De-identified, Anonymized FHIR Profiles Library
1.0.0-ballot - STU 1 Ballot

De-identified, Anonymized FHIR Profiles Library - Downloaded Version 1.0.0-ballot See the Directory of published versions

## Resource Profile: DAPLDeIdentifiedPatient - Detailed Descriptions

Page standards status: Trial-use | Maturity Level: 2

Definitions for the dapl-deidentified-patient resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. Patient
Definition | The profile establishes the core elements, extensions, vocabularies and value sets for representing deidentified patients Demographics and other administrative information about an individual or animal receiving care or other health-related services.
Short | DAPL Deidentified PatientInformation about an individual or animal receiving health care services
Control | 0..*
Is Modifier | false
Summary | false
Alternate Names | SubjectOfCare Client Resident
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Patient.id
Definition | DAPL patient identifier. The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | The patient identifier generated by DARTS deidentification serviceLogical id of this artifact
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.
Control | 0..1
Type | id string
Is Modifier | false
Must Support | true
Summary | true
4. 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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
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. 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.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Patient.text
Definition | 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.
Short | Cannot include any text in the resource as part of the deidentified data.Text summary of the resource, for human interpretation
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 information is added later.
Control | 0..01
Type | Narrative
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. 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.
Short | Cannot include any contained resources in the resource as part of the deidentified data.Contained, inline 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Control | 0..0*
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
10. Patient.extension
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. 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.
Short | ExtensionAdditional content defined by implementations
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.
Control | 10..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `Patient.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
12. Patient.extension:us-core-race
Slice Name | us-core-race
Definition | Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the Race & Ethnicity - CDC (CDCREC) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White.
Short | US Core Race Extension
Control | 0..1 This element is affected by the following invariants: ele-1, us-core-23
Type | Extension(US Core Race Extension) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) us-core-23: If "ASKU" or "UNK" are present, then no other OMB race categories can be present. (`extension.where(url = 'ombCategory').value.where(code in 'ASKU'|'UNK').exists() implies extension.where(url = 'ombCategory').count() = 1`)
14. Patient.extension:dapl-ethnicty
Slice Name | dapl-ethnicty
Definition | Indicates the ethnicity of the Patient
Short | Indicates the ethnicity of the Patient.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(DAPL Ethnicity Extension) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
16. Patient.extension:dapl-sex
Slice Name | dapl-sex
Definition | Indicates the sex of the Patient
Short | Indicates the sex of the Patient.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(DAPL Sex Extension) (Extension Type: code)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
18. Patient.extension:dapl-age-extension
Slice Name | dapl-age-extension
Definition | Indicates the age of the Patient computed based on date of birth at a specific time
Short | Age of the Patient computed using birthDate and the reporting period reference
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Extension(DAPL Age Extension) (Extension Type: Choice of: Quantity, Range)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
20. 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 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).
Short | Extensions that cannot be ignored
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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | 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.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
22. Patient.identifier
Definition | An identifier for this patient.
Short | Cannot include any identifier in the resource as part of the deidentified data.An identifier for this patient
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..0*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | true
Requirements | Patients are almost always assigned specific numerical identifiers.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Patient.active
Definition | Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Short | Whether this patient's record is in active use
Comments | If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Control | 0..1
Type | boolean
Is Modifier | true because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to be able to mark a patient record as not to be used because it was created in error.
Meaning if Missing | This resource is generally assumed to be active if no value is provided for the active element
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Patient.name
Definition | A name associated with the individual.
Short | Cannot include any name in the resource as part of the deidentified data.A name associated with the patient
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.
Control | 0..0*
Type | HumanName
Is Modifier | false
Must Support | false
Summary | true
Requirements | Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Patient.telecom
Definition | A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Short | Cannot include any telecom information in the resource as part of the deidentified data.A contact detail for the individual
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 might 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).
Control | 0..0*
Type | ContactPoint
Is Modifier | false
Must Support | false
Summary | true
Requirements | People have (primary) ways to contact them in some way such as phone, email.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Patient.birthDate
Definition | The date of birth for the individual.
Short | Cannot include any date of birth information in the resource as part of the deidentified data.The date of birth for the individual
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 maternity/infant care systems).
Control | 0..01
Type | date
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Age of the individual drives many clinical processes.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
LOINC Code | 21112-8
32. Patient.deceased[x]
Definition | Indicates if the individual is deceased or not.
