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

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.

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 its narrative along with other profiles, value sets, etc.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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.

An Extension

DSTU2: Patient.animal (new:BackboneElement)

Element Patient.animal has a context of Patient based on following the parent source element upwards and mapping to Patient. Element Patient.animal has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). An externally-defined extension that has been mapped as the representation of FHIR DSTU2 element Patient.animal: http://hl7.org/fhir/StructureDefinition/patient-animal. The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

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.

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

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

Indicates if the individual is deceased or not.

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.

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.

Link to a Patient or RelatedPerson resource that concerns the same actual individual.

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

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.

An Extension

DSTU2: Patient.link.type additional codes

The target element context Patient.link.type is a primitive-type element and this extension needs to be defined as a modifier. The context was moved up to parent element Patient.link. Element Patient.link.type is mapped to FHIR R5 element Patient.link.type as RelatedTo. The target element context Patient.link.type is a primitive-type element and this extension needs to be defined as a modifier. The context was moved up to parent element Patient.link. The mappings for Patient.link.type do not allow expression of the necessary codes, per the bindings on the source and target.

Link to a Patient or RelatedPerson resource that concerns the same actual individual.

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

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

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

The codes SHALL be taken from LinkType http://hl7.org/fhir/ValueSet/link-type|5.0.0
(required to http://hl7.org/fhir/ValueSet/link-type|5.0.0)

The type of link between this patient resource and another Patient resource, or Patient/RelatedPerson when using the seealso code

DSTU2: Patient.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element Patient.meta is mapped to FHIR R5 element Patient.meta as SourceIsBroaderThanTarget. The mappings for Patient.meta do not cover the following types: Meta. The mappings for Patient.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

DSTU2: Patient.text additional types (Narrative) additional types from child elements (div, status)

Element Patient.text is mapped to FHIR R5 element Patient.text as SourceIsBroaderThanTarget. The mappings for Patient.text do not cover the following types: Narrative. The mappings for Patient.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

DSTU2: Patient.animal (new:BackboneElement)

Element Patient.animal has a context of Patient based on following the parent source element upwards and mapping to Patient. Element Patient.animal has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). An externally-defined extension that has been mapped as the representation of FHIR DSTU2 element Patient.animal: http://hl7.org/fhir/StructureDefinition/patient-animal. The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

DSTU2: Patient.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element Patient.identifier is mapped to FHIR R5 element Patient.identifier as SourceIsBroaderThanTarget. The mappings for Patient.identifier do not cover the following types: Identifier. The mappings for Patient.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

DSTU2: Patient.name additional types (HumanName) additional types from child elements (family, given, period, prefix, suffix, text, use)

Element Patient.name is mapped to FHIR R5 element Patient.name as SourceIsBroaderThanTarget. The mappings for Patient.name do not cover the following types: HumanName. The mappings for Patient.name do not cover the following types based on type expansion: family, given, period, prefix, suffix, text, use. 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.

DSTU2: Patient.telecom additional types (ContactPoint) additional types from child elements (period, rank, system, use, value)

Element Patient.telecom is mapped to FHIR R5 element Patient.telecom as SourceIsBroaderThanTarget. The mappings for Patient.telecom do not cover the following types: ContactPoint. The mappings for Patient.telecom do not cover the following types based on type expansion: period, rank, system, use, value. 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 may 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).

DSTU2: Patient.address additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use)

Element Patient.address is mapped to FHIR R5 element Patient.address as SourceIsBroaderThanTarget. The mappings for Patient.address do not cover the following types: Address. The mappings for Patient.address do not cover the following types based on type expansion: city, country, district, line, period, postalCode, state, text, type, use. Patient may have multiple addresses with different uses or applicable periods.

DSTU2: Patient.maritalStatus additional codes

Element Patient.maritalStatus is mapped to FHIR R5 element Patient.maritalStatus as RelatedTo. The mappings for Patient.maritalStatus do not allow expression of the necessary codes, per the bindings on the source and target.

