Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for a Patient demographic information using Medical Record Number (MRN), which is a type of identifier. The MRN is identifiable by identifier.system and may be location specific.
• Query for a Patient demographic information using first name, last name, birthdate, and gender.

Mandatory and Must Support Data Elements

The following data-elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Patient Must Have:

1. a patient identifier (e.g. MRN)
2. a patient name
3. a gender*

Each Patient Must Support:

1. a birth date
2. an address

Additional USCDI Requirements

For ONC’s USCDI requirements, each Patient Must Support the following additional elements. These elements are included in the formal definition of the profile and the Patient examples.

1. contact detail (e.g. a telephone number or an email address)
2. a communication language
3. a race
4. an ethnicity
5. a tribal affiliation
6. a birth sex*
7. gender identity*
8. date of death
9. previous address
10. previous name
11. suffix

*see guidance below

Profile Specific Implementation Guidance:

• Note that Date of Death, Previous Name, Suffix,and Previous address are listed in the U.S. Core Data for Interoperability.
  • Date of Death is communicated using the Patient.deceasedDateTime element.
  • Suffix is represented using the Patient.name.suffix element.
  • Previous name is represented by setting Patient.name.use to “old” or providing an end date in Patient.name.period or doing both.
  • Previous address is represented by setting Patient.address.use to “old” or providing an end date in Patient.address.period or doing both.
  • The Patient example demonstrates how these elements are represented.
• *US Core has reviewed and updated value sets based on input from the HL7 Gender Harmony Project which is modeling gender and sex information which includes data elements, value sets, code systems. When their work is complete, US Core will align with their recommendations. In the interim, US Core has interpreted the USCDI data element “sex” as “birth-sex”, and the FHIR specification provides guidance and background for representing Administrative Gender, Sex assigned at Birth, and Gender Identity.
• Provenance and the FHIR Extension Target Element can be use to document how individual patient demographic data was captured. See Element Level Provenance on the Basic Provenance page for more information.
• The Patient’s Social Security Numbers SHOULD NOT be used as a patient identifier in Patient.identifier.value. There is increasing concern over the use of Social Security Numbers in healthcare due to the risk of identity theft and related issues. Many payers and providers have actively purged them from their systems and filter them out of incoming data.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Patient

