Vital Records Death Reporting (VRDR) FHIR Implementation Guide
3.0.0-ballot - ballot United States of America flag

This page is part of the Vital Records Death Reporting FHIR Implementation Guide (v3.0.0-ballot: STU 3 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.2.0. For a full list of available versions, see the Directory of published versions

Resource Profile: Decedent - Detailed Descriptions

Draft as of 2024-04-05

Definitions for the vrdr-decedent resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Patient
2. Patient.extension:birthPlace
Slice NamebirthPlace
ShortDecedent birthplace
LOINC Code
4. Patient.extension:birthPlace.value[x]
[x] NoteSee Choice of Data Types for further information about how to use [x]
6. Patient.extension:birthPlace.value[x].state
BindingThe codes SHALL be taken from ValueSet - States, Territories and Provinces Vital Records
(required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
LOINC Code
8. Patient.extension:NVSS-SexAtDeath
Slice NameNVSS-SexAtDeath
ShortNVSS Sex at Death
Control0..1
TypeExtension(NVSS SexAtDeath) (Extension Type: CodeableConcept)
10. Patient.extension:Spouse-Alive
Slice NameSpouse-Alive
ShortSpouse Alive?
Control0..1
TypeExtension(Spouse Is Alive) (Extension Type: CodeableConcept)
12. Patient.identifier:SSN
Slice NameSSN
ShortDecedent's Social Security Number
NoteThis is a business identifier, not a resource identifier (see discussion)
LOINC Code
14. Patient.identifier:SB
Slice NameSB
Short**Deprecated** Decedent's Social Security Number for Compatibility. Use SSN.
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
16. Patient.identifier:SB.type
Control1..?
Pattern Value{
  "coding" : [{
    "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
    "code" : "SB"
  }]
}
18. Patient.birthDate
ShortDate of Birth
LOINC Code
20. Patient.deceased[x]
[x] NoteSee Choice of Data Types for further information about how to use [x]
LOINC Code
SlicingThis element introduces a set of slices on Patient.deceased[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
  • 22. Patient.deceased[x]:deceasedBoolean
    Slice NamedeceasedBoolean
    Control0..1
    Typeboolean
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Pattern Valuetrue
    24. Patient.address
    ShortDecedent's Residence
    LOINC Code
    26. Patient.address.state
    ShortState/Jurisdiction of residence. Provide both state and jurisdiction if different.
    LOINC Code
    28. Patient.address.state.extension
    SlicingThis element introduces a set of slices on Patient.address.state.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 30. Patient.address.state.extension:residenceJurisdictionId
      Slice NameresidenceJurisdictionId
      Control0..1
      TypeExtension(Location Jurisdiction Id Vital Records) (Extension Type: string)
      32. Patient.maritalStatus
      BindingThe codes SHALL be taken from Marital Status Vital Records
      (required to http://hl7.org/fhir/us/vrdr/ValueSet/ValueSet-marital-status-vr)
      LOINC Code
      34. Patient.maritalStatus.extension:bypassEditFlag
      Slice NamebypassEditFlag
      Control0..1
      TypeExtension(Extension - BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
      36. Patient.maritalStatus.extension:bypassEditFlag.value[x]
      BindingThe codes SHALL be taken from Edit Bypass 0124
      (required to http://hl7.org/fhir/us/vrdr/ValueSet/vrdr-edit-bypass-0124-vs)
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      38. Patient.maritalStatus.text
      ShortMarital Description
      40. Patient.contact
      ShortInformant information
      LOINC Code
      42. Patient.contact.relationship
      ShortInformant Relationship (INFORMRELATE)
      Control0..1
      LOINC Code
      44. Patient.contact.relationship.text
      ShortInformant Relationship (INFORMRELATE) - first 30 characters will be used

      Guidance on how to interpret the contents of this table can be found here

      0. Patient
      Definition

      -


      Demographics and other administrative information about an individual or animal receiving care or other health-related services.

      ShortInformation about an individual or animal receiving health care services
      Comments

      -

      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate NamesSubjectOfCare Client Resident
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      us-core-6: Either Patient.name.given and/or Patient.name.family SHALL be present or a Data Absent Reason Extension SHALL be present. ((name.family.exists() or name.given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists())
      2. Patient.implicitRules
      Definition

      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

      ShortA set of rules under which this content was created
      Comments

      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      4. Patient.extension:race
      Slice Namerace
      Definition

      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 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.
      ShortUS Core Race Extension
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(US Core Race Extension) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      LOINC Code
      6. Patient.extension:ethnicity
      Slice Nameethnicity
      Definition

      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 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.

      ShortUS Core ethnicity Extension
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(US Core Ethnicity Extension) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      LOINC Code
      8. Patient.extension:birthsex
      Slice Namebirthsex
      Definition

      A code classifying the person's sex assigned at birth as specified by the Office of the National Coordinator for Health IT (ONC).

      ShortExtension
      Comments

      The codes required are intended to present birth sex (i.e., the sex recorded on the patient’s birth certificate) and not gender identity or reassigned sex.

      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(US Core Birth Sex Extension) (Extension Type: code)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      LOINC Code
      10. Patient.extension:genderIdentity
      Slice NamegenderIdentity
      Definition

      An Extension

      ShortExtension
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(US Core Gender Identity Extension) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      LOINC Code
      12. Patient.extension:birthPlace
      Slice NamebirthPlace
      Definition

      The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements.

      ShortDecedent birthplace
      Control0..1
      TypeExtension(Birth Place) (Extension Type: Address)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      LOINC Code
      14. Patient.extension:birthPlace.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Patient.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Patient.extension:birthPlace.url
        Definition

        Source of the definition for the extension code - a logical name or a URL.

        Shortidentifies the meaning of the extension
        Comments

        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/patient-birthPlace
        18. Patient.extension:birthPlace.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        TypeAddress, date, Meta, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Patient.extension:birthPlace.value[x].use
        Definition

        The purpose of this address.

        Shorthome | work | temp | old | billing - purpose of this address
        Comments

        Applications can assume that an address is current unless it explicitly says that it is temporary or old.

        Control0..1
        BindingThe codes SHALL be taken from AddressUsehttp://hl7.org/fhir/ValueSet/address-use|4.0.1
        (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

        The use of an address.

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows an appropriate address to be chosen from a list of many.

        Example<br/><b>General</b>:home
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Patient.extension:birthPlace.value[x].state
        Definition

        Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

        ShortSub-unit of country (abbreviations ok)
        Control0..1
        BindingThe codes SHALL be taken from For codes, see ValueSet - States, Territories and Provinces Vital Records
        (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Alternate NamesProvince, Territory
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. Patient.extension:parentReportedAgeAtDelivery
        Slice NameparentReportedAgeAtDelivery
        Definition

        This Extension profile represents the reported age of the parent at the delivery time of the newborn or fetus. A required code indicates whether the mother or father's age is provided. It can optionally contain a reference to the reporter (US Core Patient Profile or US Core RelatedPerson Profile).

        ShortExtension - Reported Parent Age at Delivery - Vital Records
        Control0..2
        TypeExtension(Extension - Reported Parent Age At Delivery - Vital Records) (Complex Extension)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        LOINC Code
        26. Patient.extension:fetalDeath
        Slice NamefetalDeath
        Definition

        An indicator that the status of the patient is fetal death.

        Shortfetal-death
        Control0..1
        TypeExtension(Extension - Patient Fetal Death - Vital Records) (Extension Type: Coding)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        LOINC Code
        28. Patient.extension:NVSS-SexAtDeath
        Slice NameNVSS-SexAtDeath
        Definition

        An Extension

        ShortNVSS Sex at Death
        Control0..1
        TypeExtension(NVSS SexAtDeath) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        LOINC Code
        30. Patient.extension:Spouse-Alive
        Slice NameSpouse-Alive
        Definition

        An Extension

        ShortSpouse Alive?
        Control0..1
        TypeExtension(Spouse Is Alive) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        LOINC Code
        32. Patient.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        34. Patient.identifier
        Definition

        An identifier for this patient.

        ShortAn identifier for this patient
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..*
        TypeIdentifier
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Patients are almost always assigned specific numerical identifiers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Patient.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • pattern @ type
        • 36. Patient.identifier:MRN
          Slice NameMRN
          Definition

          An identifier for this patient.

          ShortMedical Record NumberAn identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Patients are almost always assigned specific numerical identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. Patient.identifier:MRN.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control0..1
          BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

          Identifies the purpose for this identifier, if known .

          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. Patient.identifier:MRN.type
          Definition

          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

          ShortDescription of identifier
          Comments

          This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

          Control10..1
          BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
          (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

          A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows users to make use of identifiers when the identifier system is not known.

          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code" : "MR"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          42. Patient.identifier:MRN.system
          Definition

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          ShortThe namespace for the identifier value
          Comments

          Identifier.system is always case sensitive.

          Control10..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. Patient.identifier:MRN.value
          Definition

          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

          ShortThe value that is unique within the system.
          Comments

          If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

          Control10..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Example<br/><b>General</b>:123456
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. Patient.identifier:SSN
          Slice NameSSN
          Definition

          An identifier for this patient.

          ShortDecedent's Social Security NumberAn identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..1*
          TypeIdentifier
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Patients are almost always assigned specific numerical identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. Patient.identifier:SSN.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control0..1
          BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

          Identifies the purpose for this identifier, if known .

          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. Patient.identifier:SSN.type
          Definition

          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

          ShortDescription of identifier
          Comments

          This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

          Control10..1
          BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
          (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

          A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows users to make use of identifiers when the identifier system is not known.

          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code" : "SS"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Patient.identifier:SSN.system
          Definition

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          ShortThe namespace for the identifier value
          Comments

          Identifier.system is always case sensitive.

          Control10..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

          Pattern Valuehttp://hl7.org/fhir/sid/us-ssn
          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. Patient.identifier:SSN.value
          Definition

          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

          ShortThe value that is unique within the system.
          Comments

          If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

          Control10..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Example<br/><b>General</b>:123456
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. Patient.identifier:SB
          Slice NameSB
          Definition

          An identifier for this patient.

          Short**Deprecated** Decedent's Social Security Number for Compatibility. Use SSN.An identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..1*
          TypeIdentifier
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Patients are almost always assigned specific numerical identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. Patient.identifier:SB.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control0..1
          BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

          Identifies the purpose for this identifier, if known .