Short | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only.Indicates if the individual is deceased or not
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.
Control | 0..1
Type | Choice of: dateTime, boolean
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | true because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | Choice of: dateTime, boolean
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) dapl-date-1: All dateTime data elements should be truncated to a year only for de-identified resources. (`$this is dateTime implies $this.toString().length() = 4`) dapl-date-1a: All dateTime data elements should have valid year > 1900 (`$this is dateTime implies $this.toString() >= '1900'`)
34. Patient.address
Definition | An address for the individual.
Short | Included only to support zip codeAn address for the individual
Comments | Patient may have multiple addresses with different uses or applicable periods.
Control | 10..1*
Type | Address
Is Modifier | false
Must Support | true
Summary | true
Requirements | May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. Patient.address.use
Definition | The purpose of this address.
Short | home | work | temp | old | billing - purpose of this address
Comments | Applications can assume that an address is current unless it explicitly says that it is temporary or old.
Control | 0..1
Binding | The codes SHALL be taken from AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 (required to `http://hl7.org/fhir/ValueSet/address-use|4.0.1` ) The use of an address.
Type | code
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Allows an appropriate address to be chosen from a list of many.
Example | General: home
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. Patient.address.text
Definition | Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
Short | Text cannot be included in the profileText representation of the address
Comments | Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
Control | 0..01
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | A renderable, unencoded form.
Example | General: 137 Nowhere Street, Erewhon 9132
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. 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.
Short | Street names cannot be included in the profileStreet name, number, direction & P.O. Box etc.
Control | 0..0*
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Example | General: 137 Nowhere Street
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. Patient.address.postalCode
Definition | A postal code designating a region defined by the postal service.
Short | ZipCode must be included in the profilePostal code for area
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Zip
Example | General: 9132
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) dapl-potalCode-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. (`$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`)
44. Patient.address.postalCode.extension:dataAbsentReason
Slice Name | dataAbsentReason
Definition | Provides a reason why the expected value or elements in the element that is extended are missing.
Short | Reason why the data is not present
Control | 0..1
Type | Extension(Data Absent Reason) (Extension Type: code)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
46. Patient.address.postalCode.extension:dataAbsentReason.extension
Definition | An Extension 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.
Short | ExtensionAdditional content defined by implementations
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.
Control | 0..0*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `Patient.address.postalCode.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
48. Patient.address.postalCode.extension:dataAbsentReason.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies the meaning of the extension
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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://hl7.org/fhir/StructureDefinition/data-absent-reason`
50. Patient.address.postalCode.extension:dataAbsentReason.value[x]
Definition | Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Short | Value of extension
Control | 10..1 This element is affected by the following invariants: ext-1
Binding | The codes SHALL be taken from For codes, see DataAbsentReason (required to `http://hl7.org/fhir/ValueSet/data-absent-reason` )
Type | code, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. Patient.maritalStatus
Definition | This field contains a patient's most recent marital (civil) status.
Short | Cannot include information in deidentified resourcesMarital (civil) status of a patient
Control | 0..01
Binding | Unless not suitable, these codes SHALL be taken from Marital Status Codes http://hl7.org/fhir/ValueSet/marital-status|4.0.1 (extensible to `http://hl7.org/fhir/ValueSet/marital-status|4.0.1` ) The domestic partnership status of a person.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Requirements | Most, if not all systems capture it.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. Patient.multipleBirth[x]
Definition | Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Short | Cannot include information in deidentified resourcesWhether patient is part of a multiple birth
Comments | Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
Control | 0..01
Type | Choice of: boolean, integer
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. Patient.photo
Definition | Image of the patient.
Short | Cannot include information in deidentified resourcesImage of the patient
Comments | Guidelines: Use id photos, not clinical photos. Limit dimensions to thumbnail. Keep byte count low to ease resource updates.
Control | 0..0*
Type | Attachment
Is Modifier | false
Must Support | false
Summary | false
Requirements | Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. Patient.contact
Definition | A contact party (e.g. guardian, partner, friend) for the patient.
Short | Cannot include information in deidentified resourcesA contact party (e.g. guardian, partner, friend) for 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.
Control | 0..0*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Requirements | Need to track people you can contact about the patient.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) pat-1: SHALL at least contain a contact's details or a reference to an organization (`name.exists() or telecom.exists() or address.exists() or organization.exists()`) pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
61. Patient.communication
Definition | A language which may be used to communicate with the patient about his or her health.
