HL7.FHIR.US.DAVINCI-PDEX\US Core Patient

This page is part of the Da Vinci Payer Data Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). 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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