This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

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Resource Profile: PAS Practitioner

PAS constraints on Practitioner resource mandating support for elements relevant to the care team involved in a prior authorization request

Usage:

• Refer to this Resource Profile: ItemAuthorizedProvider, PAS Claim Response Base, PAS CommunicationRequest and PAS PractitionerRole
• Examples for this Resource Profile: Practitioner/ReferralPractitionerExample and Practitioner/SurgicalPractitionerExample

Formal Views of Profile Content

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

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

This structure is derived from USCorePractitionerProfile

Name	Flags	Card.	Type	Description & Constraints
Practitioner			USCorePractitionerProfile(7.0.0)	This profile also complies with the profiles US Core Practitioner Profile (3.1.1) and US Core Practitioner Profile (6.1.0)
identifier		1..*	PASIdentifier	An identifier for the person as this agent
Slices for identifier				Content/Rules for all slices
identifier:NPI		0..*	PASIdentifier	An identifier intended for computation
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	USCorePractitionerProfile(7.0.0)	A person with a formal responsibility in the provisioning of healthcare or related services This profile also complies with the profiles US Core Practitioner Profile (3.1.1) and US Core Practitioner Profile (6.1.0)
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	SΣ	1..*	PASIdentifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SC	0..*	PASIdentifier	An identifier intended for computation us-core-16: NPI must be 10 digits us-core-17: NPI check digit must be valid (Luhn algorithm check) 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
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')
telecom	SΣ	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles)
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	0..1	string	The actual contact point details
use	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
address	SΣ	0..*	Address	Address(es) of the practitioner
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street Example General: 49 MEADOW ST
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon Example General: EVERYTOWN
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes. Example General: OK
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132 Example General: 74047
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Practitioner.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
Practitioner.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
Practitioner.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
Practitioner.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Practitioner.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/) http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	USCorePractitionerProfile(7.0.0)	A person with a formal responsibility in the provisioning of healthcare or related services This profile also complies with the profiles US Core Practitioner Profile (3.1.1) and US Core Practitioner Profile (6.1.0)
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	SΣ	1..*	PASIdentifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SC	0..*	PASIdentifier	An identifier intended for computation us-core-16: NPI must be 10 digits us-core-17: NPI check digit must be valid (Luhn algorithm check) Required Pattern: At least the following
id		0..1	string	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)
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	SΣ	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	0..1	string	The actual contact point details
use	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
address	SΣ	0..*	Address	Address(es) of 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	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street Example General: 49 MEADOW ST
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon Example General: EVERYTOWN
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes. Example General: OK
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132 Example General: 74047
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
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(Organization)	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	URI
Practitioner.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Practitioner.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
Practitioner.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
Practitioner.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
Practitioner.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Practitioner.address.type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 from the FHIR Standard
Practitioner.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/) http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Practitioner.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Practitioner.qualification.code	example	v2.0360.2.7 (a valid code from http://terminology.hl7.org/CodeSystem/v2-0360|2.7) http://terminology.hl7.org/ValueSet/v2-2.7-0360 from the FHIR Standard
Practitioner.communication	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard

This structure is derived from USCorePractitionerProfile

Summary

Structures

This structure refers to these other structures:

• PAS Identifier (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-identifier)

Maturity: 3

Differential View

This structure is derived from USCorePractitionerProfile

Name	Flags	Card.	Type	Description & Constraints
Practitioner			USCorePractitionerProfile(7.0.0)	This profile also complies with the profiles US Core Practitioner Profile (3.1.1) and US Core Practitioner Profile (6.1.0)
identifier		1..*	PASIdentifier	An identifier for the person as this agent
Slices for identifier				Content/Rules for all slices
identifier:NPI		0..*	PASIdentifier	An identifier intended for computation
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	USCorePractitionerProfile(7.0.0)	A person with a formal responsibility in the provisioning of healthcare or related services This profile also complies with the profiles US Core Practitioner Profile (3.1.1) and US Core Practitioner Profile (6.1.0)
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	SΣ	1..*	PASIdentifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SC	0..*	PASIdentifier	An identifier intended for computation us-core-16: NPI must be 10 digits us-core-17: NPI check digit must be valid (Luhn algorithm check) 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
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')
telecom	SΣ	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles)
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	0..1	string	The actual contact point details
use	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
address	SΣ	0..*	Address	Address(es) of the practitioner
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street Example General: 49 MEADOW ST
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon Example General: EVERYTOWN
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes. Example General: OK
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132 Example General: 74047
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Practitioner.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
Practitioner.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
Practitioner.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
Practitioner.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Practitioner.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/) http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	USCorePractitionerProfile(7.0.0)	A person with a formal responsibility in the provisioning of healthcare or related services This profile also complies with the profiles US Core Practitioner Profile (3.1.1) and US Core Practitioner Profile (6.1.0)
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	SΣ	1..*	PASIdentifier	An identifier for the person as this agent Slice: Unordered, Open by pattern:$this
identifier:NPI	SC	0..*	PASIdentifier	An identifier intended for computation us-core-16: NPI must be 10 digits us-core-17: NPI check digit must be valid (Luhn algorithm check) Required Pattern: At least the following
id		0..1	string	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)
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	SΣ	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	0..1	string	The actual contact point details
use	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
address	SΣ	0..*	Address	Address(es) of 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	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street Example General: 49 MEADOW ST
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon Example General: EVERYTOWN
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes. Example General: OK
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132 Example General: 74047
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
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(Organization)	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	URI
Practitioner.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Practitioner.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 from the FHIR Standard
Practitioner.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
Practitioner.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard
Practitioner.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Practitioner.address.type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 from the FHIR Standard
Practitioner.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/) http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Practitioner.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Practitioner.qualification.code	example	v2.0360.2.7 (a valid code from http://terminology.hl7.org/CodeSystem/v2-0360|2.7) http://terminology.hl7.org/ValueSet/v2-2.7-0360 from the FHIR Standard
Practitioner.communication	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard

This structure is derived from USCorePractitionerProfile

Summary

Structures

This structure refers to these other structures:

• PAS Identifier (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-identifier)

Maturity: 3

Other representations of profile: CSV, Excel, Schematron