          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. Patient.identifier:SB.type
          Definition

          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

          ShortDescription of identifier
          Comments

          This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

          Control10..1
          BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
          (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

          A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows users to make use of identifiers when the identifier system is not known.

          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code" : "SB"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          62. Patient.active
          Definition

          Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

          It is often used to filter patient lists to exclude inactive patients

          Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

          ShortWhether this patient's record is in active use
          Comments

          If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

          Control0..1
          Typeboolean
          Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to be able to mark a patient record as not to be used because it was created in error.

          Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          64. Patient.name
          Definition

          A name associated with the individual.

          ShortA name associated with the patient
          Comments

          A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

          Control10..*
          TypeHumanName
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Patient.name. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ use
          • 66. Patient.name.use
            Definition

            Identifies the purpose for this name.

            Shortusual | official | temp | nickname | anonymous | old | maiden
            Comments

            Applications can assume that a name is current unless it explicitly says that it is temporary or old.

            Control10..1
            BindingThe codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

            The use of a human name.

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate name for a particular context of use to be selected from among a set of names.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. Patient.name.family
            Definition

            The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

            ShortFamily name (often called 'Surname')
            Comments

            Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

            Control10..1
            This element is affected by the following invariants: us-core-6
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate Namessurname
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            70. Patient.name.family.extension:dataAbsentReason
            Slice NamedataAbsentReason
            Definition

            Provides a reason why the expected value or elements in the element that is extended are missing.

            Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Why value is missing) (Extension Type: code)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            LOINC Code
            72. Patient.name.given
            Definition

            Given name.

            ShortGiven names (not always 'first'). Includes middle names
            Comments

            If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

            Control0..*
            This element is affected by the following invariants: us-core-6
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate Namesfirst name, middle name
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            74. Patient.name.given.extension:dataAbsentReason
            Slice NamedataAbsentReason
            Definition

            Provides a reason why the expected value or elements in the element that is extended are missing.

            Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Why value is missing) (Extension Type: code)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            LOINC Code
            76. Patient.name:currentLegalName
            Slice NamecurrentLegalName
            Definition

            A name associated with the individual.

            Shortcurrent legal nameA name associated with the patient
            Comments

            A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

            Control0..1*
            TypeHumanName
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            78. Patient.name:currentLegalName.use
            Definition

            Identifies the purpose for this name.

            Shortusual | official | temp | nickname | anonymous | old | maiden
            Comments

            Applications can assume that a name is current unless it explicitly says that it is temporary or old.

            Control10..1
            BindingThe codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

            The use of a human name.

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate name for a particular context of use to be selected from among a set of names.

            Fixed Valueofficial
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            80. Patient.name:currentLegalName.family
            Definition

            The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

            ShortFamily name (often called 'Surname')
            Comments

            Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

            Control10..1
            This element is affected by the following invariants: us-core-6
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate Namessurname
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            82. Patient.name:currentLegalName.given
            Definition

            Given name.

            ShortGiven names (not always 'first'). Includes middle names
            Comments

            If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

            Control0..*
            This element is affected by the following invariants: us-core-6
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate Namesfirst name, middle name
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            84. Patient.name:namePriorToFirstMarriage
            Slice NamenamePriorToFirstMarriage
            Definition

            A name associated with the individual.

            ShortName prior to first marriageA name associated with the patient
            Comments

            A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

            Control0..1*
            TypeHumanName
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            86. Patient.name:namePriorToFirstMarriage.use
            Definition

            Identifies the purpose for this name.

            Shortusual | official | temp | nickname | anonymous | old | maiden
            Comments

            Applications can assume that a name is current unless it explicitly says that it is temporary or old.

            Control10..1
            BindingThe codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

            The use of a human name.

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate name for a particular context of use to be selected from among a set of names.

            Fixed Valuemaiden
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            88. Patient.name:namePriorToFirstMarriage.family
            Definition

            The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

            ShortFamily name (often called 'Surname')
            Comments

            Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

            Control10..1
            This element is affected by the following invariants: us-core-6
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate Namessurname
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            90. Patient.name:namePriorToFirstMarriage.given
            Definition

            Given name.

            ShortGiven names (not always 'first'). Includes middle names
            Comments

            If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

            Control0..*
            This element is affected by the following invariants: us-core-6
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate Namesfirst name, middle name
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            92. Patient.telecom
            Definition

            A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

            ShortA contact detail for the individual
            Comments

            A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

            Control0..*
            TypeContactPoint
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Requirements

            People have (primary) ways to contact them in some way such as phone, email.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            94. Patient.telecom.system
            Definition

            Telecommunications form for contact point - what communications system is required to make use of the contact.

            Shortphone | fax | email | pager | url | sms | other
            Control10..1
            This element is affected by the following invariants: cpt-2
            BindingThe codes SHALL be taken from ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
            (required to http://hl7.org/fhir/ValueSet/contact-point-system)

            Telecommunications form for contact point.

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            96. Patient.telecom.value
            Definition

            The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

            ShortThe actual contact point details
            Comments

            Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

            Control10..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to support legacy numbers that are not in a tightly controlled format.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            98. Patient.telecom.use
            Definition

            Identifies the purpose for the contact point.

            Shorthome | work | temp | old | mobile - purpose of this contact point
            Comments

            Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

            Control0..1
            BindingThe codes SHALL be taken from ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/contact-point-use)
            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            100. Patient.gender
            Definition

            Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

            Shortmale | female | other | unknown
            Comments

            The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

            Control10..1
            BindingThe codes SHALL be taken from AdministrativeGenderhttp://hl7.org/fhir/ValueSet/administrative-gender|4.0.1
            (required to http://hl7.org/fhir/ValueSet/administrative-gender)
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Needed for identification of the individual, in combination with (at least) name and birth date.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            102. Patient.birthDate
            Definition

            The date of birth for the individual.

            ShortDate of BirthThe date of birth for the individual
            Comments

            At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

            Control0..1
            Typedate
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Age of the individual drives many clinical processes.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            LOINC Code21112-8
            104. Patient.birthDate.extension:partialDateTime
            Slice NamepartialDateTime
            Definition

            Alternative component representation of partial date and time. See [note on birth date and time].

            ShortpartialDateTIme
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Extension - Partial Date Time Vital Records) (Complex Extension)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            LOINC Code
            106. Patient.birthDate.extension:birthTime
            Slice NamebirthTime
            Definition

            The time of day that the Patient was born. This includes the date to ensure that the timezone information can be communicated effectively.

            ShortTime of day of birth
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Birth Time) (Extension Type: dateTime)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            LOINC Code
            108. Patient.birthDate.extension:bypassEditFlag
            Slice NamebypassEditFlag
            Definition

            Extension to hold a codeable concept from one of several valuesets.

            ShortExtension - BypassEditFlag Vital Records
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Extension - BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            LOINC Code
            110. Patient.birthDate.extension:bypassEditFlag.extension
            Definition

            An Extension


            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortExtensionAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..0*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on Patient.birthDate.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 112. Patient.birthDate.extension:bypassEditFlag.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Shortidentifies the meaning of the extension
              Comments

              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

              Control1..1
              Typeuri
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Fixed Valuehttp://hl7.org/fhir/us/vr-common-library/StructureDefinition/BypassEditFlag
              114. Patient.birthDate.extension:bypassEditFlag.value[x]
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              ShortTo reflect the relevant edit possibilities for date of birth.Value of extension
              Control10..1
              BindingThe codes SHALL be taken from For codes, see ValueSet - Mothers Date of Birth Edit Flags (NCHS) Vital Records
              (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-mothers-date-of-birth-edit-flags-vr)

              Date of Birth Edit Flags (NCHS)

              TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              116. Patient.deceased[x]
              Definition

              Indicates if the individual is deceased or not.

              ShortIndicates if the individual is deceased or not
              Comments

              If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

              Control0..1
              TypeChoice of: boolean, dateTime
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Patient.deceased[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • type @ $this
              • 118. Patient.deceased[x]:deceasedBoolean
                Slice NamedeceasedBoolean
                Definition

                Indicates if the individual is deceased or not.

                ShortIndicates if the individual is deceased or not
                Comments

                If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

                Control0..1
                Typeboolean, dateTime
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

                Pattern Valuetrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                120. Patient.address
                Definition

                An address for the individual.

                ShortDecedent's ResidenceAn address for the individual
                Comments

                Patient may have multiple addresses with different uses or applicable periods.

                Control0..*
                TypeAddress
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                122. Patient.address.extension:withinCityLimitsIndicator
                Slice NamewithinCityLimitsIndicator
                Definition

                Used to indicate whether or not an address is within city limits.

                ShortUsed to indicate whether or not an address is within city limits.
                Control0..1
                TypeExtension(Extension - Within City Limits Indicator Vital Records) (Extension Type: Coding)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                124. Patient.address.extension:predir
                Slice Namepredir
                Definition

                PreDirectional component of address as defined by USPS

                ShortExtension - PreDirectional Vital Records
                Control0..1
                TypeExtension(Extension - PreDirectional Vital Records) (Extension Type: string)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                126. Patient.address.extension:stnum
                Slice Namestnum
                Definition

                StreetNumber component of address as defined by USPS

                ShortExtension - StreetNumber Vital Records
                Control0..1
                TypeExtension(Extension - StreetNumber Vital Records) (Extension Type: string)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                128. Patient.address.extension:stname
                Slice Namestname
                Definition

                StreetName component of address as defined by USPS

                ShortExtension - StreetName Vital Records
                Control0..1
                TypeExtension(Extension - StreetName Vital Records) (Extension Type: string)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                130. Patient.address.extension:stdesig
                Slice Namestdesig
                Definition

                StreetDesignator component of address as defined by USPS

                ShortExtension - StreetDesignator Vital Records
                Control0..1
                TypeExtension(Extension - StreetDesignator Vital Records) (Extension Type: string)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                132. Patient.address.extension:postdir
                Slice Namepostdir
                Definition

                PostDirectional component of address as defined by USPS

                ShortExtension - PostDirectional Vital Records
                Control0..1
                TypeExtension(Extension - PostDirectional Vital Records) (Extension Type: string)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                134. Patient.address.extension:unitnumber
                Slice Nameunitnumber
                Definition

                UnitOrAptNumber component of address as defined by USPS

                ShortExtension - UnitOrAptNumber Vital Records
                Control0..1
                TypeExtension(Extension - UnitOrAptNumber Vital Records) (Extension Type: string)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                136. Patient.address.use
                Definition

                The purpose of this address.

