CARIN Consumer Realtime Pharmacy Benefit Check
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This page is part of the Consumer Real-time Pharmacy Benefit Check (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

SD.2 StructureDefinition-carin-rtpbc-patient

This profile constrains the Patient resource for carrying the limited patient information required in the consumer real-time pharmacy benefit check (RTPBC) process. In RTPBC, the sole purpose of patient information is to enable the responding payer/PBM to locate the patient’s insurance information. From there, pricing and coverage information is determined based on the patient’s member and coverage information maintained by the payer.
The function of the Patient resource in this exchange is limited to conveying identifying information needed for the responder to locate its own records related to the patient. This limited set of information consists of the patient’s…

  • given and family name
  • gender
  • date of birth
  • address

Must Support elements in this profile

Client and Responding systems
All of the elements identified above are marked Must Support though not all will be required in a given implementation (the address composite itself and each element within have a minimum cardinality of 0, to support differing patient lookup approaches). The appropriate cardinality for address elements is to be determined by implementers.


SD.2.1 Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://hl7.org/fhir/us/carin/StructureDefinition/rtpbc-patient

Published on Sun Dec 08 05:00:00 UTC 2019 as a active by CARIN Alliance.

This profile builds on Patient

Summary

Mandatory: 5 elements
Must-Support: 11 elements

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient I0..*PatientInformation about an individual or animal receiving health care services
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierAn identifier for this patient
... active ?!ΣI0..1booleanWhether this patient's record is in active use
... name SΣI1..1HumanNameA name associated with the patient
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
.... text ΣI0..1stringText representation of the full name
.... family SΣI1..1stringPatient family name
.... given SΣI1..*stringPatient given name(s)
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix ΣI0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix ΣI0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period ΣI0..1PeriodTime period when name was/is in use
... telecom ΣI0..*ContactPointA contact detail for the individual
... gender SΣI1..1codePatient gender
Binding: AdministrativeGender (required)
... birthDate SΣI1..1datePatient birth date
... deceased[x] ?!ΣI0..1Indicates if the individual is deceased or not
.... deceasedBooleanboolean
.... deceasedDateTimedateTime
... address SΣI0..1AddressPatient address
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required)
Example General: home
.... type ΣI0..1codepostal | physical | both
Binding: AddressType (required)
Example General: both
.... text ΣI0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣI0..*stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣI0..1stringName of city, town etc.
Example General: Erewhon
.... district ΣI0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣI0..1stringSub-unit of country (abbreviations ok)
Binding: CARIN RTPBC Two Letter State and Province Code Value Set (extensible)
.... postalCode SΣI0..1stringPostal code for area
Example General: 9132
.... country SΣI0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
Binding: CARIN RTPBC Pharmacy Type Value Setf (extensible)
.... period ΣI0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23T00:00:00+00:00","end":"2010-07-01T00:00:00+00:00"}
... maritalStatus I0..1CodeableConceptMarital (civil) status of a patient
Binding: Marital Status Codes (extensible)
... multipleBirth[x] I0..1Whether patient is part of a multiple birth
.... multipleBirthBooleanboolean
.... multipleBirthIntegerinteger
... photo I0..*AttachmentImage of the patient
... contact I0..*BackboneElementA contact party (e.g. guardian, partner, friend) for the patient
pat-1: SHALL at least contain a contact's details or a reference to an organization
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... relationship I0..*CodeableConceptThe kind of relationship
Binding: PatientContactRelationship (extensible)
.... name I0..1HumanNameA name associated with the contact person
.... telecom I0..*ContactPointA contact detail for the person
.... address I0..1AddressAddress for the contact person
.... gender I0..1codemale | female | other | unknown
Binding: AdministrativeGender (required)
.... organization I0..1Reference(Organization)Organization that is associated with the contact
.... period I0..1PeriodThe period during which this contact person or organization is valid to be contacted relating to this patient
... communication I0..*BackboneElementA language which may be used to communicate with the patient about his or her health
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... language I1..1CodeableConceptThe language which can be used to communicate with the patient about his or her health
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
.... preferred I0..1booleanLanguage preference indicator
... generalPractitioner I0..*Reference(Organization | Practitioner | PractitionerRole)Patient's nominated primary care provider
... managingOrganization ΣI0..1Reference(Organization)Organization that is the custodian of the patient record
... link ?!ΣI0..*BackboneElementLink to another patient resource that concerns the same actual person
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... other ΣI1..1Reference(Patient | RelatedPerson)The other patient or related person resource that the link refers to
.... type ΣI1..1codereplaced-by | replaces | refer | seealso
Binding: LinkType (required)

