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: DAPL De-identified Patient

Official URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-deidentified-patient | Version: 1.0.0-ballot
Standards status: Trial-use | Maturity Level: 2 | Computable Name: DAPLDeIdentifiedPatient

This Patient profile represents a deidentified Patient

### Introduction

This profile is used to represent de-identified patient information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance the following data elements have to be removed or de-identified

- Patient Name

- Address that is more specific than a state

  - First 3 digits of Zipcodes can be included if the population of all zipcodes starting with the same 3 digits are > 20000 people, in all other cases, the zipcodes have to be masked to 00000.
- All dates should not have a precision of more than the year. This means month and day cannot be included.
- Demographics including birthdate, deceased indicator
- Patient contact details such as telephone numbers, fax, email, URLs,
- Patient personal identifiers such as SSN, Drivers License,
- Business identifiers such as MRNs, certificate numbers, Account numbers
- Biometrics such as fingerprints, photos

In FHIR Resources, text elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Patient resource text element may contain information such as the full name, Gender and Date of Birth. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Age Computation

The Data Submitter has to compute the age based as of December 31st of the previous year for most use cases related to federal reporting such as UDS+.

Id Generation

The original patient resource id should not be included in the De-identified patient instance. Instead a new id should be created and provided as part of the FHIR resource. This Data Submitter should be capable of using the generated id to relink the data to the original patient. All resource references to the Patient submitted as part of the data exchange should refer to newly generated de-identified id.

Usage of Data Absent Reason Extension

For federal reporting, the patient data is de-identified and in the process zip codes may be masked to a value of "00000". In these cases the dataAbsentReason extension must be added to identify that the data is "masked". If the zip code is not known, a value of "00000" must be sent with a dataAbsentReason of "unknown". If the zip code is outside the country, a value of "00000" must be sent with a dataAbsentReason of "unsupported".

Sex Additional Constraints

NullFlavors may not allowed for sex reporting in some use cases such as UDS+ even though they are allowed in US Core.

Race and Ethnicity Additional Constraints

US Core allows Race and Ethnicity to be described as only text or rolled up to the OMB categories, however federal agencies may mandate reporting detailed race and ethnicity.

Sexual Orientation Additional Constraints

Health Centers which have not implemented the methods to capture Sexual Orientation, should use the null flavor coded value of "NASK" specifically.

Gender Identity Additional Constraints

Health Centers which have not implemented the methods to capture Gender Identity, should use the null flavor coded value of "NASK" specifically.

Examples

Examples of identifiable data and its corresponding de-identifiable data are present in the FHIR Artifacts examples

Usages:

- Refer to this Profile: DAPL Clinical Result Observation, DAPL Coverage, DAPL De-identified AdverseEvent, DAPL De-identified AllergyIntolerance... Show 10 more, DAPL De-identified Encounter, DAPL De-identified RelatedPerson, DAPL Diagnosis, DAPL Immunization, DAPL Income Observation, DAPL Lab Observation, DAPL MedicationRequest, DAPL MedicationStatement, DAPL Procedure and DAPL ServiceRequest
- Examples for this Profile: Patient/de-identified-age89-example, Patient/de-identified-example and Patient/de-identified-smallpop-example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | DAPL Deidentified Patient
id | S Σ | 0..1 | id | The patient identifier generated by DARTS deidentification service
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:us-core-race | S C | 0..1 | (Complex) | US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race Constraints: us-core-23
extension:dapl-ethnicty | S | 0..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
extension:dapl-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension Binding: DAPL Sex Codes (required): The set of codes to be used for sex reporting.
extension:dapl-age-extension | S | 1..1 | Quantity, Range | Age of the Patient computed using birthDate and the reporting period reference URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. Constraints: dapl-date-1, dapl-date-1a
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S Σ | 1..1 | Address | Included only to support zip code
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile Constraints: dapl-potalCode-1 Example General: 9132
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required)
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Languages (extensible): The set of languages that the patient uses
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Patient.address.use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Patient.address.postalCode.​extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Patient.communication.​language | Base | extensible | Languages | 📦1.0.0 | THO v7.1
Patient.link.type | Base | required | LinkType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dapl-date-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. | `$this is dateTime implies $this.toString().length() = 4`
dapl-date-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 | `$this is dateTime implies $this.toString() >= '1900'`
dapl-potalCode-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. | `$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Patient | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-23 | error | Patient.extension:us-core-race | 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`