                Shorthome | work | temp | old | billing - purpose of this address
                Comments

                Applications can assume that an address is current unless it explicitly says that it is temporary or old.

                Control0..1
                BindingThe codes SHALL be taken from AddressUsehttp://hl7.org/fhir/ValueSet/address-use|4.0.1
                (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

                The use of an address.

                Typecode
                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Allows an appropriate address to be chosen from a list of many.

                Example<br/><b>General</b>:home
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                138. Patient.address.line
                Definition

                This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

                ShortStreet name, number, direction & P.O. Box etc.
                Control0..*
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Example<br/><b>General</b>:137 Nowhere Street
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                140. Patient.address.city
                Definition

                The name of the city, town, suburb, village or other community or delivery center.

                ShortName of city, town etc.
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Alternate NamesMunicpality
                Example<br/><b>General</b>:Erewhon
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                142. Patient.address.city.extension:cityCode
                Slice NamecityCode
                Definition

                Numeric code from in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

                ShortCity Code
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Extension - City Code Vital Records) (Extension Type: positiveInt)
                Is Modifierfalse
                LabelCity Code
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                144. Patient.address.state
                Definition

                Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

                ShortState/Jurisdiction of residence. Provide both state and jurisdiction if different.Sub-unit of country (abbreviations ok)
                Control0..1
                BindingThe codes SHALL be taken from For codes, see ValueSet - States, Territories and Provinces Vital Records
                (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Alternate NamesProvince, Territory
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                146. Patient.address.state.extension
                Definition

                An Extension


                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortExtensionAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on Patient.address.state.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 148. Patient.address.state.extension:residenceJurisdictionId
                  Slice NameresidenceJurisdictionId
                  Definition

                  An Extension

                  ShortExtension
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Location Jurisdiction Id Vital Records) (Extension Type: string)
                  Is Modifierfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  LOINC Code
                  150. Patient.address.postalCode
                  Definition

                  A postal code designating a region defined by the postal service.

                  ShortUS Zip CodesPostal code for area
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Alternate NamesZip, Zip Code
                  Example<br/><b>General</b>:9132
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  152. Patient.address.period
                  Definition

                  Time period when address was/is in use.

                  ShortTime period when address was/is in use
                  Control0..1
                  TypePeriod
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Allows addresses to be placed in historical context.

                  Example<br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  154. Patient.maritalStatus
                  Definition

                  This field contains a patient's most recent marital (civil) status.

                  ShortMarital (civil) status of a patient
                  Control0..1
                  BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from Marital Status Vital Recordshttp://hl7.org/fhir/ValueSet/marital-status
                  (required to http://hl7.org/fhir/us/vrdr/ValueSet/ValueSet-marital-status-vr)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Most, if not all systems capture it.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  156. Patient.maritalStatus.extension:bypassEditFlag
                  Slice NamebypassEditFlag
                  Definition

                  Extension to hold a codeable concept from one of several valuesets.

                  ShortExtension - BypassEditFlag Vital Records
                  Control0..1
                  TypeExtension(Extension - BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  LOINC Code
                  158. Patient.maritalStatus.extension:bypassEditFlag.extension
                  Definition

                  An Extension


                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortExtensionAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..0*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Patient.maritalStatus.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 160. Patient.maritalStatus.extension:bypassEditFlag.url
                    Definition

                    Source of the definition for the extension code - a logical name or a URL.

                    Shortidentifies the meaning of the extension
                    Comments

                    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                    Control1..1
                    Typeuri
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    Fixed Valuehttp://hl7.org/fhir/us/vr-common-library/StructureDefinition/BypassEditFlag
                    162. Patient.maritalStatus.extension:bypassEditFlag.value[x]
                    Definition

                    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                    ShortValue of extension
                    Control10..1
                    BindingThe codes SHALL be taken from For codes, see Edit Bypass 0124
                    (required to http://hl7.org/fhir/us/vrdr/ValueSet/vrdr-edit-bypass-0124-vs)
                    TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    164. Patient.maritalStatus.text
                    Definition

                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                    ShortMarital DescriptionPlain text representation of the concept
                    Comments

                    Very often the text is the same as a displayName of one of the codings.

                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    166. Patient.contact
                    Definition

                    A contact party (e.g. guardian, partner, friend) for the patient.

                    ShortInformant informationA contact party (e.g. guardian, partner, friend) for the patient
                    Comments

                    Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to track people you can contact about the patient.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                    pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                    168. Patient.contact.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    170. Patient.contact.relationship
                    Definition

                    The nature of the relationship between the patient and the contact person.

                    ShortInformant Relationship (INFORMRELATE)The kind of relationship
                    Control0..1*
                    BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationshiphttp://hl7.org/fhir/ValueSet/patient-contactrelationship
                    (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

                    The nature of the relationship between a patient and a contact person for that patient.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Used to determine which contact person is the most relevant to approach, depending on circumstances.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    172. Patient.contact.relationship.text
                    Definition

                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                    ShortInformant Relationship (INFORMRELATE) - first 30 characters will be usedPlain text representation of the concept
                    Comments

                    Very often the text is the same as a displayName of one of the codings.

                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    174. Patient.communication
                    Definition

                    A language which may be used to communicate with the patient about his or her health.

                    ShortA language which may be used to communicate with the patient about his or her health
                    Comments

                    If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Requirements

                    If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    176. Patient.communication.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    178. Patient.communication.language
                    Definition

                    The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.

                    ShortThe language which can be used to communicate with the patient about his or her health
                    Comments

                    The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

                    Control1..1
                    BindingUnless not suitable, these codes SHALL be taken from The codes SHOULD be taken from Language codes with language and optionally a region modifierhttp://hl7.org/fhir/ValueSet/languages
                    (extensible to http://hl7.org/fhir/us/core/ValueSet/simple-language)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    180. Patient.link
                    Definition

                    Link to another patient resource that concerns the same actual patient.

                    ShortLink to another patient resource that concerns the same actual person
                    Comments

                    There is no assumption that linked patient records have mutual links.

                    Control0..*
                    TypeBackboneElement
                    Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
                    Summarytrue
                    Requirements

                    There are multiple use cases:

                    • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
                    • Distribution of patient information across multiple servers.
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    182. Patient.link.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    184. Patient.link.other
                    Definition

                    The other patient resource that the link refers to.

                    ShortThe other patient or related person resource that the link refers to
                    Comments

                    Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

                    Control1..1
                    TypeReference(Patient, RelatedPerson)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    186. Patient.link.type
                    Definition

                    The type of link between this patient resource and another patient resource.

                    Shortreplaced-by | replaces | refer | seealso
                    Control1..1
                    BindingThe codes SHALL be taken from LinkTypehttp://hl7.org/fhir/ValueSet/link-type|4.0.1
                    (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

                    The type of link between this patient resource and another patient resource.

                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                    Guidance on how to interpret the contents of this table can be found here

                    0. Patient
                    Definition

                    -

                    ShortInformation about an individual or animal receiving health care services
                    Comments

                    -

                    Control0..*
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Alternate NamesSubjectOfCare Client Resident
                    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                    dom-6: A resource should have narrative for robust management (text.`div`.exists())
                    us-core-6: Either Patient.name.given and/or Patient.name.family SHALL be present or a Data Absent Reason Extension SHALL be present. ((name.family.exists() or name.given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists())
                    2. Patient.id
                    Definition

                    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                    ShortLogical id of this artifact
                    Comments

                    The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                    Control0..1
                    Typeid
                    Is Modifierfalse
                    Summarytrue
                    4. Patient.meta
                    Definition

                    The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                    ShortMetadata about the resource
                    Control0..1
                    TypeMeta
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    6. Patient.implicitRules
                    Definition

                    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                    ShortA set of rules under which this content was created
                    Comments

                    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                    Control0..1
                    Typeuri
                    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    8. Patient.language
                    Definition

                    The base language in which the resource is written.

                    ShortLanguage of the resource content
                    Comments

                    Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                    Control0..1
                    BindingThe codes SHOULD be taken from CommonLanguages
                    (preferred to http://hl7.org/fhir/ValueSet/languages)

                    A human language.

                    Additional BindingsPurpose
                    AllLanguagesMax Binding
                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    10. Patient.text
                    Definition

                    A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                    ShortText summary of the resource, for human interpretation
                    Comments

                    Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                    Control0..1
                    TypeNarrative
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesnarrative, html, xhtml, display
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    12. Patient.contained
                    Definition

                    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                    ShortContained, inline Resources
                    Comments

                    This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                    Control0..*
                    TypeResource
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesinline resources, anonymous resources, contained resources
                    14. Patient.extension
                    Definition

                    An Extension

                    ShortExtension
                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    SlicingThis element introduces a set of slices on Patient.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 16. Patient.extension:race
                      Slice Namerace
                      Definition

                      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 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.
                      ShortUS Core Race Extension
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(US Core Race Extension) (Complex Extension)
                      Is Modifierfalse
                      Must Supportfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      18. Patient.extension:ethnicity
                      Slice Nameethnicity
                      Definition

                      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 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.

                      ShortUS Core ethnicity Extension
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(US Core Ethnicity Extension) (Complex Extension)
                      Is Modifierfalse
                      Must Supportfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      20. Patient.extension:birthsex
                      Slice Namebirthsex
                      Definition

                      A code classifying the person's sex assigned at birth as specified by the Office of the National Coordinator for Health IT (ONC).

                      ShortExtension
                      Comments

                      The codes required are intended to present birth sex (i.e., the sex recorded on the patient’s birth certificate) and not gender identity or reassigned sex.

                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(US Core Birth Sex Extension) (Extension Type: code)
                      Is Modifierfalse
                      Must Supportfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      22. Patient.extension:genderIdentity
                      Slice NamegenderIdentity
                      Definition

                      An Extension

                      ShortExtension
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(US Core Gender Identity Extension) (Extension Type: CodeableConcept)
                      Is Modifierfalse
                      Must Supportfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      24. Patient.extension:birthPlace
                      Slice NamebirthPlace
                      Definition

                      The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements.