doco Documentation for this format

Summary

Mandatory: 5 elements
Must-Support: 11 elements

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient I0..*PatientInformation about an individual or animal receiving health care services
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierAn identifier for this patient
... active ?!ΣI0..1booleanWhether this patient's record is in active use
... name SΣI1..1HumanNameA name associated with the patient
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
.... text ΣI0..1stringText representation of the full name
.... family SΣI1..1stringPatient family name
.... given SΣI1..*stringPatient given name(s)
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix ΣI0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix ΣI0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period ΣI0..1PeriodTime period when name was/is in use
... telecom ΣI0..*ContactPointA contact detail for the individual
... gender SΣI1..1codePatient gender
Binding: AdministrativeGender (required)
... birthDate SΣI1..1datePatient birth date
... deceased[x] ?!ΣI0..1Indicates if the individual is deceased or not
.... deceasedBooleanboolean
.... deceasedDateTimedateTime
... address SΣI0..1AddressPatient address
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required)
Example General: home
.... type ΣI0..1codepostal | physical | both
Binding: AddressType (required)
Example General: both
.... text ΣI0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣI0..*stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣI0..1stringName of city, town etc.
Example General: Erewhon
.... district ΣI0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣI0..1stringSub-unit of country (abbreviations ok)
Binding: CARIN RTPBC Two Letter State and Province Code Value Set (extensible)
.... postalCode SΣI0..1stringPostal code for area
Example General: 9132
.... country SΣI0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
Binding: CARIN RTPBC Pharmacy Type Value Setf (extensible)
.... period ΣI0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23T00:00:00+00:00","end":"2010-07-01T00:00:00+00:00"}
... maritalStatus I0..1CodeableConceptMarital (civil) status of a patient
Binding: Marital Status Codes (extensible)
... multipleBirth[x] I0..1Whether patient is part of a multiple birth
.... multipleBirthBooleanboolean
.... multipleBirthIntegerinteger
... photo I0..*AttachmentImage of the patient
... contact I0..*BackboneElementA contact party (e.g. guardian, partner, friend) for the patient
pat-1: SHALL at least contain a contact's details or a reference to an organization
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... relationship I0..*CodeableConceptThe kind of relationship
Binding: PatientContactRelationship (extensible)
.... name I0..1HumanNameA name associated with the contact person
.... telecom I0..*ContactPointA contact detail for the person
.... address I0..1AddressAddress for the contact person
.... gender I0..1codemale | female | other | unknown
Binding: AdministrativeGender (required)
.... organization I0..1Reference(Organization)Organization that is associated with the contact
.... period I0..1PeriodThe period during which this contact person or organization is valid to be contacted relating to this patient
... communication I0..*BackboneElementA language which may be used to communicate with the patient about his or her health
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... language I1..1CodeableConceptThe language which can be used to communicate with the patient about his or her health
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
.... preferred I0..1booleanLanguage preference indicator
... generalPractitioner I0..*Reference(Organization | Practitioner | PractitionerRole)Patient's nominated primary care provider
... managingOrganization ΣI0..1Reference(Organization)Organization that is the custodian of the patient record
... link ?!ΣI0..*BackboneElementLink to another patient resource that concerns the same actual person
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... other ΣI1..1Reference(Patient | RelatedPerson)The other patient or related person resource that the link refers to
.... type ΣI1..1codereplaced-by | replaces | refer | seealso
Binding: LinkType (required)

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron