Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm
2.0.0 - STU2 United States of America flag

This page is part of the electronic Long-Term Services and Supports Implementation Guide (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: patientBSJ1 - XML Representation

Page standards status: Informative

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<Patient xmlns="http://hl7.org/fhir">
  <id value="patientBSJ1"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/eltss/StructureDefinition/Patient-eltss"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;"><b>Betsy Smith-Johnson</b> female, DoB: 1950-11-01 ( Medical Record Number/10A3D58WH1600 (use: usual))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Record is active">Active:</td><td>true</td><td style="background-color: #f3f5da" title="Known Marital status of Patient">Marital Status:</td><td colspan="3"><span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}">Not married</span></td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3"><ul><li>ph: 210-222-1111(MOBILE)</li><li>111 Maple Ct, San Antonio, TX 78212</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Language spoken">Language:</td><td colspan="3"><span title="Codes:{urn:ietf:bcp:47 en}">US</span> (preferred)</td></tr><tr><td style="background-color: #f3f5da" title="Patient contact">Contact:</td><td colspan="3"><ul><li>Charles Johnson</li><li>Relationships:<span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode SONC}">Son</span>, <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0131 C}">Emergency Contact</span>, <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode GUARD}">Guardian</span></li><li>100 Montana St., San Antonio, TX 78203</li><li>ph: (210) 222-3333</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Nominated Contact: Daughter">Daughter:</td><td colspan="3"><ul><li>Debra Johnson</li><li>333 W. Camden St., Baltimore, MD 21201</li><li>ph: (410) 444-5555</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality.  The ethnicity codes used to represent these concepts are based upon the [CDC ethnicity and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity.  The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.">US Core Ethnicity Extension:</td><td colspan="3"><ul><li>ombCategory: <a href="http://terminology.hl7.org/5.5.0/CodeSystem-CDCREC.html#CDCREC-2186-5">CDC Race and Ethnicity</a> 2186-5: Not Hispanic or Latino</li><li>text: Not Hispanic or Latino</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality.  The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html#3) which includes over 900 concepts for representing race and ethnicity of which 921 reference race.  The race concepts are grouped by and pre-mapped to the 5 OMB race categories:

 - American Indian or Alaska Native
 - Asian
 - Black or African American
 - Native Hawaiian or Other Pacific Islander
 - White.">US Core Race Extension:</td><td colspan="3"><ul><li>ombCategory: <a href="http://terminology.hl7.org/5.5.0/CodeSystem-CDCREC.html#CDCREC-2106-3">CDC Race and Ethnicity</a> 2106-3: White</li><li>text: White</li></ul></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
    <extension url="ombCategory">
      <valueCoding>
        <system value="urn:oid:2.16.840.1.113883.6.238"/>
        <code value="2106-3"/>
        <display value="White"/>
      </valueCoding>
    </extension>
    <extension url="text">
      <valueString value="White"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity">
    <extension url="ombCategory">
      <valueCoding>
        <system value="urn:oid:2.16.840.1.113883.6.238"/>
        <code value="2186-5"/>
        <display value="Not Hispanic or Latino"/>
      </valueCoding>
    </extension>
    <extension url="text">
      <valueString value="Not Hispanic or Latino"/>
    </extension>
  </extension>
  <identifier>
    <use value="usual"/>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MR"/>
        <display value="Medical Record Number"/>
      </coding>
    </type>
    <system value="http://hl7.org/fhir/sid/us-medicare"/>
    <value value="10A3D58WH1600"/>
  </identifier>
  <active value="true"/>
  <name>
    <text value="Betsy Smith-Johnson"/>
    <family value="Smith-Johnson"/>
    <given value="Betsy"/>
  </name>
  <telecom>
    <system value="phone"/>
    <value value="210-222-1111"/>
    <use value="mobile"/>
  </telecom>
  <gender value="female"/>
  <birthDate value="1950-11-01"/>
  <address>
    <text value="111 Maple Ct, San Antonio, TX 78212"/>
    <line value="111 Maple Ct"/>
    <city value="San Antonio"/>
    <district value="Bexar"/>
    <state value="TX"/>
    <postalCode value="78212"/>
  </address>
  <maritalStatus>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"/>
      <code value="U"/>
      <display value="unmarried"/>
    </coding>
    <text value="Not married"/>
  </maritalStatus>
  <contact>
    <relationship>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
        <code value="SONC"/>
        <display value="Son"/>
      </coding>
    </relationship>
    <relationship>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0131"/>
        <code value="C"/>
        <display value="Emergency Contact"/>
      </coding>
    </relationship>
    <relationship>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
        <code value="GUARD"/>
        <display value="Guardian"/>
      </coding>
    </relationship>
    <name>
      <text value="Charles Johnson"/>
      <family value="Johnson"/>
      <given value="Charles"/>
    </name>
    <telecom>
      <system value="phone"/>
      <value value="(210) 222-3333"/>
    </telecom>
    <address>
      <text value="100 Montana St., San Antonio, TX 78203"/>
    </address>
  </contact>
  <contact>
    <relationship>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
        <code value="DAUC"/>
        <display value="Daughter"/>
      </coding>
    </relationship>
    <name>
      <text value="Debra Johnson"/>
      <family value="Johnson"/>
      <given value="Debra"/>
    </name>
    <telecom>
      <system value="phone"/>
      <value value="(410) 444-5555"/>
    </telecom>
    <address>
      <text value="333 W. Camden St., Baltimore, MD 21201"/>
    </address>
  </contact>
  <communication>
    <language>
      <coding>
        <system value="urn:ietf:bcp:47"/>
        <code value="en"/>
        <display value="English"/>
      </coding>
      <text value="US"/>
    </language>
    <preferred value="true"/>
  </communication>
</Patient>