This page is part of a downloaded copy of this specification. This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v0.1.0: STU 1 Ballot 1) based on FHIR v3.5.0. . For a full list of available versions, see the Directory of published versions

## StructureDefinition: CRD Patient - Detailed Descriptions

Definitions for the profile-patient-stu3 Profile.

Patient
Definition | The US Core Patient Profile is based upon the core FHIR Patient Resource and designed to meet the applicable patient demographic data elements from the 2015 Edition Common Clinical Data Set.
Control | 0..*
Alternate Names | SubjectOfCare Client Resident
Invariants | Defined on this element dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty()) 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 (: contained.where(('#'+id in %resource.descendants().reference).not()).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())
Patient.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | id
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Patient.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Control | 0..1
Type | Meta
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.
Control | 0..1
Type | uri
Is Modifier | true
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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
Patient.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | A human language. The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Type | code
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Patient.text
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Control | 0..1 This element is affected by the following invariants: dom-1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
Patient.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
Patient.extension
Definition | An Extension
Control | 0..*
Type | Extension
Patient.extension ([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/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 CDC Race and Ethnicity Code Set Version 1.0 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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: children().count() > id.count()) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Patient.extension ([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity]])
Definition | Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The ethnicity codes used to represent these concepts are based upon the CDC ethnicity and Ethnicity Code Set Version 1.0 which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity. The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: children().count() > id.count()) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Patient.extension ([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex]])
Definition | A code classifying the person's sex assigned at birth as specified by the Office of the National Coordinator for Health IT (ONC).
Control | 0..1 This element is affected by the following invariants: ele-1
Type | (Extension Type: code)
Comments | The codes required are intended to present birth sex (i.e., the sex recorded on the patient’s birth certificate) and not gender identity or reassigned sex.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: children().count() > id.count()) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Patient.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.identifier
Definition | An identifier for this patient.
Note | This is a business identifer, not a resource identifier (see discussion)
Control | 1..*
Type | Identifier
Must Support | true
Requirements | Patients are almost always assigned specific numerical identifiers.
Patient.identifier.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.identifier.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.identifier.use
Definition | The purpose of this identifier.
Control | 0..1
Binding | Identifies the purpose for this identifier, if known . The codes SHALL be taken from IdentifierUse
Type | code
Is Modifier | true
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments | This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Patient.identifier.type
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Control | 0..1
Binding | A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
Type | CodeableConcept
Requirements | Allows users to make use of identifiers when the identifier system is not known.
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Patient.identifier.system
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Control | 1..1
Type | uri
Must Support | true
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Example | General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Patient.identifier.value
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Control | 1..1
Type | string
Must Support | true
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
Example | General:123456
Patient.identifier.period
Definition | Time period during which identifier is/was valid for use.
Control | 0..1
Type | Period
Patient.identifier.assigner
Definition | Organization that issued/manages the identifier.
Control | 0..1
Type | Reference(Organization)
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Patient.identifier(MRIdentifier)
Definition | An identifier for this patient.
Note | This is a business identifer, not a resource identifier (see discussion)
Control | 1..1
Type | Identifier
Must Support | true
Requirements | Patients are almost always assigned specific numerical identifiers.
Patient.identifier.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.identifier.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.identifier.use
Definition | The purpose of this identifier.
Control | 0..1
Binding | Identifies the purpose for this identifier, if known . The codes SHALL be taken from IdentifierUse
Type | code
Is Modifier | true
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments | This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Patient.identifier.type
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Control | 1..1
Binding | A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
Type | CodeableConcept
Must Support | true
Requirements | Allows users to make use of identifiers when the identifier system is not known.
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Patient.identifier.type.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.identifier.type.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.identifier.type.coding
Definition | A reference to a code defined by a terminology system.
Control | 1..1
Type | Coding
Must Support | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Patient.identifier.type.coding.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.identifier.type.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.identifier.type.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Control | 1..1
Type | uri
Must Support | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Comments | The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.
Fixed Value | http://terminology.hl7.org/CodeSystem/v2-0203
Patient.identifier.type.coding.version
Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Note | This is a business versionId, not a resource version id (see discussion)
Control | 0..1
Type | string
Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
Patient.identifier.type.coding.code
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Control | 1..1
Type | code
Must Support | true
Requirements | Need to refer to a particular code in the system.
Fixed Value | MR
Patient.identifier.type.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Control | 0..1
Type | string
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Patient.identifier.type.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).
