Significant health events and conditions for a person related to the patient relevant in the context of care for the patient.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

An Extension

R4: FamilyMemberHistory.instantiatesUri (new:uri)

Element FamilyMemberHistory.instantiatesUri has a context of FamilyMemberHistory based on following the parent source element upwards and mapping to FamilyMemberHistory. Element FamilyMemberHistory.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

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. Usually modifier elements provide negation or qualification. In order 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.

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.

A code specifying the status of the record of the family history of a specific family member.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A code that identifies the status of the family history record.

If true, indicates the taking of an individual family member's history did not occur. The notDone element should not be used to document negated conditions, such as a family member that did not have a condition.

This element is labeled as a modifier because it marks the family member history as a family member history that did not occur. The more attributes are populated, the more constrained the negated statement is. This notDone element is being evaluated and will likely be removed in a subsequent release.

Creating a FamilyMemberHistory where notDone is true is intended for situations where there's a need for a specific statement in the record about something not being done. If the need is merely to indicate that a request wasn't fulfilled, that should be handled using Task.

The person who this history concerns.

The type of relationship this person has to the patient (father, mother, brother etc.).

The nature of the relationship between the patient and the related person being described in the family member history.

If true, indicates that the age value specified is an estimated value.

This element is labeled as a modifier because the fact tha age is estimated can/should change the results of any algorithm that calculates based on the specified age.

Clinicians often prefer to specify an estimaged age rather than an age range.

R4: FamilyMemberHistory.instantiatesUri (new:uri)

Element FamilyMemberHistory.instantiatesUri has a context of FamilyMemberHistory based on following the parent source element upwards and mapping to FamilyMemberHistory. Element FamilyMemberHistory.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

R4: FamilyMemberHistory.instantiatesCanonical additional types (canonical(http://hl7.org/fhir/StructureDefinition/PlanDefinition), canonical(http://hl7.org/fhir/StructureDefinition/Questionnaire), canonical(http://hl7.org/fhir/StructureDefinition/ActivityDefinition), canonical(http://hl7.org/fhir/StructureDefinition/Measure), canonical(http://hl7.org/fhir/StructureDefinition/OperationDefinition))

Element FamilyMemberHistory.instantiatesCanonical is mapped to FHIR STU3 element FamilyMemberHistory.definition as SourceIsBroaderThanTarget. The mappings for FamilyMemberHistory.instantiatesCanonical do not cover the following types: canonical.

R4: FamilyMemberHistory.sex additional types (CodeableConcept) additional types from child elements (coding)

Element FamilyMemberHistory.sex is mapped to FHIR STU3 element FamilyMemberHistory.gender as SourceIsBroaderThanTarget. The mappings for FamilyMemberHistory.sex do not cover the following types: CodeableConcept. The mappings for FamilyMemberHistory.sex do not cover the following types based on type expansion: coding. This element should ideally reflect whether the individual is genetically male or female. However, as reported information based on the knowledge of the patient or reporting friend/relative, there may be situations where the reported sex might not be totally accurate. E.g. 'Aunt Sue' might be XY rather than XX. Questions soliciting this information should be phrased to encourage capture of genetic sex where known. However, systems performing analysis should also allow for the possibility of imprecision with this element.

R4: FamilyMemberHistory.reasonReference

Element FamilyMemberHistory.reasonReference is mapped to FHIR STU3 element FamilyMemberHistory.reasonReference as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element FamilyMemberHistory.reasonReference with unmapped reference targets: DiagnosticReport, DocumentReference.

R4: FamilyMemberHistory.condition.contributedToDeath (new:boolean)

Element FamilyMemberHistory.condition.contributedToDeath has a context of FamilyMemberHistory.condition based on following the parent source element upwards and mapping to FamilyMemberHistory. Element FamilyMemberHistory.condition.contributedToDeath has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

Significant health events and conditions for a person related to the patient relevant in the context of care for the patient.

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

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

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

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

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).

A human language.

A human-readable narrative that contains a summary of the resource, and may 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 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 in formation is added later.

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.

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.

An Extension

R4: FamilyMemberHistory.instantiatesUri (new:uri)

Element FamilyMemberHistory.instantiatesUri has a context of FamilyMemberHistory based on following the parent source element upwards and mapping to FamilyMemberHistory. Element FamilyMemberHistory.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

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. Usually modifier elements provide negation or qualification. In order 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.

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.

This records identifiers associated with this family member history record that are defined by business processes and/ or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

Need to allow connection to a wider workflow.

A protocol or questionnaire that was adhered to in whole or in part by this event.