This structure is derived from Patient

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | DAPL Deidentified Patient
id | S | 0..1 | id | The patient identifier generated by DARTS deidentification service
text |  | 0..0 |  | Cannot include any text in the resource as part of the deidentified data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the deidentified data.
Slices for extension |  |  |  | Content/Rules for all slices
extension:us-core-race | S | 0..1 | (Complex) | US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
extension:dapl-ethnicty | S | 0..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
extension:dapl-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension Binding: DAPL Sex Codes (required): The set of codes to be used for sex reporting.
extension:dapl-age-extension | S | 1..1 | Quantity, Range | Age of the Patient computed using birthDate and the reporting period reference URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
identifier |  | 0..0 |  | Cannot include any identifier in the resource as part of the deidentified data.
name |  | 0..0 |  | Cannot include any name in the resource as part of the deidentified data.
telecom |  | 0..0 |  | Cannot include any telecom information in the resource as part of the deidentified data.
birthDate |  | 0..0 |  | Cannot include any date of birth information in the resource as part of the deidentified data.
deceased[x] | S C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. Constraints: dapl-date-1, dapl-date-1a
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S | 1..1 | Address | Included only to support zip code
text |  | 0..0 |  | Text cannot be included in the profile
line |  | 0..0 |  | Street names cannot be included in the profile
postalCode | S C | 1..1 | string | ZipCode must be included in the profile Constraints: dapl-potalCode-1
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x] | S | 1..1 | code | Value of extension
maritalStatus |  | 0..0 |  | Cannot include information in deidentified resources
multipleBirth[x] |  | 0..0 |  | Cannot include information in deidentified resources
photo |  | 0..0 |  | Cannot include information in deidentified resources
contact |  | 0..0 |  | Cannot include information in deidentified resources
communication |  |  |  |
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Languages (extensible): The set of languages that the patient uses
generalPractitioner |  | 0..0 |  | Cannot include information in deidentified resources
managingOrganization |  | 0..0 |  | Cannot include information in deidentified resources
link |  | 0..0 |  | Cannot include information in deidentified resources
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Patient.communication.​language | Base | extensible | Languages | 📦1.0.0 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
dapl-date-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. | `$this is dateTime implies $this.toString().length() = 4`
dapl-date-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 | `$this is dateTime implies $this.toString() >= '1900'`
dapl-potalCode-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. | `$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | DAPL Deidentified Patient
id | S Σ | 0..1 | id | The patient identifier generated by DARTS deidentification service
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:us-core-race | S C | 0..1 | (Complex) | US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race Constraints: us-core-23
extension:dapl-ethnicty | S | 0..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
extension:dapl-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension Binding: DAPL Sex Codes (required): The set of codes to be used for sex reporting.
extension:dapl-age-extension | S | 1..1 | Quantity, Range | Age of the Patient computed using birthDate and the reporting period reference URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use
gender | Σ | 0..1 | code | male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. Constraints: dapl-date-1, dapl-date-1a
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S Σ | 1..1 | Address | Included only to support zip code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile Constraints: dapl-potalCode-1 Example General: 9132
id |  | 0..1 | string | xml:id (or equivalent in JSON)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required)
value |  | 0..1 | string | Primitive value for string Max Length:1048576
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code)
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Languages (extensible): The set of languages that the patient uses
preferred |  | 0..1 | boolean | Language preference indicator
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Patient.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Patient.gender | Base | required | AdministrativeGender | 📍4.0.1 | FHIR Std.
Patient.address.use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Patient.address.type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Patient.address.postalCode.​extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Patient.contact.relationship | Base | extensible | Patient Contact Relationship | 📍4.0.1 | FHIR Std.
Patient.contact.gender | Base | required | AdministrativeGender | 📍4.0.1 | FHIR Std.
Patient.communication.​language | Base | extensible | Languages | 📦1.0.0 | THO v7.1
Patient.link.type | Base | required | LinkType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dapl-date-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. | `$this is dateTime implies $this.toString().length() = 4`
dapl-date-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 | `$this is dateTime implies $this.toString() >= '1900'`
dapl-potalCode-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. | `$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Patient | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-23 | error | Patient.extension:us-core-race | 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`

This structure is derived from Patient

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 11 elements
Prohibited: 15 elements

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
- http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
- http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension
- http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | DAPL Deidentified Patient
id | S Σ | 0..1 | id | The patient identifier generated by DARTS deidentification service
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:us-core-race | S C | 0..1 | (Complex) | US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race Constraints: us-core-23
extension:dapl-ethnicty | S | 0..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
extension:dapl-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension Binding: DAPL Sex Codes (required): The set of codes to be used for sex reporting.
extension:dapl-age-extension | S | 1..1 | Quantity, Range | Age of the Patient computed using birthDate and the reporting period reference URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. Constraints: dapl-date-1, dapl-date-1a
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S Σ | 1..1 | Address | Included only to support zip code
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile Constraints: dapl-potalCode-1 Example General: 9132
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required)
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Languages (extensible): The set of languages that the patient uses
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Patient.address.use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Patient.address.postalCode.​extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Patient.communication.​language | Base | extensible | Languages | 📦1.0.0 | THO v7.1
Patient.link.type | Base | required | LinkType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dapl-date-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. | `$this is dateTime implies $this.toString().length() = 4`
dapl-date-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 | `$this is dateTime implies $this.toString() >= '1900'`
dapl-potalCode-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. | `$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Patient | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-23 | error | Patient.extension:us-core-race | 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`

