Da Vinci Payer Data Exchange
2.0.0-ballot - ballot US

This page is part of the Da Vinci Payer Data Exchange (v2.0.0-ballot: STU2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions

US Core Patient

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The US Core Patient profile SHALL be used to express a member’s demographic information.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core Patient profile are:

R4 Element Name Cardinality Type
Patient.us-core-race us-core-race 0..1 (Complex)
Patient.us-core-ethnicity us-core-ethnicity 0..1 (Complex)
Patient.us-core-birthsex us-core-birthsex 0..1 code
Patient.identifier identifier 1..* Identifier
Patient.identifier.system system 1..1 uri
Patient.identifier.value value 1..1 string
Patient.name name 1..* HumanName
Patient.name.family family 0..1 string
Patient.name.given given 0..* string
Patient.telecom telecom 0..* ContactPoint
Patient.telecom.system system 1..1 code
Patient.telecom.value value 1..1 string
Patient.telecom.use use 0..1 code
Patient.gender gender 1..1 code
Patient.birthDate birthDate 0..1 date
Patient.address address 0..* Address
Patient.address.line line 0..* string
Patient.address.city city 0..1 string
Patient.address.state state 0..1 string
Patient.address.postalCode postalCode 0..1 string
Patient.address.period period 0..1 Period
Patient.communication communication 0..* BackboneElement
Patient.communication.language language 1..1 CodeableConcept

Table Definition

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the Patient resource from the CPCDS file are:

US Core Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
- Patient.meta.lastUpdated   0..1 Patient.meta.lastUpdated [{“163”:”Member Demographics Last Updated Date”}]
Patient.us-core-race S 0..1 Patient.us-core-race [{“128”:”Race Code”}]
Patient.us-core-ethnicity S 0..1 Patient.us-core-ethnicity [{“129”:”Ethnicity”}]
Patient.us-core-birthsex S 0..1 Patient.us-core-birthsex [{“153”:”Birth Sex”}]
Patient.identifier S 1..* Patient.identifier [{“MMI=1”:”Member id”}, {“191”:”Unique Member ID”}, {“PatnAcctNr=109, MedRecNr=110”:”Patient account number, Medical record number”}]. Note: Assign Payer System URI for Member Ids in Patient.identifier.system. Set Member Id in Patient.identifier.value
- Patient.identifier.system S 1..1   . Note: Assign Payer System URI for Member Ids in Patient.identifier.system
- Patient.identifier.value S 1..1   . Note: Set Member Id in Patient.identifier.value
Patient.name S 1..* Patient.name [{“130”:”Patient Name”}]. Note: Split Member Name into Patient.name.family, Patient.name.given
- Patient.name.family S 0..1   . Note: Split Member Name into Patient.name.family, Patient.name.given
- Patient.name.given S 0..*   . Note: Split Member Name into Patient.name.family, Patient.name.given
Patient.telecom S 0..*   . Note: Provide contact information from member record, if available
- Patient.telecom.system S 1..1   . Note: phone | fax | email | pager | url | sms | other - if avaiable
- Patient.telecom.value S 1..1   . Note: provide contact information from member record, if available
- Patient.telecom.use S 0..1   . Note: provide home | work | temp | old | mobile if known
Patient.gender S 1..1 Patient.gender [{“71”:”Gender code”}]
Patient.birthDate S 0..1 Patient.birthDate [{“70”:”Date of birth”}]
- Patient.deceasedBoolean     Patient.deceasedBoolean [{“150”:”Deceased”}]
Patient.deceasedDateTime     Patient.deceasedDateTime [{“124”:”Date of death”}]
Patient.address S 0..*   . Note: Provide address elements, if available
- Patient.address.line S 0..* Patient.address.line [{“158”:”Street Address”}]
- Patient.address.city S 0..1   . Note: Provide city, if available
- Patient.address.district   0..1 Patient.address.district [{“125”:”County”}]
- Patient.address.state S 0..1 Patient.address.state [{“126”:”State”}]
- Patient.address.postalCode S 0..1 Patient.address.postalCode [{“131”:”Zip”}]
- Patient.address.country   0..1 Patient.address.country [{“127”:”Country”}]
- Patient.address.period S 0..1   . Note: Provide validity period for address, if available
Patient.communication S 0..*   . Note: Provide preferred communication language via language code below, if available
- Patient.communication.language S 1..1   . Note: Provide preferred communication language, if available

Table Definition

The Member Number will be entered in the identifier field. The code MB SHALL be used to identify the member identifier. See the example below:

{
      "use" : "member",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ],
        "text" : "Health Plan Member Number"
      },
      "system" : "http://plan.healthplan.com",
      "value" : "987654321"
    }

Example Patient Resource

An example mapping of a Patient resource is shown here:

{
  "resourceType" : "Patient",
  "id" : "example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "

			

				Generated Narrative with Details
			

			

				id: example

			

				identifier: Medical Record Number = 1032702 (USUAL)

			

				identifier: Health Plan Member Number = 987654321 (USUAL)

			

				active: true

			

				name: Arthur B. Dent 

			

				telecom: ph: 555-555-5555(HOME), amy.shaw@example.com

			

				gender: 

			

				birthsex: Male

			

				birthDate: Jan 22, 1953

			

				address: 6518 Meadowridge Rd, Elkridge, MD 21075 US 

			

				race: White, American Indian or Alaska Native, Asian, Shoshone, Filipino

			

				ethnicity: Hispanic or Latino, Dominican, Mexican

		
"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2106-3",
            "display" : "White"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1002-5",
            "display" : "American Indian or Alaska Native"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2028-9",
            "display" : "Asian"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1586-7",
            "display" : "Shoshone"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2036-2",
            "display" : "Filipino"
          }
        },
        {
          "url" : "text",
          "valueString" : "Mixed"
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2135-2",
            "display" : "Hispanic or Latino"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2184-0",
            "display" : "Dominican"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2148-5",
            "display" : "Mexican"
          }
        },
        {
          "url" : "text",
          "valueString" : "Hispanic or Latino"
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
      "valueCode" : "M"
    }
  ],
  "identifier" : [
    {
      "use" : "member",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ],
        "text" : "Health Plan Member Number"
      },
      "system" : "http://plan.healthplan.com",
      "value" : "987654321"
    },
    {
      "use" : "usual",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MR",
            "display" : "Medical Record Number"
          }
        ],
        "text" : "Medical Record Number"
      },
      "system" : "http://hospital.smarthealthit.org",
      "value" : "1032702"
    }
  ],
  "active" : true,
  "name" : [
    {
      "family" : "Dent",
      "given" : [
        "Arthur",
        "B."
      ]
    }
  ],
  "telecom" : [
    {
      "system" : "phone",
      "value" : "555-555-5555",
      "use" : "home"
    },
    {
      "system" : "email",
      "value" : "arthur.dent@example.com"
    }
  ],
  "gender" : "male",
  "birthDate" : "1953-01-22",
  "address" : [
    {
      "line" : [
        "6518 Meadowridge Rd"
      ],
      "city" : "Elkridge",
      "state" : "MD",
      "postalCode" : "21075",
      "country" : "US"
    }
  ]
}

Refer to the US Core Additional examples of the US Core R4 Implementation Guide for further examples of completed Patient Profiles .

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