                      ShortDecedent birthplace
                      Control0..1
                      TypeExtension(Birth Place) (Extension Type: Address)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      26. Patient.extension:birthPlace.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      28. Patient.extension:birthPlace.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control0..0
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on Patient.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 30. Patient.extension:birthPlace.url
                        Definition

                        Source of the definition for the extension code - a logical name or a URL.

                        Shortidentifies the meaning of the extension
                        Comments

                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/patient-birthPlace
                        32. Patient.extension:birthPlace.value[x]
                        Definition

                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                        ShortValue of extension
                        Control1..1
                        TypeAddress
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        34. Patient.extension:birthPlace.value[x].id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        36. Patient.extension:birthPlace.value[x].extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                        ShortAdditional content defined by implementations
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on Patient.extension.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 38. Patient.extension:birthPlace.value[x].use
                          Definition

                          The purpose of this address.

                          Shorthome | work | temp | old | billing - purpose of this address
                          Comments

                          Applications can assume that an address is current unless it explicitly says that it is temporary or old.

                          Control0..1
                          BindingThe codes SHALL be taken from AddressUse
                          (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

                          The use of an address.

                          Typecode
                          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Allows an appropriate address to be chosen from a list of many.

                          Example<br/><b>General</b>:home
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          40. Patient.extension:birthPlace.value[x].type
                          Definition

                          Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

                          Shortpostal | physical | both
                          Comments

                          The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

                          Control0..1
                          BindingThe codes SHALL be taken from AddressType
                          (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1)

                          The type of an address (physical / postal).

                          Typecode
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Example<br/><b>General</b>:both
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          42. Patient.extension:birthPlace.value[x].text
                          Definition

                          Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

                          ShortText representation of the address
                          Comments

                          Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          A renderable, unencoded form.

                          Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          44. Patient.extension:birthPlace.value[x].line
                          Definition

                          This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

                          ShortStreet name, number, direction & P.O. Box etc.
                          Control0..*
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Example<br/><b>General</b>:137 Nowhere Street
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          46. Patient.extension:birthPlace.value[x].city
                          Definition

                          The name of the city, town, suburb, village or other community or delivery center.

                          ShortName of city, town etc.
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Alternate NamesMunicpality
                          Example<br/><b>General</b>:Erewhon
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          48. Patient.extension:birthPlace.value[x].city.id
                          Definition

                          unique id for the element within a resource (for internal references)

                          Shortxml:id (or equivalent in JSON)
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          50. Patient.extension:birthPlace.value[x].city.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on Patient.extension.value[x].city.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 52. Patient.extension:birthPlace.value[x].city.extension:cityCode
                            Slice NamecityCode
                            Definition

                            Numeric code in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

                            ShortExtension - City Code Vital Records
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Extension - City Code Vital Records) (Extension Type: positiveInt)
                            Is Modifierfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            54. Patient.extension:birthPlace.value[x].city.value
                            Definition

                            The actual value

                            ShortPrimitive value for string
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Max Length1048576
                            56. Patient.extension:birthPlace.value[x].district
                            Definition

                            The name of the administrative area (county).

                            ShortDistrict name (aka county)
                            Comments

                            District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

                            Control0..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Alternate NamesCounty
                            Example<br/><b>General</b>:Madison
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            58. Patient.extension:birthPlace.value[x].district.id
                            Definition

                            unique id for the element within a resource (for internal references)

                            Shortxml:id (or equivalent in JSON)
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            60. Patient.extension:birthPlace.value[x].district.extension
                            Definition

                            An Extension

                            ShortExtension
                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on Patient.extension.value[x].district.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 62. Patient.extension:birthPlace.value[x].district.extension:districtCode
                              Slice NamedistrictCode
                              Definition

                              Numeric code in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

                              ShortCounty code
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Extension - District Code Vital Records) (Extension Type: positiveInt)
                              Is Modifierfalse
                              LabelCounty code
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              64. Patient.extension:birthPlace.value[x].district.value
                              Definition

                              The actual value

                              ShortPrimitive value for string
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              Max Length1048576
                              66. Patient.extension:birthPlace.value[x].state
                              Definition

                              Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

                              ShortSub-unit of country (abbreviations ok)
                              Control0..1
                              BindingThe codes SHALL be taken from ValueSet - States, Territories and Provinces Vital Records
                              (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Alternate NamesProvince, Territory
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              68. Patient.extension:birthPlace.value[x].postalCode
                              Definition

                              A postal code designating a region defined by the postal service.

                              ShortPostal code for area
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Alternate NamesZip
                              Example<br/><b>General</b>:9132
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              70. Patient.extension:birthPlace.value[x].country
                              Definition

                              Country - a nation as commonly understood or generally accepted.

                              ShortCountry (e.g. can be ISO 3166 2 or 3 letter code)
                              Comments

                              ISO 3166 3 letter codes can be used in place of a human readable country name.

                              Control0..1
                              BindingThe codes SHALL be taken from ValueSet - Birthplace Country Vital Records
                              (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-birthplace-country-vr)
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              72. Patient.extension:birthPlace.value[x].period
                              Definition

                              Time period when address was/is in use.

                              ShortTime period when address was/is in use
                              Control0..1
                              TypePeriod
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows addresses to be placed in historical context.

                              Example<br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" }
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              74. Patient.extension:parentReportedAgeAtDelivery
                              Slice NameparentReportedAgeAtDelivery
                              Definition

                              This Extension profile represents the reported age of the parent at the delivery time of the newborn or fetus. A required code indicates whether the mother or father's age is provided. It can optionally contain a reference to the reporter (US Core Patient Profile or US Core RelatedPerson Profile).

                              ShortExtension - Reported Parent Age at Delivery - Vital Records
                              Control0..2
                              TypeExtension(Extension - Reported Parent Age At Delivery - Vital Records) (Complex Extension)
                              Is Modifierfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              76. Patient.extension:fetalDeath
                              Slice NamefetalDeath
                              Definition

                              An indicator that the status of the patient is fetal death.

                              Shortfetal-death
                              Control0..1
                              TypeExtension(Extension - Patient Fetal Death - Vital Records) (Extension Type: Coding)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              78. Patient.extension:NVSS-SexAtDeath
                              Slice NameNVSS-SexAtDeath
                              Definition

                              An Extension

                              ShortNVSS Sex at Death
                              Control0..1
                              TypeExtension(NVSS SexAtDeath) (Extension Type: CodeableConcept)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              80. Patient.extension:Spouse-Alive
                              Slice NameSpouse-Alive
                              Definition

                              An Extension

                              ShortSpouse Alive?
                              Control0..1
                              TypeExtension(Spouse Is Alive) (Extension Type: CodeableConcept)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              82. Patient.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                              Summaryfalse
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              84. Patient.identifier
                              Definition

                              An identifier for this patient.

                              ShortAn identifier for this patient
                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control1..*
                              TypeIdentifier
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Patients are almost always assigned specific numerical identifiers.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on Patient.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
                              • pattern @ type
                              • 86. Patient.identifier:MRN
                                Slice NameMRN
                                Definition

                                An identifier for this patient.

                                ShortMedical Record Number
                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..*
                                TypeIdentifier
                                Is Modifierfalse
                                Must Supporttrue
                                Summarytrue
                                Requirements

                                Patients are almost always assigned specific numerical identifiers.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                88. Patient.identifier:MRN.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                90. Patient.identifier:MRN.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                SlicingThis element introduces a set of slices on Patient.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 92. Patient.identifier:MRN.use
                                  Definition

                                  The purpose of this identifier.

                                  Shortusual | official | temp | secondary | old (If known)
                                  Comments

                                  Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                  Control0..1
                                  BindingThe codes SHALL be taken from IdentifierUse
                                  (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                  Identifies the purpose for this identifier, if known .

                                  Typecode
                                  Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  94. Patient.identifier:MRN.type
                                  Definition

                                  A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                  ShortDescription of identifier
                                  Comments

                                  This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                  Control1..1
                                  BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                  (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                  A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Allows users to make use of identifiers when the identifier system is not known.

                                  Pattern Value{
                                    "coding" : [{
                                      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                      "code" : "MR"
                                    }]
                                  }
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  96. Patient.identifier:MRN.system
                                  Definition

                                  Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                  ShortThe namespace for the identifier value
                                  Comments

                                  Identifier.system is always case sensitive.

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summarytrue
                                  Requirements

                                  There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                  Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  98. Patient.identifier:MRN.value
                                  Definition

                                  The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                  ShortThe value that is unique within the system.
                                  Comments

                                  If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                  Control1..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summarytrue
                                  Example<br/><b>General</b>:123456
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  100. Patient.identifier:MRN.period
                                  Definition

                                  Time period during which identifier is/was valid for use.

                                  ShortTime period when id is/was valid for use
                                  Control0..1
                                  TypePeriod
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  102. Patient.identifier:MRN.assigner
                                  Definition

                                  Organization that issued/manages the identifier.

                                  ShortOrganization that issued id (may be just text)
                                  Comments

                                  The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                  Control0..1
                                  TypeReference(Organization)
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  104. Patient.identifier:SSN
                                  Slice NameSSN
                                  Definition

                                  An identifier for this patient.

                                  ShortDecedent's Social Security Number
                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Control0..1
                                  TypeIdentifier
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Requirements

                                  Patients are almost always assigned specific numerical identifiers.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  106. Patient.identifier:SSN.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  108. Patient.identifier:SSN.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  SlicingThis element introduces a set of slices on Patient.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 110. Patient.identifier:SSN.use
                                    Definition

                                    The purpose of this identifier.

                                    Shortusual | official | temp | secondary | old (If known)
                                    Comments

                                    Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                    Control0..1
                                    BindingThe codes SHALL be taken from IdentifierUse
                                    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                    Identifies the purpose for this identifier, if known .

                                    Typecode
                                    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    112. Patient.identifier:SSN.type
                                    Definition

                                    A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                    ShortDescription of identifier
                                    Comments

                                    This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                    (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                    A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    Allows users to make use of identifiers when the identifier system is not known.

                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                        "code" : "SS"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    114. Patient.identifier:SSN.system
                                    Definition

                                    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                    ShortThe namespace for the identifier value
                                    Comments

                                    Identifier.system is always case sensitive.