Short | A language which may be used to communicate with the patient about his or her health
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.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | false
Requirements | If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
63. 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 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).
Short | Extensions that cannot be ignored even if unrecognized
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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
65. 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.
Short | Language must be included in the profileThe language which can be used to communicate with the patient about his or her health
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.
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from The codes SHOULD be taken from Languages http://hl7.org/fhir/ValueSet/languages|4.0.1 (extensible to `http://terminology.hl7.org/ValueSet/Languages` ) The set of languages that the patient uses A human language.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Requirements | Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
67. Patient.generalPractitioner
Definition | Patient's nominated care provider.
Short | Cannot include information in deidentified resourcesPatient's nominated primary care provider
Comments | This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability 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. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues. Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
Control | 0..0*
Type | Reference(Organization, Practitioner, PractitionerRole)
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | careProvider
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
69. Patient.managingOrganization
Definition | Organization that is the custodian of the patient record.
Short | Cannot include information in deidentified resourcesOrganization that is the custodian of the patient record
Comments | There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
Control | 0..01
Type | Reference(Organization)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Need to know who recognizes this patient record, manages and updates it.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
71. Patient.link
Definition | Link to another patient resource that concerns the same actual patient.
Short | Cannot include information in deidentified resourcesLink to another patient resource that concerns the same actual person
Comments | There is no assumption that linked patient records have mutual links.
Control | 0..0*
Type | BackboneElement
Is Modifier | true because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
Must Support | false
Summary | true
Requirements | There are multiple use cases: Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and Distribution of patient information across multiple servers.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be foundhere

0. Patient
Definition | The profile establishes the core elements, extensions, vocabularies and value sets for representing deidentified patients
Short | DAPL Deidentified Patient
2. Patient.id
Definition | DAPL patient identifier.
Short | The patient identifier generated by DARTS deidentification service
Must Support | true
4. Patient.text
Short | Cannot include any text in the resource as part of the deidentified data.
Control | 0..0
Must Support | false
6. Patient.contained
Short | Cannot include any contained resources in the resource as part of the deidentified data.
Control | 0..0
Must Support | false
8. Patient.extension:us-core-race
Slice Name | us-core-race
Control | 0..1
Type | Extension(US Core Race Extension) (Complex Extension)
Must Support | true
10. Patient.extension:dapl-ethnicty
Slice Name | dapl-ethnicty
Control | 0..1
Type | Extension(DAPL Ethnicity Extension) (Complex Extension)
Must Support | true
12. Patient.extension:dapl-sex
Slice Name | dapl-sex
Control | 0..1
Type | Extension(DAPL Sex Extension) (Extension Type: code)
Must Support | true
14. Patient.extension:dapl-age-extension
Slice Name | dapl-age-extension
Short | Age of the Patient computed using birthDate and the reporting period reference
Control | 1..1
Type | Extension(DAPL Age Extension) (Extension Type: Choice of: Quantity, Range)
Must Support | true
16. Patient.identifier
Short | Cannot include any identifier in the resource as part of the deidentified data.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..0
Must Support | false
18. Patient.name
Short | Cannot include any name in the resource as part of the deidentified data.
Control | 0..0
Must Support | false
20. Patient.telecom
Short | Cannot include any telecom information in the resource as part of the deidentified data.
Control | 0..0
Must Support | false
22. Patient.birthDate
Short | Cannot include any date of birth information in the resource as part of the deidentified data.
Control | 0..0
Must Support | false
LOINC Code |
24. Patient.deceased[x]
Short | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only.
Control | 0..1
Type | Choice of: dateTime, boolean
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | Choice of: dateTime, boolean
Invariants | dapl-date-1: All dateTime data elements should be truncated to a year only for de-identified resources. (`$this is dateTime implies $this.toString().length() = 4`) dapl-date-1a: All dateTime data elements should have valid year > 1900 (`$this is dateTime implies $this.toString() >= '1900'`)
26. Patient.address
Short | Included only to support zip code
Control | 1..1
Must Support | true
28. Patient.address.text
Short | Text cannot be included in the profile
Control | 0..0
Must Support | false
30. Patient.address.line
Short | Street names cannot be included in the profile
Control | 0..0
Must Support | false
32. Patient.address.postalCode
Short | ZipCode must be included in the profile
Control | 1..1
Must Support | true
Invariants | dapl-potalCode-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. (`$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`)
34. Patient.address.postalCode.extension:dataAbsentReason
Slice Name | dataAbsentReason
Short | Reason why the data is not present
Control | 0..1
Type | Extension(Data Absent Reason) (Extension Type: code)
Must Support | true
36. Patient.address.postalCode.extension:dataAbsentReason.value[x]
Control | 1..?