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
race		0..1	(Complex)	(USCDI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
ethnicity		0..1	(Complex)	(USCDI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
tribalAffiliation		0..*	(Complex)	(USCDI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
birthsex		0..1	code	(USCDI) Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
genderIdentity		0..*	CodeableConcept	(USCDI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible)
identifier	S	1..*	Identifier	(USCDI) An identifier for this patient
system	S	1..1	uri	(USCDI) The namespace for the identifier value
value	S	1..1	string	(USCDI) The value that is unique within the system.
name	SC	1..*	HumanName	(USCDI) A name associated with the patient us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
use		0..1	code	(USCDI) usual | official | temp | nickname | anonymous | old | maiden
family	SC	0..1	string	(USCDI) Family name (often called 'Surname')
given	SC	0..*	string	(USCDI) Given names (not always 'first'). Includes middle names
suffix		0..*	string	(USCDI) Parts that come after the name
period		0..1	Period	(USCDI) Time period when name was/is in use
telecom		0..*	ContactPoint	(USCDI) A contact detail for the individual
system	S	1..1	code	(USCDI) phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	S	1..1	string	(USCDI) The actual contact point details
use	S	0..1	code	(USCDI) home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
gender	S	1..1	code	(USCDI) male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	S	0..1	date	(USCDI) The date of birth for the individual
deceased[x]		0..1	boolean, dateTime	(USCDI) Indicates if the individual is deceased or not
address	S	0..*	Address	(USCDI) An address for the individual
use		0..1	code	(USCDI) home | work | temp | old | billing - purpose of this address
line	S	0..*	string	(USCDI) Street name, number, direction & P.O. Box etc.
city	S	0..1	string	(USCDI) Name of city, town etc.
state	S	0..1	string	(USCDI) Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	S	0..1	string	(USCDI) US Zip Codes
period		0..1	Period	(USCDI) Time period when address was/is in use
communication		0..*	BackboneElement	(USCDI) A language which may be used to communicate with the patient about his or her health
language	S	1..1	CodeableConcept	(USCDI) The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Patient.telecom.system	required	ContactPointSystem
Patient.telecom.use	required	ContactPointUse
Patient.gender	required	AdministrativeGender
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-6	error	Patient.name	At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
race		0..1	(Complex)	(USCDI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
ethnicity		0..1	(Complex)	(USCDI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
tribalAffiliation		0..*	(Complex)	(USCDI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
birthsex		0..1	code	(USCDI) Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
genderIdentity		0..*	CodeableConcept	(USCDI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	(USCDI) An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique within the system. Example General: 123456
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..*	HumanName	(USCDI) A name associated with the patient us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
use	?!Σ	0..1	code	(USCDI) usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
family	SΣC	0..1	string	(USCDI) Family name (often called 'Surname')
given	SΣC	0..*	string	(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
suffix	Σ	0..*	string	(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	(USCDI) Time period when name was/is in use
telecom	Σ	0..*	ContactPoint	(USCDI) A contact detail for the individual
system	SΣC	1..1	code	(USCDI) phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	(USCDI) The actual contact point details
use	?!SΣ	0..1	code	(USCDI) home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
gender	SΣ	1..1	code	(USCDI) male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	0..1	date	(USCDI) The date of birth for the individual
deceased[x]	?!Σ	0..1		(USCDI) Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	(USCDI) An address for the individual
use	?!Σ	0..1	code	(USCDI) home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..*	string	(USCDI) Street 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	SΣ	0..1	string	(USCDI) Name of city, town etc. Example General: Erewhon
state	SΣ	0..1	string	(USCDI) Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	(USCDI) US Zip Codes Example General: 9132
period	Σ	0..1	Period	(USCDI) Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication		0..*	BackboneElement	(USCDI) A language which may be used to communicate with the patient about his or her health
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	(USCDI) The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.identifier.use	required	IdentifierUse
Patient.name.use	required	NameUse
Patient.telecom.system	required	ContactPointSystem
Patient.telecom.use	required	ContactPointUse
Patient.gender	required	AdministrativeGender
Patient.address.use	required	AddressUse
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-6	error	Patient.name	At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
race		0..1	(Complex)	(USCDI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
ethnicity		0..1	(Complex)	(USCDI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
tribalAffiliation		0..*	(Complex)	(USCDI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
birthsex		0..1	code	(USCDI) Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
genderIdentity		0..*	CodeableConcept	(USCDI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	(USCDI) An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..*	HumanName	(USCDI) A name associated with the patient us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	(USCDI) usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	Σ	0..1	string	Text representation of the full name
family	SΣC	0..1	string	(USCDI) Family name (often called 'Surname')
given	SΣC	0..*	string	(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	Σ	0..*	string	(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	(USCDI) Time period when name was/is in use
telecom	Σ	0..*	ContactPoint	(USCDI) A contact detail for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	1..1	code	(USCDI) phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	(USCDI) The actual contact point details
use	?!SΣ	0..1	code	(USCDI) home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
gender	SΣ	1..1	code	(USCDI) male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	0..1	date	(USCDI) The date of birth for the individual
deceased[x]	?!Σ	0..1		(USCDI) Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	(USCDI) An address for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	(USCDI) home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..*	string	(USCDI) Street 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	SΣ	0..1	string	(USCDI) Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	(USCDI) Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	(USCDI) US Zip Codes Example General: 9132
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	(USCDI) Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
maritalStatus		0..1	CodeableConcept	Marital (civil) status of a patient Binding: Marital Status Codes (extensible): The domestic partnership status of a person.
multipleBirth[x]		0..1		Whether patient is part of a multiple birth
multipleBirthBoolean			boolean
multipleBirthInteger			integer
photo		0..*	Attachment	Image of the patient
contact	C	0..*	BackboneElement	A contact party (e.g. guardian, partner, friend) for the patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
relationship		0..*	CodeableConcept	The kind of relationship Binding: PatientContactRelationship (extensible): The nature of the relationship between a patient and a contact person for that patient.
name		0..1	HumanName	A name associated with the contact person
telecom		0..*	ContactPoint	A contact detail for the person
address		0..1	Address	Address for the contact person
gender		0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
organization	C	0..1	Reference(Organization)	Organization that is associated with the contact
period		0..1	Period	The period during which this contact person or organization is valid to be contacted relating to this patient
communication		0..*	BackboneElement	(USCDI) A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	(USCDI) The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
preferred		0..1	boolean	Language preference indicator
generalPractitioner		0..*	Reference(Organization | Practitioner | PractitionerRole)	Patient's nominated primary care provider
managingOrganization	Σ	0..1	Reference(Organization)	Organization that is the custodian of the patient record
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Patient.identifier.use	required	IdentifierUse
Patient.identifier.type	extensible	Identifier Type Codes
Patient.name.use	required	NameUse
Patient.telecom.system	required	ContactPointSystem
Patient.telecom.use	required	ContactPointUse
Patient.gender	required	AdministrativeGender
Patient.address.use	required	AddressUse
Patient.address.type	required	AddressType
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
Patient.maritalStatus	extensible	Marital Status Codes
Patient.contact.relationship	extensible	PatientContactRelationship
Patient.contact.gender	required	AdministrativeGender
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
pat-1	error	Patient.contact	SHALL at least contain a contact's details or a reference to an organization : name.exists() or telecom.exists() or address.exists() or organization.exists()
us-core-6	error	Patient.name	At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