                                    Control1..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                    Pattern Valuehttp://hl7.org/fhir/sid/us-ssn
                                    Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    116. Patient.identifier:SSN.value
                                    Definition

                                    The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                    ShortThe value that is unique within the system.
                                    Comments

                                    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                    Control1..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Example<br/><b>General</b>:123456
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    118. Patient.identifier:SSN.period
                                    Definition

                                    Time period during which identifier is/was valid for use.

                                    ShortTime period when id is/was valid for use
                                    Control0..1
                                    TypePeriod
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    120. Patient.identifier:SSN.assigner
                                    Definition

                                    Organization that issued/manages the identifier.

                                    ShortOrganization that issued id (may be just text)
                                    Comments

                                    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                    Control0..1
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    122. Patient.identifier:SB
                                    Slice NameSB
                                    Definition

                                    An identifier for this patient.

                                    Short**Deprecated** Decedent's Social Security Number for Compatibility. Use SSN.
                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control0..1
                                    TypeIdentifier
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Patients are almost always assigned specific numerical identifiers.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    124. Patient.identifier:SB.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    126. Patient.identifier:SB.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    SlicingThis element introduces a set of slices on Patient.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 128. Patient.identifier:SB.use
                                      Definition

                                      The purpose of this identifier.

                                      Shortusual | official | temp | secondary | old (If known)
                                      Comments

                                      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                      Control0..1
                                      BindingThe codes SHALL be taken from IdentifierUse
                                      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                      Identifies the purpose for this identifier, if known .

                                      Typecode
                                      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      130. Patient.identifier:SB.type
                                      Definition

                                      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                      ShortDescription of identifier
                                      Comments

                                      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                      Control1..1
                                      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summarytrue
                                      Requirements

                                      Allows users to make use of identifiers when the identifier system is not known.

                                      Pattern Value{
                                        "coding" : [{
                                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                          "code" : "SB"
                                        }]
                                      }
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      132. Patient.identifier:SB.system
                                      Definition

                                      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                      ShortThe namespace for the identifier value
                                      Comments

                                      Identifier.system is always case sensitive.

                                      Control0..1
                                      Typeuri
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      134. Patient.identifier:SB.value
                                      Definition

                                      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                      ShortThe value that is unique
                                      Comments

                                      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Example<br/><b>General</b>:123456
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      136. Patient.identifier:SB.period
                                      Definition

                                      Time period during which identifier is/was valid for use.

                                      ShortTime period when id is/was valid for use
                                      Control0..1
                                      TypePeriod
                                      Is Modifierfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      138. Patient.identifier:SB.assigner
                                      Definition

                                      Organization that issued/manages the identifier.

                                      ShortOrganization that issued id (may be just text)
                                      Comments

                                      The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                      Control0..1
                                      TypeReference(Organization)
                                      Is Modifierfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      140. Patient.active
                                      Definition

                                      Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

                                      It is often used to filter patient lists to exclude inactive patients

                                      Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

                                      ShortWhether this patient's record is in active use
                                      Comments

                                      If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

                                      Control0..1
                                      Typeboolean
                                      Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to be able to mark a patient record as not to be used because it was created in error.

                                      Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      142. Patient.name
                                      Definition

                                      A name associated with the individual.

                                      ShortA name associated with the patient
                                      Comments

                                      A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

                                      Control1..*
                                      TypeHumanName
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summarytrue
                                      Requirements

                                      Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      SlicingThis element introduces a set of slices on Patient.name. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                      • value @ use
                                      • 144. Patient.name.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        146. Patient.name.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on Patient.name.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 148. Patient.name.use
                                          Definition

                                          Identifies the purpose for this name.

                                          Shortusual | official | temp | nickname | anonymous | old | maiden
                                          Comments

                                          Applications can assume that a name is current unless it explicitly says that it is temporary or old.

                                          Control1..1
                                          BindingThe codes SHALL be taken from NameUse
                                          (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

                                          The use of a human name.

                                          Typecode
                                          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Allows the appropriate name for a particular context of use to be selected from among a set of names.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          150. Patient.name.text
                                          Definition

                                          Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

                                          ShortText representation of the full name
                                          Comments

                                          Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          A renderable, unencoded form.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          152. Patient.name.family
                                          Definition

                                          The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

                                          ShortFamily name (often called 'Surname')
                                          Comments

                                          Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

                                          Control1..1
                                          This element is affected by the following invariants: us-core-6
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Alternate Namessurname
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          154. Patient.name.family.id
                                          Definition

                                          unique id for the element within a resource (for internal references)

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          156. Patient.name.family.extension
                                          Definition

                                          An Extension

                                          ShortExtension
                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          SlicingThis element introduces a set of slices on Patient.name.family.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 158. Patient.name.family.extension:dataAbsentReason
                                            Slice NamedataAbsentReason
                                            Definition

                                            Provides a reason why the expected value or elements in the element that is extended are missing.

                                            Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
                                            Control0..1
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(Why value is missing) (Extension Type: code)
                                            Is Modifierfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            160. Patient.name.family.value
                                            Definition

                                            The actual value

                                            ShortPrimitive value for string
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            Max Length1048576
                                            162. Patient.name.given
                                            Definition

                                            Given name.

                                            ShortGiven names (not always 'first'). Includes middle names
                                            Comments

                                            If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

                                            Control0..*
                                            This element is affected by the following invariants: us-core-6
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Alternate Namesfirst name, middle name
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            164. Patient.name.given.id
                                            Definition

                                            unique id for the element within a resource (for internal references)

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            166. Patient.name.given.extension
                                            Definition

                                            An Extension

                                            ShortExtension
                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            SlicingThis element introduces a set of slices on Patient.name.given.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 168. Patient.name.given.extension:dataAbsentReason
                                              Slice NamedataAbsentReason
                                              Definition

                                              Provides a reason why the expected value or elements in the element that is extended are missing.

                                              Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(Why value is missing) (Extension Type: code)
                                              Is Modifierfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              170. Patient.name.given.value
                                              Definition

                                              The actual value

                                              ShortPrimitive value for string
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              Max Length1048576
                                              172. Patient.name.prefix
                                              Definition

                                              Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

                                              ShortParts that come before the name
                                              Control0..*
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              174. Patient.name.suffix
                                              Definition

                                              Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

                                              ShortParts that come after the name
                                              Control0..*
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              176. Patient.name.period
                                              Definition

                                              Indicates the period of time when this name was valid for the named person.

                                              ShortTime period when name was/is in use
                                              Control0..1
                                              TypePeriod
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Requirements

                                              Allows names to be placed in historical context.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              178. Patient.name:currentLegalName
                                              Slice NamecurrentLegalName
                                              Definition

                                              A name associated with the individual.

                                              Shortcurrent legal name
                                              Comments

                                              A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

                                              Control0..1
                                              TypeHumanName
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              180. Patient.name:currentLegalName.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              182. Patient.name:currentLegalName.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              SlicingThis element introduces a set of slices on Patient.name.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 184. Patient.name:currentLegalName.use
                                                Definition

                                                Identifies the purpose for this name.

                                                Shortusual | official | temp | nickname | anonymous | old | maiden
                                                Comments

                                                Applications can assume that a name is current unless it explicitly says that it is temporary or old.

                                                Control1..1
                                                BindingThe codes SHALL be taken from NameUse
                                                (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

                                                The use of a human name.

                                                Typecode
                                                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Allows the appropriate name for a particular context of use to be selected from among a set of names.

                                                Fixed Valueofficial
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                186. Patient.name:currentLegalName.text
                                                Definition

                                                Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

                                                ShortText representation of the full name
                                                Comments

                                                Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                A renderable, unencoded form.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                188. Patient.name:currentLegalName.family
                                                Definition

                                                The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

                                                ShortFamily name (often called 'Surname')
                                                Comments

                                                Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

                                                Control1..1
                                                This element is affected by the following invariants: us-core-6
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Alternate Namessurname
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                190. Patient.name:currentLegalName.given
                                                Definition

                                                Given name.

                                                ShortGiven names (not always 'first'). Includes middle names
                                                Comments

                                                If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

                                                Control0..*
                                                This element is affected by the following invariants: us-core-6
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Alternate Namesfirst name, middle name
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                192. Patient.name:currentLegalName.prefix
                                                Definition

                                                Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

                                                ShortParts that come before the name
                                                Control0..*
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                194. Patient.name:currentLegalName.suffix
                                                Definition

                                                Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

                                                ShortParts that come after the name
                                                Control0..*
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supportfalse
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                196. Patient.name:currentLegalName.period
                                                Definition

                                                Indicates the period of time when this name was valid for the named person.

                                                ShortTime period when name was/is in use
                                                Control0..1
                                                TypePeriod
                                                Is Modifierfalse
                                                Must Supportfalse
                                                Summarytrue
                                                Requirements

                                                Allows names to be placed in historical context.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                198. Patient.name:namePriorToFirstMarriage
                                                Slice NamenamePriorToFirstMarriage
                                                Definition

                                                A name associated with the individual.

                                                ShortName prior to first marriage
                                                Comments

                                                A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

                                                Control0..1
                                                TypeHumanName
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                200. Patient.name:namePriorToFirstMarriage.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                202. Patient.name:namePriorToFirstMarriage.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                SlicingThis element introduces a set of slices on Patient.name.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 204. Patient.name:namePriorToFirstMarriage.use
                                                  Definition

                                                  Identifies the purpose for this name.

                                                  Shortusual | official | temp | nickname | anonymous | old | maiden
                                                  Comments

                                                  Applications can assume that a name is current unless it explicitly says that it is temporary or old.

                                                  Control1..1
                                                  BindingThe codes SHALL be taken from NameUse
                                                  (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

                                                  The use of a human name.

                                                  Typecode
                                                  Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Allows the appropriate name for a particular context of use to be selected from among a set of names.

                                                  Fixed Valuemaiden
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  206. Patient.name:namePriorToFirstMarriage.text
                                                  Definition

                                                  Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

                                                  ShortText representation of the full name
                                                  Comments

                                                  Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  A renderable, unencoded form.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  208. Patient.name:namePriorToFirstMarriage.family
                                                  Definition

                                                  The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

                                                  ShortFamily name (often called 'Surname')
                                                  Comments

                                                  Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

                                                  Control1..1
                                                  This element is affected by the following invariants: us-core-6
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Alternate Namessurname
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  210. Patient.name:namePriorToFirstMarriage.given
                                                  Definition

                                                  Given name.