Type | code
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
38. Patient.maritalStatus
Short | Cannot include information in deidentified resources
Control | 0..0
Must Support | false
40. Patient.multipleBirth[x]
Short | Cannot include information in deidentified resources
Control | 0..0
Must Support | false
42. Patient.photo
Short | Cannot include information in deidentified resources
Control | 0..0
Must Support | false
44. Patient.contact
Short | Cannot include information in deidentified resources
Control | 0..0
Must Support | false
46. Patient.communication
48. Patient.communication.language
Short | Language must be included in the profile
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from Languages (extensible to `http://terminology.hl7.org/ValueSet/Languages` ) The set of languages that the patient uses
Must Support | true
50. Patient.generalPractitioner
Short | Cannot include information in deidentified resources
Control | 0..0
Must Support | false
52. Patient.managingOrganization
Short | Cannot include information in deidentified resources
Control | 0..0
Must Support | false
54. Patient.link
Short | Cannot include information in deidentified resources
Control | 0..0
Must Support | false

Guidance on how to interpret the contents of this table can be foundhere

0. Patient
Definition | The profile establishes the core elements, extensions, vocabularies and value sets for representing deidentified patients
Short | DAPL Deidentified Patient
Control | 0..*
Is Modifier | false
Summary | false
Alternate Names | SubjectOfCare Client Resident
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. Patient.id
Definition | DAPL patient identifier.
Short | The patient identifier generated by DARTS deidentification service
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.
Control | 0..1
Type | id
Is Modifier | false
Must Support | true
Summary | true
4. Patient.meta
Definition | 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.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. 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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
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. 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.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. Patient.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
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).
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages|4.0.1` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. Patient.text
Definition | 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.
Short | Cannot include any text in the resource as part of the deidentified data.
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 information is added later.
Control | 0..0
Type | Narrative
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. 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.
Short | Cannot include any contained resources in the resource as part of the deidentified data.
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Control | 0..0
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. Patient.extension
Definition | An Extension
Short | Extension
Control | 1..*
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `Patient.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. Patient.extension:us-core-race
Slice Name | us-core-race
Definition | Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the Race & Ethnicity - CDC (CDCREC) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White.
Short | US Core Race Extension
Control | 0..1 This element is affected by the following invariants: ele-1, us-core-23
Type | Extension(US Core Race Extension) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) us-core-23: If "ASKU" or "UNK" are present, then no other OMB race categories can be present. (`extension.where(url = 'ombCategory').value.where(code in 'ASKU'|'UNK').exists() implies extension.where(url = 'ombCategory').count() = 1`)
18. Patient.extension:dapl-ethnicty
Slice Name | dapl-ethnicty
Definition | Indicates the ethnicity of the Patient
Short | Indicates the ethnicity of the Patient.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(DAPL Ethnicity Extension) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
20. Patient.extension:dapl-sex
Slice Name | dapl-sex
Definition | Indicates the sex of the Patient
Short | Indicates the sex of the Patient.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(DAPL Sex Extension) (Extension Type: code)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
22. Patient.extension:dapl-age-extension
Slice Name | dapl-age-extension
Definition | Indicates the age of the Patient computed based on date of birth at a specific time
Short | Age of the Patient computed using birthDate and the reporting period reference
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Extension(DAPL Age Extension) (Extension Type: Choice of: Quantity, Range)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
24. 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 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).
Short | Extensions that cannot be ignored
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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | 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.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
26. Patient.identifier
Definition | An identifier for this patient.
Short | Cannot include any identifier in the resource as part of the deidentified data.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..0
Type | Identifier
Is Modifier | false
Must Support | false
Summary | true
Requirements | Patients are almost always assigned specific numerical identifiers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
28. Patient.active
Definition | Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Short | Whether this patient's record is in active use
Comments | If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Control | 0..1
Type | boolean
Is Modifier | true because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to be able to mark a patient record as not to be used because it was created in error.
