0.3.0 - Second STU ballot

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 (v0.3.0: STU 1 Ballot 2) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

## StructureDefinition: PatientR4 - Detailed Descriptions

Definitions for the profile-patient-r4 Profile.

1. 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-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.div.exists())
2. Patient.id
Definition | 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.
3. Patient.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Control | 0..1
Type | Meta
4. Patient.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
5. Patient.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | A human language. The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages
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).
6. Patient.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Control | 0..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 information is added later.
7. 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
8. Patient.extension
Definition | An Extension
Control | 0..*
Type | Extension
9. Patient.extension:race
Definition | An Extension
Control | 0..1
Type | Extension(UsCoreRaceExtension) (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)
Must Support | true
10. Patient.extension:ethnicity
Definition | An Extension
Control | 0..1
Type | Extension(UsCoreEthnicityExtension) (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)
Must Support | true
11. Patient.extension:birthsex
Definition | An Extension
Control | 0..1
Type | Extension(UsCoreBirthSexExtension) (Extension Type: code)
Must Support | true
12. Patient.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
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.
13. Patient.identifier
Definition | An identifier for this patient.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..*
Type | Identifier
Must Support | true
Requirements | Patients are almost always assigned specific numerical identifiers.
14. 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
15. Patient.identifier.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
16. 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 | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
17. 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.
18. 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.
Comments | Identifier.system is always case sensitive.
Example | General:http://www.acme.com/identifiers/patient
19. 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. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Example | General:123456
20. Patient.identifier.period
Definition | Time period during which identifier is/was valid for use.
Control | 0..1
Type | Period
21. 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.
22. Patient.identifier:MRIdentifier
Definition | An identifier for this patient.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..1
Type | Identifier
Must Support | true
Requirements | Patients are almost always assigned specific numerical identifiers.
23. Patient.identifier:MRIdentifier.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
24. Patient.identifier:MRIdentifier.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
25. Patient.identifier:MRIdentifier.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 | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
26. Patient.identifier:MRIdentifier.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.
27. Patient.identifier:MRIdentifier.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
28. Patient.identifier:MRIdentifier.type.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
29. Patient.identifier:MRIdentifier.type.coding
Definition | A reference to a code defined by a terminology system.
Control | 1..1
Type | Coding
Must Support | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
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.
30. Patient.identifier:MRIdentifier.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
31. Patient.identifier:MRIdentifier.type.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
32. Patient.identifier:MRIdentifier.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 reference to some definition that establishes the system clearly and unambiguously.
Fixed Value | http://terminology.hl7.org/CodeSystem/v2-0203
33. Patient.identifier:MRIdentifier.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.
34. Patient.identifier:MRIdentifier.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
35. Patient.identifier:MRIdentifier.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.
36. Patient.identifier:MRIdentifier.type.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - e.g. 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.
37. Patient.identifier:MRIdentifier.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.
38. Patient.identifier:MRIdentifier.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.
Comments | Identifier.system is always case sensitive.
Example | General:http://www.acme.com/identifiers/patient
39. Patient.identifier:MRIdentifier.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. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Example | General:123456
40. Patient.identifier:MRIdentifier.period
Definition | Time period during which identifier is/was valid for use.
Control | 0..1
Type | Period
41. Patient.identifier:MRIdentifier.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.
42. Patient.active
Definition | Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
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 | If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Meaning if Missing | This resource is generally assumed to be active if no value is provided for the active element
43. 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.
44. 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
45. Patient.name.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
46. 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 | Applications can assume that a name is current unless it explicitly says that it is temporary or old.
47. Patient.name.text
Definition | Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
Control | 0..1
Type | string
Requirements | A renderable, unencoded form.
Comments | Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
48. 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).
49. 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 parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
50. 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
51. 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
52. 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.
53. 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 might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
54. 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.
Comments | The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
55. 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 maternity/infant care systems).
LOINC Code | 21112-8
56. 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.
57. Patient.address
Definition | An address for the individual.
Control | 0..*
Type | Address
Must Support | true
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.
58. Patient.address.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
59. Patient.address.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
60. Patient.address.use
Definition | The purpose of this address.
Control | 0..1
Binding | The use of an address. The codes SHALL be taken from AddressUse
Type | code
Is Modifier | true
Requirements | Allows an appropriate address to be chosen from a list of many.
Comments | Applications can assume that an address is current unless it explicitly says that it is temporary or old.
Example | General:home
61. Patient.address.type
Definition | Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
Control | 0..1
Binding | The type of an address (physical / postal). The codes SHALL be taken from AddressType
Type | code
Comments | The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
Example | General:both
62. Patient.address.text
Definition | Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
Control | 0..1
Type | string
Requirements | A renderable, unencoded form.
Comments | Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
Example | General:137 Nowhere Street, Erewhon 9132
63. Patient.address.line
Definition | This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.
Control | 0..*
Type | string
Example | General:137 Nowhere Street
64. Patient.address.city
Definition | The name of the city, town, suburb, village or other community or delivery center.
Control | 0..1
Type | string
Alternate Names | Municpality
Example | General:Erewhon
65. Patient.address.district
Definition | The name of the administrative area (county).
Control | 0..1
Type | string
Alternate Names | County
Comments | District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Example | General:Madison
66. Patient.address.state
Definition | Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).
Control | 0..1
Type | string
Must Support | true
Alternate Names | Province, Territory
67. Patient.address.postalCode
Definition | A postal code designating a region defined by the postal service.
Control | 0..1
Type | string
Alternate Names | Zip
Example | General:9132
68. Patient.address.country
Definition | Country - a nation as commonly understood or generally accepted.
Control | 0..1
Type | string
Must Support | true
Comments | ISO 3166 3 letter codes can be used in place of a human readable country name.
69. Patient.address.period
Definition | Time period when address was/is in use.
Control | 0..1
Type | Period
Requirements | Allows addresses to be placed in historical context.
Example | General:<valuePeriod xmlns="http://hl7.org/fhir"> <start value="2010-03-23T00:00:00+11:00"/> <end value="2010-07-01T00:00:00+10:00"/> </valuePeriod>
70. 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.
71. Patient.multipleBirth[x]
Definition | Indicates whether the patient is part of a multiple (boolean) 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 triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
72. 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.
Comments | Guidelines: Use id photos, not clinical photos. Limit dimensions to thumbnail. Keep byte count low to ease resource updates.
73. 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() or (children().count() > id.count())) pat-1: SHALL at least contain a contact's details or a reference to an organization (: name.exists() or telecom.exists() or address.exists() or organization.exists())
74. 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
75. Patient.contact.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
76. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
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.
77. 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 PatientContactRelationship; 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.
78. 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.
79. 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.
80. 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.
81. 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.
82. 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.
83. 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
84. Patient.communication
Definition | A language 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 are 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() or (children().count() > id.count()))
85. 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
86. Patient.communication.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
87. Patient.communication.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
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.
88. 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 Max Binding: Language codes with language and optionally a region modifier
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.
89. 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.
90. Patient.generalPractitioner
Definition | Patient's nominated care provider.
Control | 0..*
Type | Reference(Organization | Practitioner | PractitionerRole)
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/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues. Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
91. 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).
92. 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 use cases: Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and Distribution of patient information across multiple servers.
Comments | There is no assumption that linked patient records have mutual links.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
93. 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
94. Patient.link.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
95. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
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.
96. 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.
97. 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