Differential View

This structure is derived from Patient

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
race		0..1	(Complex)	(USCDI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
ethnicity		0..1	(Complex)	(USCDI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
tribalAffiliation		0..*	(Complex)	(USCDI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
birthsex		0..1	code	(USCDI) Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
genderIdentity		0..*	CodeableConcept	(USCDI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible)
identifier	S	1..*	Identifier	(USCDI) An identifier for this patient
system	S	1..1	uri	(USCDI) The namespace for the identifier value
value	S	1..1	string	(USCDI) The value that is unique within the system.
name	SC	1..*	HumanName	(USCDI) A name associated with the patient us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
use		0..1	code	(USCDI) usual | official | temp | nickname | anonymous | old | maiden
family	SC	0..1	string	(USCDI) Family name (often called 'Surname')
given	SC	0..*	string	(USCDI) Given names (not always 'first'). Includes middle names
suffix		0..*	string	(USCDI) Parts that come after the name
period		0..1	Period	(USCDI) Time period when name was/is in use
telecom		0..*	ContactPoint	(USCDI) A contact detail for the individual
system	S	1..1	code	(USCDI) phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	S	1..1	string	(USCDI) The actual contact point details
use	S	0..1	code	(USCDI) home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
gender	S	1..1	code	(USCDI) male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	S	0..1	date	(USCDI) The date of birth for the individual
deceased[x]		0..1	boolean, dateTime	(USCDI) Indicates if the individual is deceased or not
address	S	0..*	Address	(USCDI) An address for the individual
use		0..1	code	(USCDI) home | work | temp | old | billing - purpose of this address
line	S	0..*	string	(USCDI) Street name, number, direction & P.O. Box etc.
city	S	0..1	string	(USCDI) Name of city, town etc.
state	S	0..1	string	(USCDI) Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	S	0..1	string	(USCDI) US Zip Codes
period		0..1	Period	(USCDI) Time period when address was/is in use
communication		0..*	BackboneElement	(USCDI) A language which may be used to communicate with the patient about his or her health
language	S	1..1	CodeableConcept	(USCDI) The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Patient.telecom.system	required	ContactPointSystem
Patient.telecom.use	required	ContactPointUse
Patient.gender	required	AdministrativeGender
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-6	error	Patient.name	At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
race		0..1	(Complex)	(USCDI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
ethnicity		0..1	(Complex)	(USCDI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
tribalAffiliation		0..*	(Complex)	(USCDI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
birthsex		0..1	code	(USCDI) Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
genderIdentity		0..*	CodeableConcept	(USCDI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	(USCDI) An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique within the system. Example General: 123456
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..*	HumanName	(USCDI) A name associated with the patient us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
use	?!Σ	0..1	code	(USCDI) usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
family	SΣC	0..1	string	(USCDI) Family name (often called 'Surname')
given	SΣC	0..*	string	(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
suffix	Σ	0..*	string	(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	(USCDI) Time period when name was/is in use
telecom	Σ	0..*	ContactPoint	(USCDI) A contact detail for the individual
system	SΣC	1..1	code	(USCDI) phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	(USCDI) The actual contact point details
use	?!SΣ	0..1	code	(USCDI) home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
gender	SΣ	1..1	code	(USCDI) male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	0..1	date	(USCDI) The date of birth for the individual
deceased[x]	?!Σ	0..1		(USCDI) Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	(USCDI) An address for the individual
use	?!Σ	0..1	code	(USCDI) home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..*	string	(USCDI) Street 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	SΣ	0..1	string	(USCDI) Name of city, town etc. Example General: Erewhon
state	SΣ	0..1	string	(USCDI) Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	(USCDI) US Zip Codes Example General: 9132
period	Σ	0..1	Period	(USCDI) Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication		0..*	BackboneElement	(USCDI) A language which may be used to communicate with the patient about his or her health
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	(USCDI) The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.identifier.use	required	IdentifierUse
Patient.name.use	required	NameUse
Patient.telecom.system	required	ContactPointSystem
Patient.telecom.use	required	ContactPointUse
Patient.gender	required	AdministrativeGender