Meaning if Missing | This resource is generally assumed to be active if no value is provided for the active element
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
30. Patient.name
Definition | A name associated with the individual.
Short | Cannot include any name in the resource as part of the deidentified data.
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.
Control | 0..0
Type | HumanName
Is Modifier | false
Must Support | false
Summary | true
Requirements | Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
32. Patient.telecom
Definition | A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Short | Cannot include any telecom information in the resource as part of the deidentified data.
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 might 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).
Control | 0..0
Type | ContactPoint
Is Modifier | false
Must Support | false
Summary | true
Requirements | People have (primary) ways to contact them in some way such as phone, email.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. Patient.gender
Definition | Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Short | male | female | other | unknown
Comments | The gender might 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 male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, 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, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
Control | 0..1
Binding | The codes SHALL be taken from AdministrativeGender (required to `http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1` ) The gender of a person used for administrative purposes.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Needed for identification of the individual, in combination with (at least) name and birth date.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. Patient.birthDate
Definition | The date of birth for the individual.
Short | Cannot include any date of birth information in the resource as part of the deidentified data.
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 maternity/infant care systems).
Control | 0..0
Type | date
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Age of the individual drives many clinical processes.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
LOINC Code | 21112-8
38. Patient.deceased[x]
Definition | Indicates if the individual is deceased or not.
Short | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only.
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.
Control | 0..1
Type | Choice of: dateTime, boolean
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | true because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | Choice of: dateTime, boolean
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) dapl-date-1: All dateTime data elements should be truncated to a year only for de-identified resources. (`$this is dateTime implies $this.toString().length() = 4`) dapl-date-1a: All dateTime data elements should have valid year > 1900 (`$this is dateTime implies $this.toString() >= '1900'`)
40. Patient.address
Definition | An address for the individual.
Short | Included only to support zip code
Comments | Patient may have multiple addresses with different uses or applicable periods.
Control | 1..1
Type | Address
Is Modifier | false
Must Support | true
Summary | true
Requirements | May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. 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.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
44. Patient.address.extension
Definition | 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.
Short | Additional content defined by implementations
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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `Patient.address.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
46. Patient.address.use
Definition | The purpose of this address.
Short | home | work | temp | old | billing - purpose of this address
Comments | Applications can assume that an address is current unless it explicitly says that it is temporary or old.
Control | 0..1
Binding | The codes SHALL be taken from AddressUse (required to `http://hl7.org/fhir/ValueSet/address-use|4.0.1` ) The use of an address.
Type | code
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Allows an appropriate address to be chosen from a list of many.
Example | General: home
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
48. 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.
Short | postal | physical | both
Comments | The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
Control | 0..1
Binding | The codes SHALL be taken from AddressType (required to `http://hl7.org/fhir/ValueSet/address-type|4.0.1` ) The type of an address (physical / postal).
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Example | General: both
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
50. Patient.address.text
Definition | Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
Short | Text cannot be included in the profile
Comments | Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
Control | 0..0
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | A renderable, unencoded form.
Example | General: 137 Nowhere Street, Erewhon 9132
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. 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.
Short | Street names cannot be included in the profile
Control | 0..0
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Example | General: 137 Nowhere Street
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. Patient.address.city
Definition | The name of the city, town, suburb, village or other community or delivery center.
Short | Name of city, town etc.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Alternate Names | Municpality
Example | General: Erewhon
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
56. Patient.address.district
Definition | The name of the administrative area (county).
Short | District name (aka county)
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.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Alternate Names | County
Example | General: Madison
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. 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 (e.g. US 2 letter state codes).
Short | Sub-unit of country (abbreviations ok)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Alternate Names | Province, Territory
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. Patient.address.postalCode
Definition | A postal code designating a region defined by the postal service.
Short | ZipCode must be included in the profile
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Zip
Example | General: 9132
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) dapl-potalCode-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. (`$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`)
62. Patient.address.postalCode.id
Definition | unique id for the element within a resource (for internal references)
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
64. Patient.address.postalCode.extension
Definition | An Extension
Short | Extension
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `Patient.address.postalCode.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
66. Patient.address.postalCode.extension:dataAbsentReason
Slice Name | dataAbsentReason
Definition | Provides a reason why the expected value or elements in the element that is extended are missing.