                                                  ShortGiven names (not always 'first'). Includes middle names
                                                  Comments

                                                  If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

                                                  Control0..*
                                                  This element is affected by the following invariants: us-core-6
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Alternate Namesfirst name, middle name
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  212. Patient.name:namePriorToFirstMarriage.prefix
                                                  Definition

                                                  Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

                                                  ShortParts that come before the name
                                                  Control0..*
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  214. Patient.name:namePriorToFirstMarriage.suffix
                                                  Definition

                                                  Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

                                                  ShortParts that come after the name
                                                  Control0..*
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supportfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  216. Patient.name:namePriorToFirstMarriage.period
                                                  Definition

                                                  Indicates the period of time when this name was valid for the named person.

                                                  ShortTime period when name was/is in use
                                                  Control0..1
                                                  TypePeriod
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summarytrue
                                                  Requirements

                                                  Allows names to be placed in historical context.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  218. Patient.telecom
                                                  Definition

                                                  A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

                                                  ShortA contact detail for the individual
                                                  Comments

                                                  A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

                                                  Control0..*
                                                  TypeContactPoint
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summarytrue
                                                  Requirements

                                                  People have (primary) ways to contact them in some way such as phone, email.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  220. Patient.telecom.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  222. Patient.telecom.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  SlicingThis element introduces a set of slices on Patient.telecom.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 224. Patient.telecom.system
                                                    Definition

                                                    Telecommunications form for contact point - what communications system is required to make use of the contact.

                                                    Shortphone | fax | email | pager | url | sms | other
                                                    Control1..1
                                                    This element is affected by the following invariants: cpt-2
                                                    BindingThe codes SHALL be taken from ContactPointSystem
                                                    (required to http://hl7.org/fhir/ValueSet/contact-point-system)

                                                    Telecommunications form for contact point.

                                                    Typecode
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    226. Patient.telecom.value
                                                    Definition

                                                    The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

                                                    ShortThe actual contact point details
                                                    Comments

                                                    Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

                                                    Control1..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

                                                    Need to support legacy numbers that are not in a tightly controlled format.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    228. Patient.telecom.use
                                                    Definition

                                                    Identifies the purpose for the contact point.

                                                    Shorthome | work | temp | old | mobile - purpose of this contact point
                                                    Comments

                                                    Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

                                                    Control0..1
                                                    BindingThe codes SHALL be taken from ContactPointUse
                                                    (required to http://hl7.org/fhir/ValueSet/contact-point-use)
                                                    Typecode
                                                    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

                                                    Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    230. Patient.telecom.rank
                                                    Definition

                                                    Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

                                                    ShortSpecify preferred order of use (1 = highest)
                                                    Comments

                                                    Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

                                                    Control0..1
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    232. Patient.telecom.period
                                                    Definition

                                                    Time period when the contact point was/is in use.

                                                    ShortTime period when the contact point was/is in use
                                                    Control0..1
                                                    TypePeriod
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    234. Patient.gender
                                                    Definition

                                                    Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

                                                    Shortmale | female | other | unknown
                                                    Comments

                                                    The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

                                                    Control1..1
                                                    BindingThe codes SHALL be taken from AdministrativeGender
                                                    (required to http://hl7.org/fhir/ValueSet/administrative-gender)
                                                    Typecode
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

                                                    Needed for identification of the individual, in combination with (at least) name and birth date.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    236. Patient.birthDate
                                                    Definition

                                                    The date of birth for the individual.

                                                    ShortDate of Birth
                                                    Comments

                                                    At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

                                                    Control0..1
                                                    Typedate
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

                                                    Age of the individual drives many clinical processes.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    LOINC Code21112-8
                                                    238. Patient.birthDate.id
                                                    Definition

                                                    unique id for the element within a resource (for internal references)

                                                    Shortxml:id (or equivalent in JSON)
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    240. Patient.birthDate.extension
                                                    Definition

                                                    An Extension

                                                    ShortExtension
                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    SlicingThis element introduces a set of slices on Patient.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 242. Patient.birthDate.extension:partialDateTime
                                                      Slice NamepartialDateTime
                                                      Definition

                                                      Alternative component representation of partial date and time. See [note on birth date and time].

                                                      ShortpartialDateTIme
                                                      Control0..1
                                                      This element is affected by the following invariants: ele-1
                                                      TypeExtension(Extension - Partial Date Time Vital Records) (Complex Extension)
                                                      Is Modifierfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      244. Patient.birthDate.extension:birthTime
                                                      Slice NamebirthTime
                                                      Definition

                                                      The time of day that the Patient was born. This includes the date to ensure that the timezone information can be communicated effectively.

                                                      ShortTime of day of birth
                                                      Control0..1
                                                      This element is affected by the following invariants: ele-1
                                                      TypeExtension(Birth Time) (Extension Type: dateTime)
                                                      Is Modifierfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      246. Patient.birthDate.extension:bypassEditFlag
                                                      Slice NamebypassEditFlag
                                                      Definition

                                                      Extension to hold a codeable concept from one of several valuesets.

                                                      ShortExtension - BypassEditFlag Vital Records
                                                      Control0..1
                                                      This element is affected by the following invariants: ele-1
                                                      TypeExtension(Extension - BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
                                                      Is Modifierfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      248. Patient.birthDate.extension:bypassEditFlag.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      250. Patient.birthDate.extension:bypassEditFlag.extension
                                                      Definition

                                                      An Extension

                                                      ShortExtension
                                                      Control0..0
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      SlicingThis element introduces a set of slices on Patient.birthDate.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 252. Patient.birthDate.extension:bypassEditFlag.url
                                                        Definition

                                                        Source of the definition for the extension code - a logical name or a URL.

                                                        Shortidentifies the meaning of the extension
                                                        Comments

                                                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                        Control1..1
                                                        Typeuri
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        Fixed Valuehttp://hl7.org/fhir/us/vr-common-library/StructureDefinition/BypassEditFlag
                                                        254. Patient.birthDate.extension:bypassEditFlag.value[x]
                                                        Definition

                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                        ShortTo reflect the relevant edit possibilities for date of birth.
                                                        Control1..1
                                                        BindingThe codes SHALL be taken from ValueSet - Mothers Date of Birth Edit Flags (NCHS) Vital Records
                                                        (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-mothers-date-of-birth-edit-flags-vr)

                                                        Date of Birth Edit Flags (NCHS)

                                                        TypeCodeableConcept
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        256. Patient.birthDate.value
                                                        Definition

                                                        The actual value

                                                        ShortPrimitive value for date
                                                        Control0..1
                                                        Typedate
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        258. Patient.deceased[x]
                                                        Definition

                                                        Indicates if the individual is deceased or not.

                                                        ShortIndicates if the individual is deceased or not
                                                        Comments

                                                        If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

                                                        Control0..1
                                                        TypeChoice of: boolean, dateTime
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        SlicingThis element introduces a set of slices on Patient.deceased[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                        • type @ $this
                                                        • 260. Patient.deceased[x]:deceasedBoolean
                                                          Slice NamedeceasedBoolean
                                                          Definition

                                                          Indicates if the individual is deceased or not.

                                                          ShortIndicates if the individual is deceased or not
                                                          Comments

                                                          If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

                                                          Control0..1
                                                          Typeboolean
                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                          Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

                                                          Pattern Valuetrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          262. Patient.address
                                                          Definition

                                                          An address for the individual.

                                                          ShortDecedent's Residence
                                                          Comments

                                                          Patient may have multiple addresses with different uses or applicable periods.

                                                          Control0..*
                                                          TypeAddress
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Requirements

                                                          May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          264. Patient.address.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          266. Patient.address.extension
                                                          Definition

                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                          ShortAdditional content defined by implementations
                                                          Comments

                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          SlicingThis element introduces a set of slices on Patient.address.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 268. Patient.address.extension:withinCityLimitsIndicator
                                                            Slice NamewithinCityLimitsIndicator
                                                            Definition

                                                            Used to indicate whether or not an address is within city limits.

                                                            ShortUsed to indicate whether or not an address is within city limits.
                                                            Control0..1
                                                            TypeExtension(Extension - Within City Limits Indicator Vital Records) (Extension Type: Coding)
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            270. Patient.address.extension:predir
                                                            Slice Namepredir
                                                            Definition

                                                            PreDirectional component of address as defined by USPS

                                                            ShortExtension - PreDirectional Vital Records
                                                            Control0..1
                                                            TypeExtension(Extension - PreDirectional Vital Records) (Extension Type: string)
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            272. Patient.address.extension:stnum
                                                            Slice Namestnum
                                                            Definition

                                                            StreetNumber component of address as defined by USPS

                                                            ShortExtension - StreetNumber Vital Records
                                                            Control0..1
                                                            TypeExtension(Extension - StreetNumber Vital Records) (Extension Type: string)
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            274. Patient.address.extension:stname
                                                            Slice Namestname
                                                            Definition

                                                            StreetName component of address as defined by USPS

                                                            ShortExtension - StreetName Vital Records
                                                            Control0..1
                                                            TypeExtension(Extension - StreetName Vital Records) (Extension Type: string)
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            276. Patient.address.extension:stdesig
                                                            Slice Namestdesig
                                                            Definition

                                                            StreetDesignator component of address as defined by USPS

                                                            ShortExtension - StreetDesignator Vital Records
                                                            Control0..1
                                                            TypeExtension(Extension - StreetDesignator Vital Records) (Extension Type: string)
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            278. Patient.address.extension:postdir
                                                            Slice Namepostdir
                                                            Definition

                                                            PostDirectional component of address as defined by USPS

                                                            ShortExtension - PostDirectional Vital Records
                                                            Control0..1
                                                            TypeExtension(Extension - PostDirectional Vital Records) (Extension Type: string)
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            280. Patient.address.extension:unitnumber
                                                            Slice Nameunitnumber
                                                            Definition

                                                            UnitOrAptNumber component of address as defined by USPS

                                                            ShortExtension - UnitOrAptNumber Vital Records
                                                            Control0..1
                                                            TypeExtension(Extension - UnitOrAptNumber Vital Records) (Extension Type: string)
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            282. Patient.address.use
                                                            Definition

                                                            The purpose of this address.

                                                            Shorthome | work | temp | old | billing - purpose of this address
                                                            Comments

                                                            Applications can assume that an address is current unless it explicitly says that it is temporary or old.

