Da Vinci Prior Authorization Support (PAS) FHIR IG
1.0.0 - STU 1

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.0.0: STU 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: PAS Beneficiary Patient

Defining URL:http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary
Version:1.0.0
Name:PASBeneficiary
Title:PAS Beneficiary Patient
Status:Active as of 2020-12-20T19:17:24+00:00
Definition:

A patient who is the beneficiary of an insurance plan.

Publisher:HL7 International - Financial Management Work Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from USCorePatientProfile

Summary

Must-Support: 6 elements

This structure is derived from USCorePatientProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient 0..*USCorePatientProfileInformation about an individual or animal receiving health care services
... identifier
.... type S0..1CodeableConceptDescription of identifier
Binding: https://valueset.x12.org/x217/005010/request/2010C/NM1/1/08/00/66 (required): Codes designating the system/method of code structure used for Identification Code. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

... name
.... prefix S0..*stringParts that come before the name
.... suffix S0..*stringParts that come after the name
... address
.... district S0..1stringDistrict name (aka county)
.... country S0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient 0..*USCorePatientProfileInformation about an individual or animal receiving health care services
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... us-core-race S0..1(Complex)US Core Race Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
... us-core-ethnicity S0..1(Complex)US Core ethnicity Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
... us-core-birthsex S0..1codeExtension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex
Binding: Birth Sex (required): Code for sex assigned at birth


... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..*IdentifierAn identifier for this patient
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: https://valueset.x12.org/x217/005010/request/2010C/NM1/1/08/00/66 (required): Codes designating the system/method of code structure used for Identification Code. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

.... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringThe value that is unique within the system.
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!Σ0..1booleanWhether this patient's record is in active use
... name SΣI1..*HumanNameA name associated with the patient
us-core-8: Patient.name.given or Patient.name.family or both SHALL be present
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

.... text Σ0..1stringText representation of the full name
.... family SΣI0..1stringFamily name (often called 'Surname')
.... given SΣI0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period Σ0..1PeriodTime period when name was/is in use
... telecom SΣ0..*ContactPointA contact detail for the individual
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... system SΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

.... value SΣ1..1stringThe actual contact point details
.... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
.... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
.... period Σ0..1PeriodTime period when the contact point was/is in use
... gender SΣ1..1codemale | female | other | unknown
Binding: AdministrativeGender (required)
... birthDate SΣ0..1dateThe date of birth for the individual
... deceased[x] ?!Σ0..1Indicates if the individual is deceased or not
.... deceasedBooleanboolean
.... deceasedDateTimedateTime
... address SΣ0..*AddressAn address for the individual
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..*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 SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district SΣ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period SΣ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23T00:00:00+11:00","end":"2010-07-01T00:00:00+10:00"}
... maritalStatus 0..1CodeableConceptMarital (civil) status of a patient
Binding: Marital Status Codes (extensible): The domestic partnership status of a person.

... multipleBirth[x] 0..1(Slice Definition)Whether patient is part of a multiple birth
Slice: Unordered, Closed by type:$this
.... multipleBirth[x]:multipleBirthInteger S0..1integerWhether patient is part of a multiple birth
... photo 0..*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 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... relationship 0..*CodeableConceptThe kind of relationship
Binding: PatientContactRelationship (extensible): The nature of the relationship between a patient and a contact person for that patient.


.... name 0..1HumanNameA name associated with the contact person
.... telecom 0..*ContactPointA contact detail for the person
.... address 0..1AddressAddress for the contact person
.... gender 0..1codemale | female | other | unknown
Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.

.... organization I0..1Reference(Organization)Organization that is associated with the contact
.... period 0..1PeriodThe period during which this contact person or organization is valid to be contacted relating to this patient
... communication S0..*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 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... language S1..1CodeableConceptThe 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..1booleanLanguage preference indicator
... generalPractitioner 0..*Reference(Organization | Practitioner | PractitionerRole)Patient's nominated primary care provider
... managingOrganization Σ0..1Reference(Organization)Organization that is the custodian of the patient record
... link ?!Σ0..*BackboneElementLink to another patient resource that concerns the same actual person
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... other Σ1..1Reference(Patient | RelatedPerson)The other patient or related person resource that the link refers to
.... type Σ1..1codereplaced-by | replaces | refer | seealso
Binding: LinkType (required): The type of link between this patient resource and another patient resource.


doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient 0..*USCorePatientProfileInformation about an individual or animal receiving health care services
... us-core-race 0..1(Complex)US Core Race Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
... us-core-ethnicity 0..1(Complex)US Core ethnicity Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
... us-core-birthsex 0..1codeExtension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex
Binding: Birth Sex (required): Code for sex assigned at birth


.... type Σ0..1CodeableConceptDescription of identifier
Binding: https://valueset.x12.org/x217/005010/request/2010C/NM1/1/08/00/66 (required): Codes designating the system/method of code structure used for Identification Code. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

.... system Σ1..1uriThe namespace for the identifier value
.... value Σ1..1stringThe value that is unique within the system.
... name ΣI1..*HumanNameA name associated with the patient
us-core-8: Patient.name.given or Patient.name.family or both SHALL be present
.... family ΣI0..1stringFamily name (often called 'Surname')
.... given ΣI0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix Σ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix Σ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
... telecom Σ0..*ContactPointA contact detail for the individual
.... system ΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

.... value Σ1..1stringThe actual contact point details
.... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
... gender Σ1..1codemale | female | other | unknown
Binding: AdministrativeGender (required)
... birthDate Σ0..1dateThe date of birth for the individual
... address Σ0..*AddressAn address for the individual
.... line Σ0..*stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
.... city Σ0..1stringName of city, town etc.
.... district Σ0..1stringDistrict name (aka county)
.... state Σ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.

.... postalCode Σ0..1stringUS Zip Codes
.... country Σ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period Σ0..1PeriodTime period when address was/is in use
... multipleBirth[x]:multipleBirthInteger 0..1integerWhether patient is part of a multiple birth
... communication 0..*BackboneElementA language which may be used to communicate with the patient about his or her health
.... language 1..1CodeableConceptThe 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)

doco Documentation for this format

This structure is derived from USCorePatientProfile

Summary

Must-Support: 6 elements

Differential View

This structure is derived from USCorePatientProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient 0..*USCorePatientProfileInformation about an individual or animal receiving health care services
... identifier
.... type S0..1CodeableConceptDescription of identifier
Binding: https://valueset.x12.org/x217/005010/request/2010C/NM1/1/08/00/66 (required): Codes designating the system/method of code structure used for Identification Code. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

... name
.... prefix S0..*stringParts that come before the name
.... suffix S0..*stringParts that come after the name
... address
.... district S0..1stringDistrict name (aka county)
.... country S0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient 0..*USCorePatientProfileInformation about an individual or animal receiving health care services
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... us-core-race S0..1(Complex)US Core Race Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
... us-core-ethnicity S0..1(Complex)US Core ethnicity Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
... us-core-birthsex S0..1codeExtension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex
Binding: Birth Sex (required): Code for sex assigned at birth


... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..*IdentifierAn identifier for this patient
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ0..1CodeableConceptDescription of identifier
Binding: https://valueset.x12.org/x217/005010/request/2010C/NM1/1/08/00/66 (required): Codes designating the system/method of code structure used for Identification Code. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

.... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringThe value that is unique within the system.
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!Σ0..1booleanWhether this patient's record is in active use
... name SΣI1..*HumanNameA name associated with the patient
us-core-8: Patient.name.given or Patient.name.family or both SHALL be present
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

.... text Σ0..1stringText representation of the full name
.... family SΣI0..1stringFamily name (often called 'Surname')
.... given SΣI0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix SΣ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix SΣ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period Σ0..1PeriodTime period when name was/is in use
... telecom SΣ0..*ContactPointA contact detail for the individual
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... system SΣI1..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

.... value SΣ1..1stringThe actual contact point details
.... use ?!SΣ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
.... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
.... period Σ0..1PeriodTime period when the contact point was/is in use
... gender SΣ1..1codemale | female | other | unknown
Binding: AdministrativeGender (required)
... birthDate SΣ0..1dateThe date of birth for the individual
... deceased[x] ?!Σ0..1Indicates if the individual is deceased or not
.... deceasedBooleanboolean
.... deceasedDateTimedateTime
... address SΣ0..*AddressAn address for the individual
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..*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 SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district SΣ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period SΣ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23T00:00:00+11:00","end":"2010-07-01T00:00:00+10:00"}
... maritalStatus 0..1CodeableConceptMarital (civil) status of a patient
Binding: Marital Status Codes (extensible): The domestic partnership status of a person.

... multipleBirth[x] 0..1(Slice Definition)Whether patient is part of a multiple birth
Slice: Unordered, Closed by type:$this
.... multipleBirth[x]:multipleBirthInteger S0..1integerWhether patient is part of a multiple birth
... photo 0..*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 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... relationship 0..*CodeableConceptThe kind of relationship
Binding: PatientContactRelationship (extensible): The nature of the relationship between a patient and a contact person for that patient.


.... name 0..1HumanNameA name associated with the contact person
.... telecom 0..*ContactPointA contact detail for the person
.... address 0..1AddressAddress for the contact person
.... gender 0..1codemale | female | other | unknown
Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.

.... organization I0..1Reference(Organization)Organization that is associated with the contact
.... period 0..1PeriodThe period during which this contact person or organization is valid to be contacted relating to this patient
... communication S0..*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 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... language S1..1CodeableConceptThe 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..1booleanLanguage preference indicator
... generalPractitioner 0..*Reference(Organization | Practitioner | PractitionerRole)Patient's nominated primary care provider
... managingOrganization Σ0..1Reference(Organization)Organization that is the custodian of the patient record
... link ?!Σ0..*BackboneElementLink to another patient resource that concerns the same actual person
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... other Σ1..1Reference(Patient | RelatedPerson)The other patient or related person resource that the link refers to
.... type Σ1..1codereplaced-by | replaces | refer | seealso
Binding: LinkType (required): The type of link between this patient resource and another patient resource.


doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet
Patient.languagepreferredCommonLanguages
Max Binding: AllLanguages
Patient.identifier.userequiredIdentifierUse
Patient.identifier.typerequiredhttps://valueset.x12.org/x217/005010/request/2010C/NM1/1/08/00/66
Patient.name.userequiredNameUse
Patient.telecom.systemrequiredContactPointSystem
Patient.telecom.userequiredContactPointUse
Patient.genderrequiredAdministrativeGender
Patient.address.userequiredAddressUse
Patient.address.typerequiredAddressType
Patient.address.stateextensibleUspsTwoLetterAlphabeticCodes
Patient.maritalStatusextensibleMarital Status Codes
Patient.contact.relationshipextensiblePatientContactRelationship
Patient.contact.genderrequiredAdministrativeGender
Patient.communication.languageextensibleLanguageCodesWithLanguageAndOptionallyARegionModifier
Patient.link.typerequiredLinkType

Constraints

IdPathDetailsRequirements
us-core-8Patient.namePatient.name.given or Patient.name.family or both SHALL be present
: family.exists() or given.exists()
pat-1Patient.contactSHALL at least contain a contact's details or a reference to an organization
: name.exists() or telecom.exists() or address.exists() or organization.exists()