Short | Reason why the data is not present
Control | 0..1
Type | Extension(Data Absent Reason) (Extension Type: code)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
68. Patient.address.postalCode.extension:dataAbsentReason.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | id
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
70. Patient.address.postalCode.extension:dataAbsentReason.extension
Definition | An Extension
Short | Extension
Control | 0..0
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `Patient.address.postalCode.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
72. Patient.address.postalCode.extension:dataAbsentReason.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies the meaning of the extension
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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://hl7.org/fhir/StructureDefinition/data-absent-reason`
74. Patient.address.postalCode.extension:dataAbsentReason.value[x]
Definition | Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Short | Value of extension
Control | 1..1 This element is affected by the following invariants: ext-1
Binding | The codes SHALL be taken from DataAbsentReason (required to `http://hl7.org/fhir/ValueSet/data-absent-reason` )
Type | code
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. Patient.address.postalCode.value
Definition | The actual value
Short | Primitive value for string
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Max Length: | 1048576
78. Patient.address.country
Definition | Country - a nation as commonly understood or generally accepted.
Short | Country (e.g. can be ISO 3166 2 or 3 letter code)
Comments | ISO 3166 3 letter codes can be used in place of a human readable country name.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
80. Patient.address.period
Definition | Time period when address was/is in use.
Short | Time period when address was/is in use
Control | 0..1
Type | Period
Is Modifier | false
Summary | true
Requirements | Allows addresses to be placed in historical context.
Example | General: { "start" : "2010-03-23", "end" : "2010-07-01" }
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
82. Patient.maritalStatus
Definition | This field contains a patient's most recent marital (civil) status.
Short | Cannot include information in deidentified resources
Control | 0..0
Binding | Unless not suitable, these codes SHALL be taken from Marital Status Codes (extensible to `http://hl7.org/fhir/ValueSet/marital-status|4.0.1` ) The domestic partnership status of a person.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Requirements | Most, if not all systems capture it.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
84. Patient.multipleBirth[x]
Definition | Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Short | Cannot include information in deidentified resources
Comments | Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
Control | 0..0
Type | Choice of: boolean, integer
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
86. Patient.photo
Definition | Image of the patient.
Short | Cannot include information in deidentified resources
Comments | Guidelines: Use id photos, not clinical photos. Limit dimensions to thumbnail. Keep byte count low to ease resource updates.
Control | 0..0
Type | Attachment
Is Modifier | false
Must Support | false
Summary | false
Requirements | Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
88. Patient.contact
Definition | A contact party (e.g. guardian, partner, friend) for the patient.
Short | Cannot include information in deidentified resources
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.
Control | 0..0
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Requirements | Need to track people you can contact about the patient.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) pat-1: SHALL at least contain a contact's details or a reference to an organization (`name.exists() or telecom.exists() or address.exists() or organization.exists()`)
100. Patient.communication
Definition | A language which may be used to communicate with the patient about his or her health.
Short | A language which may be used to communicate with the patient about his or her health
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.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | false
Requirements | If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
102. 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.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
104. Patient.communication.extension
Definition | 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.
Short | Additional content defined by implementations
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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
106. 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 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).
Short | Extensions that cannot be ignored even if unrecognized
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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
108. 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.
Short | Language must be included in the profile
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.
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from Languages (extensible to `http://terminology.hl7.org/ValueSet/Languages` ) The set of languages that the patient uses
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Requirements | Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
110. Patient.communication.preferred
Definition | Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Short | Language preference indicator
Comments | This language is specifically identified for communicating healthcare information.
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. Patient.generalPractitioner
Definition | Patient's nominated care provider.
Short | Cannot include information in deidentified resources
Comments | This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability 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. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues. Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
Control | 0..0
Type | Reference(Organization, Practitioner, PractitionerRole)
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | careProvider
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
114. Patient.managingOrganization
Definition | Organization that is the custodian of the patient record.
Short | Cannot include information in deidentified resources
Comments | There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
Control | 0..0
Type | Reference(Organization)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Need to know who recognizes this patient record, manages and updates it.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
116. Patient.link
Definition | Link to another patient resource that concerns the same actual patient.
Short | Cannot include information in deidentified resources
Comments | There is no assumption that linked patient records have mutual links.
Control | 0..0
Type | BackboneElement
Is Modifier | true because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
Must Support | false
Summary | true
Requirements | There are multiple use cases: Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and Distribution of patient information across multiple servers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)