                                                            Control0..1
                                                            BindingThe codes SHALL be taken from AddressUse
                                                            (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

                                                            The use of an address.

                                                            Typecode
                                                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Requirements

                                                            Allows an appropriate address to be chosen from a list of many.

                                                            Example<br/><b>General</b>:home
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            284. Patient.address.type
                                                            Definition

                                                            Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

                                                            Shortpostal | physical | both
                                                            Comments

                                                            The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

                                                            Control0..1
                                                            BindingThe codes SHALL be taken from AddressType
                                                            (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1)

                                                            The type of an address (physical / postal).

                                                            Typecode
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Example<br/><b>General</b>:both
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            286. Patient.address.text
                                                            Definition

                                                            Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

                                                            ShortText representation of the address
                                                            Comments

                                                            Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Requirements

                                                            A renderable, unencoded form.

                                                            Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            288. Patient.address.line
                                                            Definition

                                                            This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

                                                            ShortStreet name, number, direction & P.O. Box etc.
                                                            Control0..*
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Example<br/><b>General</b>:137 Nowhere Street
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            290. Patient.address.city
                                                            Definition

                                                            The name of the city, town, suburb, village or other community or delivery center.

                                                            ShortName of city, town etc.
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Alternate NamesMunicpality
                                                            Example<br/><b>General</b>:Erewhon
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            292. Patient.address.city.id
                                                            Definition

                                                            unique id for the element within a resource (for internal references)

                                                            Shortxml:id (or equivalent in JSON)
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            294. Patient.address.city.extension
                                                            Definition

                                                            An Extension

                                                            ShortExtension
                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            SlicingThis element introduces a set of slices on Patient.address.city.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 296. Patient.address.city.extension:cityCode
                                                              Slice NamecityCode
                                                              Definition

                                                              Numeric code from in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

                                                              ShortCity Code
                                                              Control0..1
                                                              This element is affected by the following invariants: ele-1
                                                              TypeExtension(Extension - City Code Vital Records) (Extension Type: positiveInt)
                                                              Is Modifierfalse
                                                              LabelCity Code
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              298. Patient.address.city.value
                                                              Definition

                                                              The actual value

                                                              ShortPrimitive value for string
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              Max Length1048576
                                                              300. Patient.address.district
                                                              Definition

                                                              The name of the administrative area (county).

                                                              ShortDistrict name (aka county)
                                                              Comments

                                                              District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Alternate NamesCounty
                                                              Example<br/><b>General</b>:Madison
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              302. Patient.address.district.id
                                                              Definition

                                                              unique id for the element within a resource (for internal references)

                                                              Shortxml:id (or equivalent in JSON)
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              304. Patient.address.district.extension
                                                              Definition

                                                              An Extension

                                                              ShortExtension
                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              SlicingThis element introduces a set of slices on Patient.address.district.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 306. Patient.address.district.extension:districtCode
                                                                Slice NamedistrictCode
                                                                Definition

                                                                Numeric code in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

                                                                ShortCounty code
                                                                Control0..1
                                                                This element is affected by the following invariants: ele-1
                                                                TypeExtension(Extension - District Code Vital Records) (Extension Type: positiveInt)
                                                                Is Modifierfalse
                                                                LabelCounty code
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                308. Patient.address.district.value
                                                                Definition

                                                                The actual value

                                                                ShortPrimitive value for string
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                Max Length1048576
                                                                310. Patient.address.state
                                                                Definition

                                                                Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

                                                                ShortState/Jurisdiction of residence. Provide both state and jurisdiction if different.
                                                                Control0..1
                                                                BindingThe codes SHALL be taken from ValueSet - States, Territories and Provinces Vital Records
                                                                (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Alternate NamesProvince, Territory
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                312. Patient.address.state.id
                                                                Definition

                                                                unique id for the element within a resource (for internal references)

                                                                Shortxml:id (or equivalent in JSON)
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                314. Patient.address.state.extension
                                                                Definition

                                                                An Extension

                                                                ShortExtension
                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                SlicingThis element introduces a set of slices on Patient.address.state.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 316. Patient.address.state.extension:residenceJurisdictionId
                                                                  Slice NameresidenceJurisdictionId
                                                                  Definition

                                                                  An Extension

                                                                  ShortExtension
                                                                  Control0..1
                                                                  This element is affected by the following invariants: ele-1
                                                                  TypeExtension(Location Jurisdiction Id Vital Records) (Extension Type: string)
                                                                  Is Modifierfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  318. Patient.address.state.value
                                                                  Definition

                                                                  The actual value

                                                                  ShortPrimitive value for string
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  Summaryfalse
                                                                  Max Length1048576
                                                                  320. Patient.address.postalCode
                                                                  Definition

                                                                  A postal code designating a region defined by the postal service.

                                                                  ShortUS Zip Codes
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Alternate NamesZip, Zip Code
                                                                  Example<br/><b>General</b>:9132
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  322. Patient.address.country
                                                                  Definition

                                                                  Country - a nation as commonly understood or generally accepted.

                                                                  ShortCountry (e.g. can be ISO 3166 2 or 3 letter code)
                                                                  Comments

                                                                  ISO 3166 3 letter codes can be used in place of a human readable country name.

                                                                  Control0..1
                                                                  BindingThe codes SHALL be taken from ValueSet - Residence Country Vital Records
                                                                  (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-residence-country-vr)
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  324. Patient.address.period
                                                                  Definition

                                                                  Time period when address was/is in use.

                                                                  ShortTime period when address was/is in use
                                                                  Control0..1
                                                                  TypePeriod
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Requirements

                                                                  Allows addresses to be placed in historical context.

                                                                  Example<br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" }
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  326. Patient.maritalStatus
                                                                  Definition

                                                                  This field contains a patient's most recent marital (civil) status.

                                                                  ShortMarital (civil) status of a patient
                                                                  Control0..1
                                                                  BindingThe codes SHALL be taken from Marital Status Vital Records
                                                                  (required to http://hl7.org/fhir/us/vrdr/ValueSet/ValueSet-marital-status-vr)
                                                                  TypeCodeableConcept
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Requirements

                                                                  Most, if not all systems capture it.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  328. Patient.maritalStatus.id
                                                                  Definition

                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                  ShortUnique id for inter-element referencing
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  Summaryfalse
                                                                  330. Patient.maritalStatus.extension
                                                                  Definition

                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                  ShortAdditional content defined by implementations
                                                                  Comments

                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                  Control0..*
                                                                  TypeExtension
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Alternate Namesextensions, user content
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  SlicingThis element introduces a set of slices on Patient.maritalStatus.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 332. Patient.maritalStatus.extension:bypassEditFlag
                                                                    Slice NamebypassEditFlag
                                                                    Definition

                                                                    Extension to hold a codeable concept from one of several valuesets.

                                                                    ShortExtension - BypassEditFlag Vital Records
                                                                    Control0..1
                                                                    TypeExtension(Extension - BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    334. Patient.maritalStatus.extension:bypassEditFlag.id
                                                                    Definition

                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                    ShortUnique id for inter-element referencing
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Summaryfalse
                                                                    336. Patient.maritalStatus.extension:bypassEditFlag.extension
                                                                    Definition

                                                                    An Extension

                                                                    ShortExtension
                                                                    Control0..0
                                                                    TypeExtension
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    SlicingThis element introduces a set of slices on Patient.maritalStatus.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 338. Patient.maritalStatus.extension:bypassEditFlag.url
                                                                      Definition

                                                                      Source of the definition for the extension code - a logical name or a URL.

                                                                      Shortidentifies the meaning of the extension
                                                                      Comments

                                                                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                      Control1..1
                                                                      Typeuri
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      Fixed Valuehttp://hl7.org/fhir/us/vr-common-library/StructureDefinition/BypassEditFlag
                                                                      340. Patient.maritalStatus.extension:bypassEditFlag.value[x]
                                                                      Definition

                                                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                      ShortValue of extension
                                                                      Control1..1
                                                                      BindingThe codes SHALL be taken from Edit Bypass 0124
                                                                      (required to http://hl7.org/fhir/us/vrdr/ValueSet/vrdr-edit-bypass-0124-vs)
                                                                      TypeCodeableConcept
                                                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      342. Patient.maritalStatus.coding
                                                                      Definition

                                                                      A reference to a code defined by a terminology system.

                                                                      ShortCode defined by a terminology system
                                                                      Comments

                                                                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                      Control0..*
                                                                      TypeCoding
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Requirements

                                                                      Allows for alternative encodings within a code system, and translations to other code systems.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      344. Patient.maritalStatus.text
                                                                      Definition

                                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                      ShortMarital Description
                                                                      Comments

                                                                      Very often the text is the same as a displayName of one of the codings.

                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

                                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      346. Patient.multipleBirth[x]
                                                                      Definition

                                                                      If not single birth, specify born 1st, 2nd, etc. – For multiple deliveries, the order this infant was delivered in the set. Include all live births and fetal losses.

                                                                      ShortIf not single birth - born first, second, third, etc.
                                                                      Comments

                                                                      Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

                                                                      Control0..1
                                                                      TypeChoice of: boolean, integer
                                                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summaryfalse
                                                                      Requirements

                                                                      For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      348. Patient.multipleBirth[x].id
                                                                      Definition

                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                      ShortUnique id for inter-element referencing
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      350. Patient.multipleBirth[x].extension
                                                                      Definition

                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                      ShortAdditional content defined by implementations
                                                                      Comments

                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Alternate Namesextensions, user content
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      SlicingThis element introduces a set of slices on Patient.multipleBirth[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 352. Patient.multipleBirth[x].extension:bypassEditFlag
                                                                        Slice NamebypassEditFlag
                                                                        Definition

                                                                        Extension to hold a codeable concept from one of several valuesets.

                                                                        ShortExtension - BypassEditFlag Vital Records
                                                                        Control0..1
                                                                        TypeExtension(Extension - BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        354. Patient.multipleBirth[x].extension:bypassEditFlag.id
                                                                        Definition

                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        ShortUnique id for inter-element referencing
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Summaryfalse
                                                                        356. Patient.multipleBirth[x].extension:bypassEditFlag.extension
                                                                        Definition

                                                                        An Extension

                                                                        ShortExtension
                                                                        Control0..0
                                                                        TypeExtension
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        SlicingThis element introduces a set of slices on Patient.multipleBirth[x].extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 358. Patient.multipleBirth[x].extension:bypassEditFlag.url
                                                                          Definition

                                                                          Source of the definition for the extension code - a logical name or a URL.

