A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc.

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

R4B: Account.partOf (new:Reference(Account))

Element Account.partOf has a context of Account based on following the parent source element upwards and mapping to Account. Element Account.partOf 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 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.

Indicates whether the account is presently used/usable or not.

This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid.

Indicates whether the account is available to be used.

An Extension

R4B: Account.status

Element Account.status is mapped to FHIR STU3 element Account.status as SourceIsBroaderThanTarget. The target context Account.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid.

R4B: Account.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, source, tag, versionId)

Element Account.meta is mapped to FHIR STU3 element Account.meta as SourceIsBroaderThanTarget. The mappings for Account.meta do not cover the following types: Meta. The mappings for Account.meta do not cover the following types based on type expansion: lastUpdated, profile, security, source, tag, versionId.

R4B: Account.text additional types (Narrative) additional types from child elements (div, status)

Element Account.text is mapped to FHIR STU3 element Account.text as SourceIsBroaderThanTarget. The mappings for Account.text do not cover the following types: Narrative. The mappings for Account.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. 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.

R4B: Account.partOf (new:Reference(Account))

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

R4B: Account.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element Account.identifier is mapped to FHIR STU3 element Account.identifier as SourceIsBroaderThanTarget. The mappings for Account.identifier do not cover the following types: Identifier. The mappings for Account.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

R4B: Account.status

Element Account.status is mapped to FHIR STU3 element Account.status as SourceIsBroaderThanTarget. The target context Account.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid.

R4B: Account.subject

Element Account.subject is mapped to FHIR STU3 element Account.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.subject with unmapped reference targets: Device, HealthcareService, Location, Organization, Patient, Practitioner, PractitionerRole. Accounts can be applied to non-patients for tracking other non-patient related activities, such as group services (patients not tracked, and costs charged to another body), or might not be allocated.

R4B: Account.servicePeriod additional types (Period) additional types from child elements (end, start)

Element Account.servicePeriod is mapped to FHIR STU3 element Account.period as SourceIsBroaderThanTarget. The mappings for Account.servicePeriod do not cover the following types: Period. The mappings for Account.servicePeriod do not cover the following types based on type expansion: end, start. It is possible for transactions to be posted outside the service period, as long as the service was provided within the defined service period.

R4B: Account.coverage.coverage additional types from child elements (display, identifier, reference, type)

Element Account.coverage.coverage is mapped to FHIR STU3 element Account.coverage.coverage as SourceIsBroaderThanTarget. The mappings for Account.coverage.coverage do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.coverage.coverage with unmapped reference targets: Coverage.

R4B: Account.owner additional types from child elements (display, identifier, reference, type)

Element Account.owner is mapped to FHIR STU3 element Account.owner as SourceIsBroaderThanTarget. The mappings for Account.owner do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.owner with unmapped reference targets: Organization.

R4B: Account.guarantor.party

Element Account.guarantor.party is mapped to FHIR STU3 element Account.guarantor.party as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.guarantor.party with unmapped reference targets: Organization, Patient, RelatedPerson.

R4B: Account.guarantor.period additional types (Period) additional types from child elements (end, start)

Element Account.guarantor.period is mapped to FHIR STU3 element Account.guarantor.period as SourceIsBroaderThanTarget. The mappings for Account.guarantor.period do not cover the following types: Period. The mappings for Account.guarantor.period do not cover the following types based on type expansion: end, start.

A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc.

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.

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

An Extension

R4B: Account.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, source, tag, versionId)

Element Account.meta is mapped to FHIR STU3 element Account.meta as SourceIsBroaderThanTarget. The mappings for Account.meta do not cover the following types: Meta. The mappings for Account.meta do not cover the following types based on type expansion: lastUpdated, profile, security, source, tag, versionId.

The version specific identifier, as it appears in the version portion of the URL. This values 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 value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

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.

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.

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.

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

An Extension

R4B: Account.text additional types (Narrative) additional types from child elements (div, status)

Element Account.text is mapped to FHIR STU3 element Account.text as SourceIsBroaderThanTarget. The mappings for Account.text do not cover the following types: Narrative. The mappings for Account.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. 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.

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 may 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, 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

R4B: Account.partOf (new:Reference(Account))

Element Account.partOf has a context of Account based on following the parent source element upwards and mapping to Account. Element Account.partOf 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 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.

Unique identifier used to reference the account. May or may not be intended for human use (e.g. credit card number).