DSTU2: Patient.photo additional types (Attachment) additional types from child elements (contentType, creation, data, hash, language, size, title, url)

Element Patient.photo is mapped to FHIR R5 element Patient.photo as SourceIsBroaderThanTarget. The mappings for Patient.photo do not cover the following types: Attachment. The mappings for Patient.photo do not cover the following types based on type expansion: contentType, creation, data, hash, language, size, title, url.

DSTU2: Patient.contact.name additional types (HumanName) additional types from child elements (family, given, period, prefix, suffix, text, use)

Element Patient.contact.name is mapped to FHIR R5 element Patient.contact.name as SourceIsBroaderThanTarget. The mappings for Patient.contact.name do not cover the following types: HumanName. The mappings for Patient.contact.name do not cover the following types based on type expansion: family, given, period, prefix, suffix, text, use.

DSTU2: Patient.contact.telecom additional types (ContactPoint) additional types from child elements (period, rank, system, use, value)

Element Patient.contact.telecom is mapped to FHIR R5 element Patient.contact.telecom as SourceIsBroaderThanTarget. The mappings for Patient.contact.telecom do not cover the following types: ContactPoint. The mappings for Patient.contact.telecom do not cover the following types based on type expansion: period, rank, system, use, value. 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.

DSTU2: Patient.contact.address additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use)

Element Patient.contact.address is mapped to FHIR R5 element Patient.contact.address as SourceIsBroaderThanTarget. The mappings for Patient.contact.address do not cover the following types: Address. The mappings for Patient.contact.address do not cover the following types based on type expansion: city, country, district, line, period, postalCode, state, text, type, use.

DSTU2: Patient.contact.organization additional types from child elements (display, reference)

Element Patient.contact.organization is mapped to FHIR R5 element Patient.contact.organization as SourceIsBroaderThanTarget. The mappings for Patient.contact.organization do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Patient.contact.organization with unmapped reference targets: Organization.

DSTU2: Patient.contact.period additional types (Period) additional types from child elements (end, start)

Element Patient.contact.period is mapped to FHIR R5 element Patient.contact.period as SourceIsBroaderThanTarget. The mappings for Patient.contact.period do not cover the following types: Period. The mappings for Patient.contact.period do not cover the following types based on type expansion: end, start.

DSTU2: Patient.careProvider additional types from child elements (display, reference)

Element Patient.careProvider is mapped to FHIR R5 element Patient.generalPractitioner as RelatedTo. The mappings for Patient.careProvider do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Patient.careProvider with unmapped reference targets: Organization, Practitioner. This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles. This is not to be used to record Care Teams, these should be recorded on either the CarePlan or EpisodeOfCare resources.

DSTU2: Patient.managingOrganization additional types from child elements (display, reference)

Element Patient.managingOrganization is mapped to FHIR R5 element Patient.managingOrganization as SourceIsBroaderThanTarget. The mappings for Patient.managingOrganization do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Patient.managingOrganization with unmapped reference targets: Organization. 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).

DSTU2: Patient.link.type additional codes

The target element context Patient.link.type is a primitive-type element and this extension needs to be defined as a modifier. The context was moved up to parent element Patient.link. Element Patient.link.type is mapped to FHIR R5 element Patient.link.type as RelatedTo. The target element context Patient.link.type is a primitive-type element and this extension needs to be defined as a modifier. The context was moved up to parent element Patient.link. The mappings for Patient.link.type do not allow expression of the necessary codes, per the bindings on the source and target.

DSTU2: Patient.link.other additional types from child elements (display, reference)

Element Patient.link.other is mapped to FHIR R5 element Patient.link.other as SourceIsBroaderThanTarget. The mappings for Patient.link.other do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Patient.link.other with unmapped reference targets: Patient.

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

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

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

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.