                                                                          Shortidentifies the meaning of the extension
                                                                          Comments

                                                                          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                          Control1..1
                                                                          Typeuri
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          Fixed Valuehttp://hl7.org/fhir/us/vr-common-library/StructureDefinition/BypassEditFlag
                                                                          360. Patient.multipleBirth[x].extension:bypassEditFlag.value[x]
                                                                          Definition

                                                                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                          ShortValue of extension
                                                                          Control1..1
                                                                          BindingThe codes SHALL be taken from ValueSet - Plurality Edit Flags (NCHS) Vital Records
                                                                          (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-plurality-edit-flags-vr)

                                                                          Plurality Edit Flags (NCHS)

                                                                          TypeCodeableConcept
                                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          362. Patient.multipleBirth[x].extension:multipleBirthTotal
                                                                          Slice NamemultipleBirthTotal
                                                                          Definition

                                                                          Where a patient is a part of a multiple delivery, this is the total number of deliveries that occurred in this pregnancy.

                                                                          ShortTotal births in this pregnancy
                                                                          Control0..1
                                                                          TypeExtension(Patient Multiple Birth Total) (Extension Type: positiveInt)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          364. Patient.photo
                                                                          Definition

                                                                          Image of the patient.

                                                                          ShortImage of the patient
                                                                          Comments

                                                                          Guidelines:

                                                                          • Use id photos, not clinical photos.
                                                                          • Limit dimensions to thumbnail.
                                                                          • Keep byte count low to ease resource updates.
                                                                          Control0..*
                                                                          TypeAttachment
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          366. Patient.contact
                                                                          Definition

                                                                          A contact party (e.g. guardian, partner, friend) for the patient.

                                                                          ShortInformant information
                                                                          Comments

                                                                          Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

                                                                          Control0..*
                                                                          TypeBackboneElement
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Need to track people you can contact about the patient.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                                                                          368. Patient.contact.id
                                                                          Definition

                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                          ShortUnique id for inter-element referencing
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          370. Patient.contact.extension
                                                                          Definition

                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                          ShortAdditional content defined by implementations
                                                                          Comments

                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate Namesextensions, user content
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          372. Patient.contact.modifierExtension
                                                                          Definition

                                                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                                          Comments

                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                          Summarytrue
                                                                          Requirements

                                                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                          Alternate Namesextensions, user content, modifiers
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          374. Patient.contact.relationship
                                                                          Definition

                                                                          The nature of the relationship between the patient and the contact person.

                                                                          ShortInformant Relationship (INFORMRELATE)
                                                                          Control0..1
                                                                          BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationship
                                                                          (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

                                                                          The nature of the relationship between a patient and a contact person for that patient.

                                                                          TypeCodeableConcept
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Used to determine which contact person is the most relevant to approach, depending on circumstances.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          376. Patient.contact.relationship.id
                                                                          Definition

                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                          ShortUnique id for inter-element referencing
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          378. Patient.contact.relationship.extension
                                                                          Definition

                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                          ShortAdditional content defined by implementations
                                                                          Comments

                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate Namesextensions, user content
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          SlicingThis element introduces a set of slices on Patient.contact.relationship.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 380. Patient.contact.relationship.coding
                                                                            Definition

                                                                            A reference to a code defined by a terminology system.

                                                                            ShortCode defined by a terminology system
                                                                            Comments

                                                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                            Control0..*
                                                                            TypeCoding
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Requirements

                                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            382. Patient.contact.relationship.text
                                                                            Definition

                                                                            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                            ShortInformant Relationship (INFORMRELATE) - first 30 characters will be used
                                                                            Comments

                                                                            Very often the text is the same as a displayName of one of the codings.

                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            384. Patient.contact.name
                                                                            Definition

                                                                            A name associated with the contact person.

                                                                            ShortA name associated with the contact person
                                                                            Control0..1
                                                                            TypeHumanName
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Requirements

                                                                            Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            386. Patient.contact.telecom
                                                                            Definition

                                                                            A contact detail for the person, e.g. a telephone number or an email address.

                                                                            ShortA contact detail for the person
                                                                            Comments

                                                                            Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

                                                                            Control0..*
                                                                            TypeContactPoint
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Requirements

                                                                            People have (primary) ways to contact them in some way such as phone, email.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            388. Patient.contact.address
                                                                            Definition

                                                                            Address for the contact person.

                                                                            ShortAddress for the contact person
                                                                            Control0..1
                                                                            TypeAddress
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Requirements

                                                                            Need to keep track where the contact person can be contacted per postal mail or visited.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            390. Patient.contact.gender
                                                                            Definition

                                                                            Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.

                                                                            Shortmale | female | other | unknown
                                                                            Control0..1
                                                                            BindingThe codes SHALL be taken from AdministrativeGender
                                                                            (required to http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1)

                                                                            The gender of a person used for administrative purposes.

                                                                            Typecode
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summaryfalse
                                                                            Requirements

                                                                            Needed to address the person correctly.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            392. Patient.contact.organization
                                                                            Definition

                                                                            Organization on behalf of which the contact is acting or for which the contact is working.

                                                                            ShortOrganization that is associated with the contact
                                                                            Control0..1
                                                                            This element is affected by the following invariants: pat-1
                                                                            TypeReference(Organization)
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Requirements

                                                                            For guardians or business related contacts, the organization is relevant.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            394. Patient.contact.period
                                                                            Definition

                                                                            The period during which this contact person or organization is valid to be contacted relating to this patient.

                                                                            ShortThe period during which this contact person or organization is valid to be contacted relating to this patient
                                                                            Control0..1
                                                                            TypePeriod
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            396. Patient.communication
                                                                            Definition

                                                                            A language which may be used to communicate with the patient about his or her health.

                                                                            ShortA language which may be used to communicate with the patient about his or her health
                                                                            Comments

                                                                            If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

                                                                            Control0..*
                                                                            TypeBackboneElement
                                                                            Is Modifierfalse
                                                                            Must Supportfalse
                                                                            Summaryfalse
                                                                            Requirements

                                                                            If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            398. Patient.communication.id
                                                                            Definition

                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                            ShortUnique id for inter-element referencing
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Summaryfalse
                                                                            400. Patient.communication.extension
                                                                            Definition

                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                            ShortAdditional content defined by implementations
                                                                            Comments

                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                            Control0..*
                                                                            TypeExtension
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Alternate Namesextensions, user content
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            402. Patient.communication.modifierExtension
                                                                            Definition

                                                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                            ShortExtensions that cannot be ignored even if unrecognized
                                                                            Comments

                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                            Control0..*
                                                                            TypeExtension
                                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                            Summarytrue
                                                                            Requirements

                                                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                            Alternate Namesextensions, user content, modifiers
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            404. Patient.communication.language
                                                                            Definition

                                                                            The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.

                                                                            ShortThe language which can be used to communicate with the patient about his or her health
                                                                            Comments

                                                                            The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

                                                                            Control1..1
                                                                            BindingUnless not suitable, these codes SHALL be taken from Language codes with language and optionally a region modifier
                                                                            (extensible to http://hl7.org/fhir/us/core/ValueSet/simple-language)
                                                                            TypeCodeableConcept
                                                                            Is Modifierfalse
                                                                            Must Supporttrue
                                                                            Summaryfalse
                                                                            Requirements

                                                                            Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            406. Patient.communication.preferred
                                                                            Definition

                                                                            Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

                                                                            ShortLanguage preference indicator
                                                                            Comments

                                                                            This language is specifically identified for communicating healthcare information.

                                                                            Control0..1
                                                                            Typeboolean
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summaryfalse
                                                                            Requirements

                                                                            People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            408. Patient.generalPractitioner
                                                                            Definition

                                                                            Patient's nominated care provider.

                                                                            ShortPatient's nominated primary care provider
                                                                            Comments

                                                                            This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

                                                                            Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

                                                                            Control0..*
                                                                            TypeReference(Organization, Practitioner, PractitionerRole)
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Alternate NamescareProvider
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            410. Patient.managingOrganization
                                                                            Definition

                                                                            Organization that is the custodian of the patient record.

                                                                            ShortOrganization that is the custodian of the patient record
                                                                            Comments

                                                                            There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

                                                                            Control0..1
                                                                            TypeReference(Organization)
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Requirements

                                                                            Need to know who recognizes this patient record, manages and updates it.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            412. Patient.link
                                                                            Definition

                                                                            Link to another patient resource that concerns the same actual patient.

                                                                            ShortLink to another patient resource that concerns the same actual person
                                                                            Comments

                                                                            There is no assumption that linked patient records have mutual links.

                                                                            Control0..*
                                                                            TypeBackboneElement
                                                                            Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
                                                                            Summarytrue
                                                                            Requirements

                                                                            There are multiple use cases:

                                                                            • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
                                                                            • Distribution of patient information across multiple servers.
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            414. Patient.link.id
                                                                            Definition

                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                            ShortUnique id for inter-element referencing
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Summaryfalse
                                                                            416. Patient.link.extension
                                                                            Definition

                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                            ShortAdditional content defined by implementations
                                                                            Comments

                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                            Control0..*
                                                                            TypeExtension
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Alternate Namesextensions, user content
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            418. Patient.link.modifierExtension
                                                                            Definition

                                                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                            ShortExtensions that cannot be ignored even if unrecognized
                                                                            Comments

                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                            Control0..*
                                                                            TypeExtension
                                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                            Summarytrue
                                                                            Requirements

                                                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                            Alternate Namesextensions, user content, modifiers
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            420. Patient.link.other
                                                                            Definition

                                                                            The other patient resource that the link refers to.

                                                                            ShortThe other patient or related person resource that the link refers to
                                                                            Comments

                                                                            Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

                                                                            Control1..1
                                                                            TypeReference(Patient, RelatedPerson)
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            422. Patient.link.type
                                                                            Definition

                                                                            The type of link between this patient resource and another patient resource.

                                                                            Shortreplaced-by | replaces | refer | seealso
                                                                            Control1..1
                                                                            BindingThe codes SHALL be taken from LinkType
                                                                            (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

                                                                            The type of link between this patient resource and another patient resource.

                                                                            Typecode
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))