Differential View

This structure is derived from Patient

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | DAPL Deidentified Patient
id | S | 0..1 | id | The patient identifier generated by DARTS deidentification service
text |  | 0..0 |  | Cannot include any text in the resource as part of the deidentified data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the deidentified data.
Slices for extension |  |  |  | Content/Rules for all slices
extension:us-core-race | S | 0..1 | (Complex) | US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
extension:dapl-ethnicty | S | 0..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
extension:dapl-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension Binding: DAPL Sex Codes (required): The set of codes to be used for sex reporting.
extension:dapl-age-extension | S | 1..1 | Quantity, Range | Age of the Patient computed using birthDate and the reporting period reference URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
identifier |  | 0..0 |  | Cannot include any identifier in the resource as part of the deidentified data.
name |  | 0..0 |  | Cannot include any name in the resource as part of the deidentified data.
telecom |  | 0..0 |  | Cannot include any telecom information in the resource as part of the deidentified data.
birthDate |  | 0..0 |  | Cannot include any date of birth information in the resource as part of the deidentified data.
deceased[x] | S C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. Constraints: dapl-date-1, dapl-date-1a
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S | 1..1 | Address | Included only to support zip code
text |  | 0..0 |  | Text cannot be included in the profile
line |  | 0..0 |  | Street names cannot be included in the profile
postalCode | S C | 1..1 | string | ZipCode must be included in the profile Constraints: dapl-potalCode-1
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x] | S | 1..1 | code | Value of extension
maritalStatus |  | 0..0 |  | Cannot include information in deidentified resources
multipleBirth[x] |  | 0..0 |  | Cannot include information in deidentified resources
photo |  | 0..0 |  | Cannot include information in deidentified resources
contact |  | 0..0 |  | Cannot include information in deidentified resources
communication |  |  |  |
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Languages (extensible): The set of languages that the patient uses
generalPractitioner |  | 0..0 |  | Cannot include information in deidentified resources
managingOrganization |  | 0..0 |  | Cannot include information in deidentified resources
link |  | 0..0 |  | Cannot include information in deidentified resources
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Patient.communication.​language | Base | extensible | Languages | 📦1.0.0 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
dapl-date-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. | `$this is dateTime implies $this.toString().length() = 4`
dapl-date-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 | `$this is dateTime implies $this.toString() >= '1900'`
dapl-potalCode-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. | `$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | DAPL Deidentified Patient
id | S Σ | 0..1 | id | The patient identifier generated by DARTS deidentification service
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:us-core-race | S C | 0..1 | (Complex) | US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race Constraints: us-core-23
extension:dapl-ethnicty | S | 0..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
extension:dapl-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension Binding: DAPL Sex Codes (required): The set of codes to be used for sex reporting.
extension:dapl-age-extension | S | 1..1 | Quantity, Range | Age of the Patient computed using birthDate and the reporting period reference URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use
gender | Σ | 0..1 | code | male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. Constraints: dapl-date-1, dapl-date-1a
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S Σ | 1..1 | Address | Included only to support zip code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile Constraints: dapl-potalCode-1 Example General: 9132
id |  | 0..1 | string | xml:id (or equivalent in JSON)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required)
value |  | 0..1 | string | Primitive value for string Max Length:1048576
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code)
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Languages (extensible): The set of languages that the patient uses
preferred |  | 0..1 | boolean | Language preference indicator
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Patient.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Patient.gender | Base | required | AdministrativeGender | 📍4.0.1 | FHIR Std.
Patient.address.use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Patient.address.type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Patient.address.postalCode.​extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Patient.contact.relationship | Base | extensible | Patient Contact Relationship | 📍4.0.1 | FHIR Std.
Patient.contact.gender | Base | required | AdministrativeGender | 📍4.0.1 | FHIR Std.
Patient.communication.​language | Base | extensible | Languages | 📦1.0.0 | THO v7.1
Patient.link.type | Base | required | LinkType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dapl-date-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. | `$this is dateTime implies $this.toString().length() = 4`
dapl-date-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 | `$this is dateTime implies $this.toString() >= '1900'`
dapl-potalCode-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. | `$this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$')`
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Patient | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-23 | error | Patient.extension:us-core-race | 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`

This structure is derived from Patient

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 11 elements
Prohibited: 15 elements

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
- http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-ethnicity-extension
- http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-sex-extension
- http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-age-extension
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0

Maturity: 2

Other representations of profile: CSV, Excel, Schematron