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

An Extension

DSTU2: Patient.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element Patient.meta is mapped to FHIR R5 element Patient.meta as SourceIsBroaderThanTarget. The mappings for Patient.meta do not cover the following types: Meta. The mappings for Patient.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

When the resource last changed - e.g. when the version changed.

This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Unless not suitable, these codes SHALL be taken from AllSecurityLabels
(extensible to http://hl7.org/fhir/ValueSet/security-labels|5.0.0)

Security Labels from the Healthcare Privacy and Security Classification System.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

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.

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 its narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

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).

IETF language tag for a human language

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.

Contained resources do not have a 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.

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

An Extension

DSTU2: Patient.text additional types (Narrative) additional types from child elements (div, status)

Element Patient.text is mapped to FHIR R5 element Patient.text as SourceIsBroaderThanTarget. The mappings for Patient.text do not cover the following types: Narrative. The mappings for Patient.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

The status of a resource narrative.

The actual narrative content, a stripped down version of XHTML.

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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.

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, 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.

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.

An Extension

DSTU2: Patient.animal (new:BackboneElement)

Element Patient.animal has a context of Patient based on following the parent source element upwards and mapping to Patient. Element Patient.animal has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). An externally-defined extension that has been mapped as the representation of FHIR DSTU2 element Patient.animal: http://hl7.org/fhir/StructureDefinition/patient-animal. The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

An identifier for this patient.

Patients are almost always assigned specific numerical identifiers.

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

An Extension

DSTU2: Patient.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element Patient.identifier is mapped to FHIR R5 element Patient.identifier as SourceIsBroaderThanTarget. The mappings for Patient.identifier do not cover the following types: Identifier. The mappings for Patient.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

The purpose of this identifier.

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

Identifies the purpose for this identifier, if known .

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

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

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.

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

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

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

Identifier.system is always case sensitive.

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.

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

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 http://hl7.org/fhir/StructureDefinition/rendered-value). 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.

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

Organization that issued/manages the identifier.

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.

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.

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

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

A name associated with the individual.

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. Animal names may be communicated as given names, and optionally may include a family name.

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

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

An Extension

DSTU2: Patient.name additional types (HumanName) additional types from child elements (family, given, period, prefix, suffix, text, use)

Element Patient.name is mapped to FHIR R5 element Patient.name as SourceIsBroaderThanTarget. The mappings for Patient.name do not cover the following types: HumanName. The mappings for Patient.name do not cover the following types based on type expansion: family, given, period, prefix, suffix, text, use. 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.

Identifies the purpose for this name.

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

The use of a human name.

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

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.

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.

A renderable, unencoded form.

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.

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

Given name.

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.

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.

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.

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

Allows names to be placed in historical context.

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

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).

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

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

An Extension

DSTU2: Patient.telecom additional types (ContactPoint) additional types from child elements (period, rank, system, use, value)

Element Patient.telecom is mapped to FHIR R5 element Patient.telecom as SourceIsBroaderThanTarget. The mappings for Patient.telecom do not cover the following types: ContactPoint. The mappings for Patient.telecom do not cover the following types based on type expansion: period, rank, system, use, value. 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 may 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).

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

The codes SHALL be taken from ContactPointSystem
(required to http://hl7.org/fhir/ValueSet/contact-point-system|5.0.0)

Telecommunications form for contact point.

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

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

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

Identifies the purpose for the contact point.

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

Use of contact point.

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

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.

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

Ranks need not be unique. E.g. it's possible to have multiple contacts with rank=1. If the ranks have different systems or uses, this would be interpreted to mean "X is my most preferred phone number, Y is my most preferred email address" or "X is my preferred home email and Y is my preferred work email". If the system and use for equally-ranked contacts are the same, then the level of preference is equivalent for both repetitions.

Ranks need not be sequential and not all repetitions must have a rank. For example, it's possible to have 4 contacts with ranks of 2, 5 and two with no rank specified. That would be interpreted to mean the first is preferred over the second and no preference stated for the remaining contacts.

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

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

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.

The gender of a person used for administrative purposes.