Control | 0..1
Type | boolean
Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
Patient.identifier.type.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Control | 0..1
Type | string
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Comments | Very often the text is the same as a displayName of one of the codings.
Patient.identifier.system
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Control | 1..1
Type | uri
Must Support | true
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Example | General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Patient.identifier.value
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Control | 1..1
Type | string
Must Support | true
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
Example | General:123456
Patient.identifier.period
Definition | Time period during which identifier is/was valid for use.
Control | 0..1
Type | Period
Patient.identifier.assigner
Definition | Organization that issued/manages the identifier.
Control | 0..1
Type | Reference(Organization)
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Patient.active
Definition | Whether this patient record is in active use.
Control | 0..1
Type | boolean
Is Modifier | true
Requirements | Need to be able to mark a patient record as not to be used because it was created in error.
Comments | Default is true. If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient This element is labeled as a modifier because when the patient record is marked as not active it is not expected to be used/referenced without being changed back to active.
Default Value | true
Patient.name
Definition | A name associated with the individual.
Control | 1..*
Type | HumanName
Must Support | true
Requirements | Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Comments | A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.
Patient.name.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.name.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.name.use
Definition | Identifies the purpose for this name.
Control | 0..1
Binding | The use of a human name The codes SHALL be taken from NameUse
Type | code
Is Modifier | true
Requirements | Allows the appropriate name for a particular context of use to be selected from among a set of names.
Comments | This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.
Patient.name.text
Definition | A full text representation of the name.
Control | 0..1
Type | string
Requirements | A renderable, unencoded form.
Comments | Can provide both a text representation and structured parts.
Patient.name.family
Definition | The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.
Control | 1..1
Type | string
Must Support | true
Alternate Names | surname
Comments | Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).
Patient.name.given
Definition | Given name.
Control | 1..*
Type | string
Must Support | true
Alternate Names | first name, middle name
Comments | If only initials are recorded, they may be used in place of the full name. Not called "first name" since given names do not always come first.
Patient.name.prefix
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.
Control | 0..*
Type | string
Patient.name.suffix
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.
Control | 0..*
Type | string
Patient.name.period
Definition | Indicates the period of time when this name was valid for the named person.
Control | 0..1
Type | Period
Requirements | Allows names to be placed in historical context.
Patient.telecom
Definition | A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Control | 0..*
Type | ContactPoint
Requirements | People have (primary) ways to contact them in some way such as phone, email.
Comments | A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address may not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
Patient.gender
Definition | Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Control | 1..1
Binding | The codes SHALL be taken from AdministrativeGender
Type | code
Must Support | true
Requirements | Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.
Comments | The gender may not match the biological sex as determined by genetics, or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error.
Patient.birthDate
Definition | The date of birth for the individual.
Control | 0..1
Type | date
Must Support | true
Requirements | Age of the individual drives many clinical processes.
Comments | At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternaty/infant care systems).
LOINC Code | 21112-8
Patient.deceased[x]
Definition | Indicates if the individual is deceased or not.
Control | 0..1
Type | Choice of: boolean, dateTime
[x] Note | See Choice of Data Types for further information about how to use [x]
Is Modifier | 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.
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. 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.
Patient.address
Definition | Addresses for the individual.
Control | 0..*
Type | Address
Requirements | May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Comments | Patient may have multiple addresses with different uses or applicable periods.
Patient.maritalStatus
Definition | This field contains a patient's most recent marital (civil) status.
Control | 0..1
Binding | The domestic partnership status of a person. The codes SHALL be taken from Marital Status Codes; other codes may be used where these codes are not suitable
Type | CodeableConcept
Requirements | Most, if not all systems capture it.
Patient.multipleBirth[x]
Definition | Indicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer).
Control | 0..1
Type | Choice of: boolean, integer
[x] Note | See Choice of Data Types for further information about how to use [x]
Requirements | For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Comments | Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in tripplets would be valueInteger=2 and the third born would have valueInteger=3 If a bool value was provided for this tripplets examle, then all 3 patient records would have valueBool=true (the ordering is not indicated).
Patient.photo
Definition | Image of the patient.
Control | 0..*
Type | Attachment
Requirements | Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Patient.contact
Definition | A contact party (e.g. guardian, partner, friend) for the patient.
Control | 0..*
Type | BackboneElement
Requirements | Need to track people you can contact about the patient.
