This page is part of the Da Vinci Payer Data Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

3-6-1 US Core Patient

The US Core Patient profile SHALL be used to express a members demographic information.

The essential fields in the Patient profile are:

R4 Hierarchical Name	R4 Name	Card.	Type
Patient	Patient	0..*
Patient.id	id	0..1	id
Patient.us-core-race	us-core-race	0..1	(Complex)
Patient.us-core-ethnicity	us-core-ethnicity	0..1	(Complex)
Patient.us-core-birthsex	us-core-birthsex	0..1	code
Patient.identifier	identifier	1..*	Identifier
Patient.identifier.system	system	1..1	uri
Patient.identifier.value	value	1..1	string
Patient.name	name	1..*	HumanName
Patient.name.family	family	1..1	string
Patient.name.given	given	1..*	string
Patient.gender	gender	1..1	code
Patient.birthDate	birthDate	0..1	date
Patient.communication	communication	0..*	BackboneElement
Patient.communication.language	language	1..1	CodeableConcept

The Member Number will be entered in the *identifier field. The code MB SHALL be used to identify the member identifier. See the example below:

{
      "use" : "member",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ],
        "text" : "Health Plan Member Number"
      },
      "system" : "http://plan.healthplan.com",
      "value" : "987654321"
    }

3-6-1-1 Health Plan Mapping Assistance

A collaboration of Health Plan experts have performed an evaluation of claims information and developed a mapping of data for Members to the US Core Patient profile. This is shown below as an assistance to implementers:

Line	PayerSource	CMS BB 2.0 Field	Data Descriptor	FHIR Profile	Profile Field	ValueSet	Notes
1.1	Member	BENE_ID	Patientid	US Core Patient	.identifier.value
2.1	Member	DOB_DT	Date of birth	US Core Patient	.birthDate
3.1	Member		Date of Death	US Core Patient	.deceased[dateTime]
4.1	Member	BENE_COUNTY_CD	County	US Core Patient	.contact.address.district
5.1	Member	BENE_STATE_CD	State	US Core Patient	.contact.address.state
6.1	Member	BENE_CNTY_CD	Country	US Core Patient	.contact.address.country
7.1	Member	BENE_RACE_CD	Race code	US Core Patient	.us-core-race
8.1	Member		Ethnicity	US Core Patient	.us-core-ethnicity
9.1	Member	GNDR_CD	Gender code	US Core Patient	.gender	Valueset-administrative-gender - FHIR v3.0.1
10.1	Member		Name	US Core Patient	.name
11.1	Member	BENE_MLG_CNTCT_ZIP_CD	Zip code	US Core Patient	.contact.address.postalCode
7.1	Claim		Patient account number	US Core Patient	.identifier.value
8.1	Claim		Medical record number	US Core Patient	.identifier.value
F.1	R4		Birth sex	US Core Patient	.us-core-birthsex	US-Core-R4/ValueSet-birthsex	UNK
F.2	R4		Telecom	US Core Patient	.telecom		Provide If Available
F.3	R4		Language	US Core Patient	.communication		Provide If Available

Where an entry is provided in the CMS BB2.0 FIELD column above the definition of the field can be reviewed using the following URL:

https://bluebutton.cms.gov/resources/variables/{CMS_BB2.0_FIELD}/

Where {CMS_BB2.0_FIELD} is replaced with the Field value in lower case. For example:

https://bluebutton.cms.gov/resources/variables/bene_id/ https://bluebutton.cms.gov/resources/variables/dob_dt/

3-6-1-2 Example Patient Resource

An example mapping of a Patient resource is shown here:

{
  "resourceType" : "Patient",
  "id" : "example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "
			
				Generated Narrative with Details
			
			
				id: example
			
				identifier: Medical Record Number = 1032702 (USUAL)
			
				identifier: Health Plan Member Number = 987654321 (USUAL)
			
				active: true
			
				name: Arthur B. Dent 
			
				telecom: ph: 555-555-5555(HOME), amy.shaw@example.com
			
				gender: 
			
				birthsex: Male
			
				birthDate: Jan 22, 1953
			
				address: 6518 Meadowridge Rd, Elkridge, MD 21075 US 
			
				race: White, American Indian or Alaska Native, Asian, Shoshone, Filipino
			
				ethnicity: Hispanic or Latino, Dominican, Mexican
		"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2106-3",
            "display" : "White"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1002-5",
            "display" : "American Indian or Alaska Native"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2028-9",
            "display" : "Asian"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1586-7",
            "display" : "Shoshone"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2036-2",
            "display" : "Filipino"
          }
        },
        {
          "url" : "text",
          "valueString" : "Mixed"
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2135-2",
            "display" : "Hispanic or Latino"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2184-0",
            "display" : "Dominican"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2148-5",
            "display" : "Mexican"
          }
        },
        {
          "url" : "text",
          "valueString" : "Hispanic or Latino"
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
      "valueCode" : "M"
    }
  ],
  "identifier" : [
    {
      "use" : "member",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ],
        "text" : "Health Plan Member Number"
      },
      "system" : "http://plan.healthplan.com",
      "value" : "987654321"
    },
    {
      "use" : "usual",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MR",
            "display" : "Medical Record Number"
          }
        ],
        "text" : "Medical Record Number"
      },
      "system" : "http://hospital.smarthealthit.org",
      "value" : "1032702"
    }
  ],
  "active" : true,
  "name" : [
    {
      "family" : "Dent",
      "given" : [
        "Arthur",
        "B."
      ]
    }
  ],
  "telecom" : [
    {
      "system" : "phone",
      "value" : "555-555-5555",
      "use" : "home"
    },
    {
      "system" : "email",
      "value" : "arthur.dent@example.com"
    }
  ],
  "gender" : "male",
  "birthDate" : "1953-01-22",
  "address" : [
    {
      "line" : [
        "6518 Meadowridge Rd"
      ],
      "city" : "Elkridge",
      "state" : "MD",
      "postalCode" : "21075",
      "country" : "US"
    }
  ]
}

Refer to the US Core Additional examples of the US Core R4 Implementation Guide for further examples of completed Patient Profiles .