Patient.address.use	required	AddressUse
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-6	error	Patient.name	At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	Information about an individual or animal receiving health care services
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
race		0..1	(Complex)	(USCDI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
ethnicity		0..1	(Complex)	(USCDI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
tribalAffiliation		0..*	(Complex)	(USCDI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
birthsex		0..1	code	(USCDI) Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
genderIdentity		0..*	CodeableConcept	(USCDI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	(USCDI) An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	(USCDI) The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	(USCDI) The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..*	HumanName	(USCDI) A name associated with the patient us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	(USCDI) usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	Σ	0..1	string	Text representation of the full name
family	SΣC	0..1	string	(USCDI) Family name (often called 'Surname')
given	SΣC	0..*	string	(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	Σ	0..*	string	(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	(USCDI) Time period when name was/is in use
telecom	Σ	0..*	ContactPoint	(USCDI) A contact detail for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	1..1	code	(USCDI) phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	(USCDI) The actual contact point details
use	?!SΣ	0..1	code	(USCDI) home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
gender	SΣ	1..1	code	(USCDI) male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	0..1	date	(USCDI) The date of birth for the individual
deceased[x]	?!Σ	0..1		(USCDI) Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	(USCDI) An address for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	(USCDI) home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..*	string	(USCDI) Street 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	SΣ	0..1	string	(USCDI) Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	(USCDI) Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	(USCDI) US Zip Codes Example General: 9132
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	(USCDI) Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
maritalStatus		0..1	CodeableConcept	Marital (civil) status of a patient Binding: Marital Status Codes (extensible): The domestic partnership status of a person.
multipleBirth[x]		0..1		Whether patient is part of a multiple birth
multipleBirthBoolean			boolean
multipleBirthInteger			integer
photo		0..*	Attachment	Image of the patient
contact	C	0..*	BackboneElement	A contact party (e.g. guardian, partner, friend) for the patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
relationship		0..*	CodeableConcept	The kind of relationship Binding: PatientContactRelationship (extensible): The nature of the relationship between a patient and a contact person for that patient.
name		0..1	HumanName	A name associated with the contact person
telecom		0..*	ContactPoint	A contact detail for the person
address		0..1	Address	Address for the contact person
gender		0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
organization	C	0..1	Reference(Organization)	Organization that is associated with the contact
period		0..1	Period	The period during which this contact person or organization is valid to be contacted relating to this patient
communication		0..*	BackboneElement	(USCDI) A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	(USCDI) The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
preferred		0..1	boolean	Language preference indicator
generalPractitioner		0..*	Reference(Organization | Practitioner | PractitionerRole)	Patient's nominated primary care provider
managingOrganization	Σ	0..1	Reference(Organization)	Organization that is the custodian of the patient record
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Patient.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Patient.identifier.use	required	IdentifierUse
Patient.identifier.type	extensible	Identifier Type Codes
Patient.name.use	required	NameUse
Patient.telecom.system	required	ContactPointSystem
Patient.telecom.use	required	ContactPointUse
Patient.gender	required	AdministrativeGender
Patient.address.use	required	AddressUse
Patient.address.type	required	AddressType
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
Patient.maritalStatus	extensible	Marital Status Codes
Patient.contact.relationship	extensible	PatientContactRelationship
Patient.contact.gender	required	AdministrativeGender
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier
Patient.link.type	required	LinkType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
pat-1	error	Patient.contact	SHALL at least contain a contact's details or a reference to an organization : name.exists() or telecom.exists() or address.exists() or organization.exists()
us-core-6	error	Patient.name	At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

This structure is derived from Patient

Summary

Mandatory: 5 elements (2 nested mandatory elements)
Must-Support: 17 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
• http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
• http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
• http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex
• http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• The syntax used to describe the interactions is described here.

• Servers providing access to patient data can use US Core SMART Scopes for:
  • resource level scopes (for example, patient/Patient.rs).
• See the General Requirements section for additional rules and expectations when a server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support both read Patient by id AND Patient search using the _id search parameter:

   GET [base]/Patient/[id] or GET [base]/Patient?_id=[id]

   Example:

   1. GET [base]/Patient/1032702
   2. GET [base]/Patient?_id=1032702

   Implementation Notes: (how to search by the logical id of the resource)

2. SHALL support searching a patient by an identifier such as a MPI using the identifier search parameter:

   GET [base]/Patient?identifier={system|}[code]

   Example:

   1. GET [base]/Patient?identifier=http://hospital.smarthealthit.org|1032702

   Implementation Notes: Fetches a bundle containing any Patient resources matching the identifier (how to search by token)

3. SHALL support searching for a patient by a server defined search that matches any of the string fields in the HumanName, including family, given, prefix, suffix, and/or text using the name search parameter:

   GET [base]/Patient?name=[string]

   Example:

   1. GET [base]/Patient?name=Shaw

   Implementation Notes: Fetches a bundle of all Patient resources matching the name (how to search by string)

4. SHALL support searching using the combination of the birthdate and name search parameters:

   GET [base]/Patient?birthdate=[date]&name=[string]

   Example:

   1. GET [base]/Patient?name=Shaw&birthdate=2007-03-20

   Implementation Notes: Fetches a bundle of all Patient resources matching the specified birthdate and name (how to search by date and how to search by string)

5. SHALL support searching using the combination of the gender and name search parameters:

   GET [base]/Patient?gender={system|}[code]&name=[string]

   Example:

   1. GET [base]/Patient?name=Shaw&gender=female

   Implementation Notes: Fetches a bundle of all Patient resources matching the specified gender and name (how to search by string and how to search by token)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the birthdate and family search parameters:

   GET [base]/Patient?birthdate=[date]&family=[string]

   Example:

   1. GET [base]/Patient?family=Shaw&birthdate=2007-03-20

   Implementation Notes: Fetches a bundle of all Patient resources matching the specified birthdate and family (how to search by date and how to search by string)

2. SHOULD support searching using the combination of the death-date and family search parameters:

   GET [base]/Patient?death-date=[date]&family=[string]

   Example:

   1. GET [base]/Patient?family=Shaw&death-date=2022-07-22

   Implementation Notes: Fetches a bundle of all Patient resources matching the specified death-date and family (how to search by date and how to search by string)

3. SHOULD support searching using the combination of the family and gender search parameters:

   GET [base]/Patient?family=[string]&gender={system|}[code]

   Example:

   1. GET [base]/Patient?family=Shaw&gender=female

   Implementation Notes: Fetches a bundle of all Patient resources matching the specified family and gender (how to search by string and how to search by token)