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

The date of birth for the individual.

Partial dates are allowed if the specific date of birth 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).

Age of the individual drives many clinical processes.

Indicates if the individual is deceased or not.

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.

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.

An address for the individual.

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

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

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

An Extension

DSTU2: Patient.address additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use)

Element Patient.address is mapped to FHIR R5 element Patient.address as SourceIsBroaderThanTarget. The mappings for Patient.address do not cover the following types: Address. The mappings for Patient.address do not cover the following types based on type expansion: city, country, district, line, period, postalCode, state, text, type, use. Patient may have multiple addresses with different uses or applicable periods.

The purpose of this address.

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

The use of an address (home / work / etc.).

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

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

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).

The type of an address (physical / postal).

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.

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.

A renderable, unencoded form.

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

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

The name of the administrative area (county).

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.

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).

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

Country - a nation as commonly understood or generally accepted.

ISO 3166 2- or 3- letter codes MAY be used in place of a human readable country name.

Time period when address was/is in use.

Allows addresses to be placed in historical context.

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

The domestic partnership status of a person.

Most, if not all systems capture it.

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

An Extension

DSTU2: Patient.maritalStatus additional codes

Element Patient.maritalStatus is mapped to FHIR R5 element Patient.maritalStatus as RelatedTo. The mappings for Patient.maritalStatus do not allow expression of the necessary codes, per the bindings on the source and target.

A reference to a code defined by a terminology system.

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.

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

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.

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

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.

Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

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).

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

Image of the patient.

Guidelines:

• Use id photos, not clinical photos.
• Limit dimensions to thumbnail.
• Keep byte count low to ease resource updates.

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

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

An Extension

DSTU2: Patient.photo additional types (Attachment) additional types from child elements (contentType, creation, data, hash, language, size, title, url)

Element Patient.photo is mapped to FHIR R5 element Patient.photo as SourceIsBroaderThanTarget. The mappings for Patient.photo do not cover the following types: Attachment. The mappings for Patient.photo do not cover the following types based on type expansion: contentType, creation, data, hash, language, size, title, url.

Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)

Processors of the data need to be able to know how to interpret the data.

The human language of the content. The value can be any valid value according to BCP 47.

IETF language tag for a human language.

Users need to be able to choose between the languages in a set of attachments.

The actual data of the attachment - a sequence of bytes, base64 encoded.

The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

The data needs to able to be transmitted inline.

A location where the data can be accessed.

If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

The data needs to be transmitted by reference.

The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

The calculated hash of the data using SHA-1. Represented using base64.

The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

A label or set of text to display in place of the data.

May sometimes be derived from the source filename.

Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

The date that the attachment was first created.

This is often tracked as an integrity issue for use of the attachment.

Height of the image in pixels (photo/video).

Width of the image in pixels (photo/video).

The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required.

if the number of frames is not supplied, the value may be unknown. Applications should not assume that there is only one frame unless it is explicitly stated.

The duration of the recording in seconds - for audio and video.

The duration might differ from occurrencePeriod if recording was paused.

The number of pages when printed.

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

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.

Need to track people you can contact about the patient.

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

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 managable, 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.

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.

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 managable, 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).

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.

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.

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

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

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

A name associated with the contact person.

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

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

An Extension

DSTU2: Patient.contact.name additional types (HumanName) additional types from child elements (family, given, period, prefix, suffix, text, use)

Element Patient.contact.name is mapped to FHIR R5 element Patient.contact.name as SourceIsBroaderThanTarget. The mappings for Patient.contact.name do not cover the following types: HumanName. The mappings for Patient.contact.name do not cover the following types based on type expansion: family, given, period, prefix, suffix, text, use.

Identifies the purpose for this name.

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

The use of a human name.

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

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.

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.

A renderable, unencoded form.

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.

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

Given name.

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.

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.

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.

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

Allows names to be placed in historical context.

A contact detail for the person, e.g. a telephone number or an email address.

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.

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

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

An Extension