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

An Extension

R4B: Account.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element Account.identifier is mapped to FHIR STU3 element Account.identifier as SourceIsBroaderThanTarget. The mappings for Account.identifier do not cover the following types: Identifier. The mappings for Account.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

The purpose of this identifier.

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. 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, a URL that describes a set values that are unique.

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 Rendered Value extension.

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.

Indicates whether the account is presently used/usable or not.

This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid.

Indicates whether the account is available to be used.

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

An Extension

R4B: Account.status

Element Account.status is mapped to FHIR STU3 element Account.status as SourceIsBroaderThanTarget. The target context Account.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid.

Primitive value for code

Categorizes the account for reporting and searching purposes.

The usage type of this account, permits categorization of accounts.

Name used for the account when displaying it to humans in reports, etc.

Identifies the patient, device, practitioner, location or other object the account is associated with.

Accounts can be applied to non patients for tracking other non patient related activities, such as group services (patients not tracked, and costs charged to another body), or may not be allocated.

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

An Extension

R4B: Account.subject

Element Account.subject is mapped to FHIR STU3 element Account.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.subject with unmapped reference targets: Device, HealthcareService, Location, Organization, Patient, Practitioner, PractitionerRole. Accounts can be applied to non-patients for tracking other non-patient related activities, such as group services (patients not tracked, and costs charged to another body), or might not be allocated.

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.

Identifies the period of time the account applies to; e.g. accounts created per fiscal year, quarter, etc.

It is possible for transactions relevant to a coverage period to be posted to the account before or after the coverage period, however the services that are being charged for must be within this period.

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

An Extension

R4B: Account.servicePeriod additional types (Period) additional types from child elements (end, start)

Element Account.servicePeriod is mapped to FHIR STU3 element Account.period as SourceIsBroaderThanTarget. The mappings for Account.servicePeriod do not cover the following types: Period. The mappings for Account.servicePeriod do not cover the following types based on type expansion: end, start. It is possible for transactions to be posted outside the service period, as long as the service was provided within the defined service period.

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

Indicates the period of time over which the account is allowed to have transactions posted to it. This period may be different to the coveragePeriod which is the duration of time that services may occur.

Accounts are able to be active only during a specific period, and the dates to which charges should be able to be applied.

Represents the sum of all credits less all debits associated with the account. Might be positive, zero or negative.

The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account.

Typically this may be some form of insurance, internal charges, or self-pay.

Local or jurisdicational business rules may determine which coverage covers which types of billable items charged to the account, and in which order. Where the order is important, a local/jurisdicational extension may be defined to specify the order for the type of charge.

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. 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.

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 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 party(s) that are responsible for payment (or part of) of charges applied to this account (including self-pay).

A coverage may only be resposible for specific types of charges, and the sequence of the coverages in the account could be important when processing billing.

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

An Extension

R4B: Account.coverage.coverage additional types from child elements (display, identifier, reference, type)

Element Account.coverage.coverage is mapped to FHIR STU3 element Account.coverage.coverage as SourceIsBroaderThanTarget. The mappings for Account.coverage.coverage do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.coverage.coverage with unmapped reference targets: Coverage.

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.

The priority of the coverage in the context of this account.

It is common in some jurisdictions for there to be multiple coverages allocated to an account, and a sequence is required to order the settling of the account (often with insurance claiming).

Indicates the organization, department, etc. with responsibility for the account.

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

An Extension

R4B: Account.owner additional types from child elements (display, identifier, reference, type)

Element Account.owner is mapped to FHIR STU3 element Account.owner as SourceIsBroaderThanTarget. The mappings for Account.owner do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.owner with unmapped reference targets: Organization.

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.

Provides additional information about what the account tracks and how it is used.

Parties financially responsible for the account.

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. 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.

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 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 entity who is responsible.

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

An Extension

R4B: Account.guarantor.party

Element Account.guarantor.party is mapped to FHIR STU3 element Account.guarantor.party as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element Account.guarantor.party with unmapped reference targets: Organization, Patient, RelatedPerson.

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 guarantor may be placed on credit hold or otherwise have their role temporarily suspended.

The timeframe during which the guarantor accepts responsibility for the account.

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

An Extension

R4B: Account.guarantor.period additional types (Period) additional types from child elements (end, start)

Element Account.guarantor.period is mapped to FHIR STU3 element Account.guarantor.period as SourceIsBroaderThanTarget. The mappings for Account.guarantor.period do not cover the following types: Period. The mappings for Account.guarantor.period do not cover the following types based on type expansion: end, start.

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.