Comments | Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (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())
Patient.contact.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.contact.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.contact.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.contact.relationship
Definition | The nature of the relationship between the patient and the contact person.
Control | 0..*
Binding | The nature of the relationship between a patient and a contact person for that patient. The codes SHALL be taken from v2 Contact Role; other codes may be used where these codes are not suitable
Type | CodeableConcept
Requirements | Used to determine which contact person is the most relevant to approach, depending on circumstances.
Patient.contact.name
Definition | A name associated with the contact person.
Control | 0..1
Type | HumanName
Requirements | Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
Patient.contact.telecom
Definition | A contact detail for the person, e.g. a telephone number or an email address.
Control | 0..*
Type | ContactPoint
Requirements | People have (primary) ways to contact them in some way such as phone, email.
Comments | Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
Patient.contact.address
Definition | Address for the contact person.
Control | 0..1
Type | Address
Requirements | Need to keep track where the contact person can be contacted per postal mail or visited.
Patient.contact.gender
Definition | Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Control | 0..1
Binding | The gender of a person used for administrative purposes. The codes SHALL be taken from AdministrativeGender
Type | code
Requirements | Needed to address the person correctly.
Patient.contact.organization
Definition | Organization on behalf of which the contact is acting or for which the contact is working.
Control | 0..1 This element is affected by the following invariants: pat-1
Type | Reference(Organization)
Requirements | For guardians or business related contacts, the organization is relevant.
Patient.contact.period
Definition | The period during which this contact person or organization is valid to be contacted relating to this patient.
Control | 0..1
Type | Period
Patient.animal
Definition | This patient is known to be an animal.
Control | 0..0
Type | BackboneElement
Is Modifier | true
Requirements | Many clinical systems are extended to care for animal patients as well as human.
Comments | The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
Patient.animal.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.animal.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.animal.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.animal.species
Definition | Identifies the high level taxonomic categorization of the kind of animal.
Control | 1..1
Binding | The species of an animal. For example codes, see AnimalSpecies
Type | CodeableConcept
Requirements | Need to know what kind of animal.
Comments | If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).
Patient.animal.breed
Definition | Identifies the detailed categorization of the kind of animal.
Control | 0..1
Binding | The breed of an animal. For example codes, see AnimalBreeds
Type | CodeableConcept
Requirements | May need to know the specific kind within the species.
Comments | Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.
Patient.animal.genderStatus
Definition | Indicates the current state of the animal's reproductive organs.
Control | 0..1
Binding | The state of the animal's reproductive organs. For example codes, see GenderStatus
Type | CodeableConcept
Requirements | Gender status can affect housing and animal behavior.
Patient.communication
Definition | Languages which may be used to communicate with the patient about his or her health.
Control | 0..*
Type | BackboneElement
Must Support | true
Requirements | If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.
Comments | If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
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.
Control | 0..1
Type | string
Patient.communication.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.communication.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.communication.language
Definition | The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
Control | 1..1
Binding | The codes SHALL be taken from Language codes with language and optionally a region modifier; other codes may be used where these codes are not suitable
Type | CodeableConcept
Must Support | true
Requirements | Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Comments | The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
Patient.communication.preferred
Definition | Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Control | 0..1
Type | boolean
Requirements | People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
Comments | This language is specifically identified for communicating healthcare information.
Patient.generalPractitioner
Definition | Patient's nominated care provider.
Control | 0..*
Type | Reference(Organization | Practitioner)
Alternate Names | careProvider
Comments | This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.
Patient.managingOrganization
Definition | Organization that is the custodian of the patient record.
Control | 0..1
Type | Reference(Organization)
Requirements | Need to know who recognizes this patient record, manages and updates it.
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).
Patient.link
Definition | Link to another patient resource that concerns the same actual patient.
Control | 0..*
Type | BackboneElement
Is Modifier | true
Requirements | There are multiple usecases: Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers.
Comments | There is no assumption that linked patient records have mutual links. This element is labelled as a modifier because it may 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'.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
Patient.link.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
Patient.link.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.link.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Patient.link.other
Definition | The other patient resource that the link refers to.
Control | 1..1
Type | Reference(Patient | RelatedPerson)
Comments | Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
Patient.link.type
Definition | The type of link between this patient resource and another patient resource.
Control | 1..1
Binding | The type of link between this patient resource and another patient resource. The codes SHALL be taken from LinkType
Type | code