioner
Definition

Patient's nominated care provider.

Control0..*
TypeChoice of: Reference(Profile daf-organization), Reference(Profile daf-pract)
Must Supporttrue
Alternate NamescareProvider
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.

Patient.managingOrganization
Definition

A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, etc.

Control0..1
TypeReference(Profile daf-organization)
Must Supporttrue
Patient.link
Definition

Link to another patient resource that concerns the same actual patient.

Control0..*
TypeBackboneElement
Is Modifiertrue
Requirements

There are multiple usecases: * Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers.

Comments

There is no assumption that linked patient records have mutual links.

Patient.link.id
Definition

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

Control0..1
Typestring
Patient.link.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Patient.link.modifierExtension
Definition

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Patient.link.other
Definition

The other patient resource that the link refers to.

Control1..1
TypeChoice of: Reference(Patient), Reference(RelatedPerson)
Is Modifiertrue
Comments

Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

Patient.link.type
Definition

The type of link between this patient resource and another patient resource.

Control1..1
BindingThe type of link between this patient resource and another patient resource.
The codes SHALL be taken from LinkType
Typecode
Is Modifiertrue