Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present).

Each Practitioner must have:

1. Either a National Provider Identifier (NPI), or CMS Certification Number(CCN) identifier

Additional Profile specific implementation guidance:

The “Full View” tab below displays all the identifier slices including the CCN slice defined in this guide and NPI slice which is inherited indirectly from the [US Core Practitioner Profile].

Examples

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

This structure is derived from QICorePractitioner

Name	Flags	Card.	Type	Description & Constraints
Practitioner	C	0..*	QICorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services deqm-4: Either an NPI, EIN, or CCN identifier SHALL be present
Slices for identifier	SC	1..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:ccn	S	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.336
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
deqm-4	error	Practitioner	Either an NPI, EIN, or CCN identifier SHALL be present : (identifier.system contains 'urn:oid:2.16.840.1.113883.4.4') or (identifier.system contains 'urn:oid:2.16.840.1.113883.4.336') or (identifier.system contains 'http://hl7.org/fhir/sid/us-npi')

Name	Flags	Card.	Type	Description & Constraints
Practitioner	C	0..*	QICorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services deqm-4: Either an NPI, EIN, or CCN identifier SHALL be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	1..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
identifier:ccn	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.336
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
value	SΣ	1..1	string	The value that is unique Example General: 123456
identifier:ein	SΣ	0..1	Identifier	There is not a general Tax Identifier Numer (TIN) OID. There is an SSN, a PTIN, and an ITIN, but no TIN generally. So the only slice specified here is EIN, if consumers determine a need for an SSN, submit a comment to that effect. Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.4
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
value	SΣ	1..1	string	The value that is unique Example General: 123456
name	SΣ	1..*	HumanName	The name(s) associated with the practitioner
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
family	SΣ	1..1	string	Family name (often called 'Surname')
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Practitioner.identifier:ccn.use	required	IdentifierUse
Practitioner.identifier:ein.use	required	IdentifierUse
Practitioner.name.use	required	NameUse

Constraints

Id	Grade	Path(s)	Details	Requirements
deqm-4	error	Practitioner	Either an NPI, EIN, or CCN identifier SHALL be present : (identifier.system contains 'urn:oid:2.16.840.1.113883.4.4') or (identifier.system contains 'urn:oid:2.16.840.1.113883.4.336') or (identifier.system contains 'http://hl7.org/fhir/sid/us-npi')

Name	Flags	Card.	Type	Description & Constraints
Practitioner	C	0..*	QICorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services deqm-4: Either an NPI, EIN, or CCN identifier SHALL be present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	1..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:ccn	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.336
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:ein	SΣ	0..1	Identifier	There is not a general Tax Identifier Numer (TIN) OID. There is an SSN, a PTIN, and an ITIN, but no TIN generally. So the only slice specified here is EIN, if consumers determine a need for an SSN, submit a comment to that effect. Required Pattern: At least the following
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.4
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	Σ	0..1	boolean	Whether this practitioner's record is in active use
name	SΣ	1..*	HumanName	The name(s) associated with the practitioner
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	Σ	0..1	string	Text representation of the full name
family	SΣ	1..1	string	Family name (often called 'Surname')
given	Σ	0..*	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	Σ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	Time period when name was/is in use
telecom	Σ	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles)
address	Σ	0..*	Address	Address(es) of the practitioner that are not role specific (typically home address)
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	Σ	0..1	date	The date on which the practitioner was born
photo		0..*	Attachment	Image of the person
qualification		0..*	BackboneElement	Certification, licenses, or training pertaining to the provision of care
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier		0..*	Identifier	An identifier for this qualification for the practitioner
code		1..1	CodeableConcept	Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
period		0..1	Period	Period during which the qualification is valid
issuer		0..1	Reference(QICoreOrganization)	Organization that regulates and issues the qualification
communication		0..*	CodeableConcept	A language the practitioner can use in patient communication Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Practitioner.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Practitioner.identifier:ccn.use	required	IdentifierUse
Practitioner.identifier:ccn.type	extensible	Identifier Type Codes
Practitioner.identifier:ein.use	required	IdentifierUse
Practitioner.identifier:ein.type	extensible	Identifier Type Codes
Practitioner.name.use	required	NameUse
Practitioner.gender	required	AdministrativeGender
Practitioner.qualification.code	example	v2.0360.2.7 (a valid code from http://terminology.hl7.org/CodeSystem/v2-0360|2.7)
Practitioner.communication	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding