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

An Extension

R4: FamilyMemberHistory.instantiatesCanonical additional types (canonical(http://hl7.org/fhir/StructureDefinition/PlanDefinition), canonical(http://hl7.org/fhir/StructureDefinition/Questionnaire), canonical(http://hl7.org/fhir/StructureDefinition/ActivityDefinition), canonical(http://hl7.org/fhir/StructureDefinition/Measure), canonical(http://hl7.org/fhir/StructureDefinition/OperationDefinition))

Element FamilyMemberHistory.instantiatesCanonical is mapped to FHIR STU3 element FamilyMemberHistory.definition as SourceIsBroaderThanTarget. The mappings for FamilyMemberHistory.instantiatesCanonical do not cover the following types: canonical.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

A code specifying the status of the record of the family history of a specific family member.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A code that identifies the status of the family history record.

If true, indicates the taking of an individual family member's history did not occur. The notDone element should not be used to document negated conditions, such as a family member that did not have a condition.

This element is labeled as a modifier because it marks the family member history as a family member history that did not occur. The more attributes are populated, the more constrained the negated statement is. This notDone element is being evaluated and will likely be removed in a subsequent release.

Creating a FamilyMemberHistory where notDone is true is intended for situations where there's a need for a specific statement in the record about something not being done. If the need is merely to indicate that a request wasn't fulfilled, that should be handled using Task.

Describes why the family member's history is absent.

This notDoneReason element is being evaluated and will likely be replaced in a subsequent release (e.g. dataAbsentReason).

Codes describing the reason why a family member history was not done.

This is a separate element to allow it to have a distinct binding from reasonCode.

The person who this history concerns.

The date (and possibly time) when the family member history was taken.

This should be captured even if the same as the date on the List aggregating the full family history.

Allows determination of how current the summary is.

This will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair".

Allows greater ease in ensuring the same person is being talked about.

The type of relationship this person has to the patient (father, mother, brother etc.).

The nature of the relationship between the patient and the related person being described in the family member history.

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

The gender of a person used for administrative purposes.

Not all relationship codes imply gender and the relative's gender can be relevant for risk assessments.

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

An Extension

R4: FamilyMemberHistory.sex additional types (CodeableConcept) additional types from child elements (coding)

Element FamilyMemberHistory.sex is mapped to FHIR STU3 element FamilyMemberHistory.gender as SourceIsBroaderThanTarget. The mappings for FamilyMemberHistory.sex do not cover the following types: CodeableConcept. The mappings for FamilyMemberHistory.sex do not cover the following types based on type expansion: coding. This element should ideally reflect whether the individual is genetically male or female. However, as reported information based on the knowledge of the patient or reporting friend/relative, there may be situations where the reported sex might not be totally accurate. E.g. 'Aunt Sue' might be XY rather than XX. Questions soliciting this information should be phrased to encourage capture of genetic sex where known. However, systems performing analysis should also allow for the possibility of imprecision with this element.

Primitive value for code

The actual or approximate date of birth of the relative.

Allows calculation of the relative's age.

The age of the relative at the time the family member history is recorded.

use estimatedAge to indicate whether the age is actual or not.

While age can be calculated from date of birth, sometimes recording age directly is more natureal for clinicians.

If true, indicates that the age value specified is an estimated value.

This element is labeled as a modifier because the fact tha age is estimated can/should change the results of any algorithm that calculates based on the specified age.

Clinicians often prefer to specify an estimaged age rather than an age range.

Deceased flag or the actual or approximate age of the relative at the time of death for the family member history record.

Describes why the family member history occurred in coded or textual form.

Textual reasons can be caprued using reasonCode.text.

Codes indicating why the family member history was done.

Indicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event.

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

An Extension

R4: FamilyMemberHistory.reasonReference

Element FamilyMemberHistory.reasonReference is mapped to FHIR STU3 element FamilyMemberHistory.reasonReference as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element FamilyMemberHistory.reasonReference with unmapped reference targets: DiagnosticReport, DocumentReference.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible.

The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition.

If none of the conditions listed have an outcome of "death" specified, that indicates that none of the specified conditions are known to have been the primary cause of death.

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

An Extension

R4: FamilyMemberHistory.condition.contributedToDeath (new:boolean)

Element FamilyMemberHistory.condition.contributedToDeath has a context of FamilyMemberHistory.condition based on following the parent source element upwards and mapping to FamilyMemberHistory. Element FamilyMemberHistory.condition.contributedToDeath has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

The actual condition specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system.

Identification of the Condition or diagnosis.

Indicates what happened as a result of this condition. If the condition resulted in death, deceased date is captured on the relation.

The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.

Either the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence.

Age of onset of a condition in relatives is predictive of risk for the patient.

An area where general notes can be placed about this specific condition.