Differential View

This structure is derived from QICorePractitioner

Name	Flags	Card.	Type	Description & Constraints
Practitioner	C	0..*	QICorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services deqm-4: Either an NPI, EIN, or CCN identifier SHALL be present
Slices for identifier	SC	1..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:ccn	S	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.336
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
deqm-4	error	Practitioner	Either an NPI, EIN, or CCN identifier SHALL be present : (identifier.system contains 'urn:oid:2.16.840.1.113883.4.4') or (identifier.system contains 'urn:oid:2.16.840.1.113883.4.336') or (identifier.system contains 'http://hl7.org/fhir/sid/us-npi')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Practitioner	C	0..*	QICorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services deqm-4: Either an NPI, EIN, or CCN identifier SHALL be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	1..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
identifier:ccn	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.336
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
value	SΣ	1..1	string	The value that is unique Example General: 123456
identifier:ein	SΣ	0..1	Identifier	There is not a general Tax Identifier Numer (TIN) OID. There is an SSN, a PTIN, and an ITIN, but no TIN generally. So the only slice specified here is EIN, if consumers determine a need for an SSN, submit a comment to that effect. Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.4
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
value	SΣ	1..1	string	The value that is unique Example General: 123456
name	SΣ	1..*	HumanName	The name(s) associated with the practitioner
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
family	SΣ	1..1	string	Family name (often called 'Surname')
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Practitioner.identifier:ccn.use	required	IdentifierUse
Practitioner.identifier:ein.use	required	IdentifierUse
Practitioner.name.use	required	NameUse

Constraints

Id	Grade	Path(s)	Details	Requirements
deqm-4	error	Practitioner	Either an NPI, EIN, or CCN identifier SHALL be present : (identifier.system contains 'urn:oid:2.16.840.1.113883.4.4') or (identifier.system contains 'urn:oid:2.16.840.1.113883.4.336') or (identifier.system contains 'http://hl7.org/fhir/sid/us-npi')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Practitioner	C	0..*	QICorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services deqm-4: Either an NPI, EIN, or CCN identifier SHALL be present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	1..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:ccn	SΣ	0..1	Identifier	An identifier for the person as this agent Required Pattern: At least the following
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.336
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:ein	SΣ	0..1	Identifier	There is not a general Tax Identifier Numer (TIN) OID. There is an SSN, a PTIN, and an ITIN, but no TIN generally. So the only slice specified here is EIN, if consumers determine a need for an SSN, submit a comment to that effect. Required Pattern: At least the following
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.4
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!SΣ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	Σ	0..1	boolean	Whether this practitioner's record is in active use
name	SΣ	1..*	HumanName	The name(s) associated with the practitioner
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	Σ	0..1	string	Text representation of the full name
family	SΣ	1..1	string	Family name (often called 'Surname')
given	Σ	0..*	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	Σ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	Time period when name was/is in use
telecom	Σ	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles)
address	Σ	0..*	Address	Address(es) of the practitioner that are not role specific (typically home address)
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	Σ	0..1	date	The date on which the practitioner was born
photo		0..*	Attachment	Image of the person
qualification		0..*	BackboneElement	Certification, licenses, or training pertaining to the provision of care
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier		0..*	Identifier	An identifier for this qualification for the practitioner
code		1..1	CodeableConcept	Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
period		0..1	Period	Period during which the qualification is valid
issuer		0..1	Reference(QICoreOrganization)	Organization that regulates and issues the qualification
communication		0..*	CodeableConcept	A language the practitioner can use in patient communication Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Practitioner.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Practitioner.identifier:ccn.use	required	IdentifierUse
Practitioner.identifier:ccn.type	extensible	Identifier Type Codes
Practitioner.identifier:ein.use	required	IdentifierUse
Practitioner.identifier:ein.type	extensible	Identifier Type Codes
Practitioner.name.use	required	NameUse
Practitioner.gender	required	AdministrativeGender
Practitioner.qualification.code	example	v2.0360.2.7 (a valid code from http://terminology.hl7.org/CodeSystem/v2-0360|2.7)
Practitioner.communication	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding

This structure is derived from QICorePractitioner

Summary

Mandatory: 1 element
Must-Support: 2 elements

Slices

This structure defines the following Slices:

• The element Practitioner.identifier is sliced based on the value of pattern:$this

This profile is used in the following transactions:

• Medication Reconciliation (MRP)
• Colorectal Cancer Screening (COL)
• Venous Thromboembolism Prophylaxis (VTE-1)