HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1

HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1 - Local Development build (v0.9.1). See the Directory of published versions

Patient

Definitions for obf-Patient.

1. Patient
Definition

A person in the role of a patient. Sometimes, the patient is not the subject of information in a clinical statement where the Patient is the SubjectOfRecord.

Compatibility: Lies at the intersection of Argonaut and US Core Patient. MaritalStatus has a required binding in Argonaut, but an extensible binding in US-Core. To be feasible under both DSTU2 Argonaut and STU3 US-Core, the required binding strength is adopted.

Control0..*
Alternate NamesSubjectOfCare Client Resident
InvariantsDefined on this element
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.div.exists())
2. Patient.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. Patient.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Control0..1
TypeMeta
4. Patient.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

5. Patient.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHOULD be taken from CommonLanguages
Max Binding: AllLanguages
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

6. Patient.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

7. Patient.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

8. Patient.extension
Definition

An Extension

Control0..*
TypeExtension
9. Patient.extension:race
Definition

An Extension

Control0..1
TypeExtension(USCoreRaceExtension) (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta)
Must Supporttrue
10. Patient.extension:ethnicity
Definition

An Extension

Control0..1
TypeExtension(USCoreEthnicityExtension) (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta)
Must Supporttrue
11. Patient.extension:birthsex
Definition

An Extension

Control0..1
TypeExtension(USCoreBirthSexExtension) (Extension Type: code)
Must Supporttrue
12. Patient.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

13. Patient.identifier
Definition

An identifier for this patient.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..*
TypeIdentifier
Must Supporttrue
Requirements

Patients are almost always assigned specific numerical identifiers.

14. Patient.identifier.id
Definition

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

Control0..1
Typestring
15. Patient.identifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

16. Patient.identifier.use
Definition

The purpose of this identifier.

Control0..1
BindingIdentifies the purpose for this identifier, if known .
The codes SHALL be taken from IdentifierUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

17. Patient.identifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingA coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

18. Patient.identifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control1..1
Typeuri
Must Supporttrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

19. Patient.identifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Must Supporttrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

20. Patient.identifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
21. Patient.identifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

22. Patient.active
Definition

Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

It is often used to filter patient lists to exclude inactive patients

Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

Control0..1
Typeboolean
Is Modifiertrue
Requirements

Need to be able to mark a patient record as not to be used because it was created in error.

Comments

If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
23. Patient.name
Definition

A name associated with the individual.

Control1..*
TypeHumanName
Must Supporttrue
Requirements

Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

Comments

A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

InvariantsDefined on this element
us-core-8: Patient.name.given or Patient.name.family or both SHALL be present (: family.exists() or given.exists())
24. Patient.name.id
Definition

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

Control0..1
Typestring
25. Patient.name.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

26. Patient.name.use
Definition

Identifies the purpose for this name.

Control0..1
BindingThe use of a human name.
The codes SHALL be taken from NameUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate name for a particular context of use to be selected from among a set of names.

Comments

Applications can assume that a name is current unless it explicitly says that it is temporary or old.

27. Patient.name.text
Definition

Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

Control0..1
Typestring
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

28. Patient.name.family
Definition

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

Control0..1
Typestring
Must Supporttrue
Alternate Namessurname
Comments

Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

29. Patient.name.given
Definition

Given name.

Control0..*
Typestring
Must Supporttrue
Alternate Namesfirst name, middle name
Comments

If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

30. Patient.name.prefix
Definition

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

Control0..*
Typestring
31. Patient.name.suffix
Definition

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

Control0..*
Typestring
32. Patient.name.period
Definition

Indicates the period of time when this name was valid for the named person.

Control0..1
TypePeriod
Requirements

Allows names to be placed in historical context.

33. Patient.telecom
Definition

A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

Control0..*
TypeContactPoint
Must Supporttrue
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

34. Patient.telecom.id
Definition

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

Control0..1
Typestring
35. Patient.telecom.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

36. Patient.telecom.system
Definition

Telecommunications form for contact point - what communications system is required to make use of the contact.

Control1..1 This element is affected by the following invariants: cpt-2
BindingTelecommunications form for contact point.
The codes SHALL be taken from ContactPointSystem
Typecode
Must Supporttrue
37. Patient.telecom.value
Definition

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

Control1..1
Typestring
Must Supporttrue
Requirements

Need to support legacy numbers that are not in a tightly controlled format.

Comments

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

38. Patient.telecom.use
Definition

Identifies the purpose for the contact point.

Control0..1
BindingUse of contact point.
The codes SHALL be taken from ContactPointUse
Typecode
Is Modifiertrue
Requirements

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

Comments

Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

39. Patient.telecom.rank
Definition

Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

Control0..1
TypepositiveInt
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

40. Patient.telecom.period
Definition

Time period when the contact point was/is in use.

Control0..1
TypePeriod
41. Patient.gender
Definition

Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

Control1..1
BindingThe codes SHALL be taken from AdministrativeGender
Typecode
Must Supporttrue
Requirements

Needed for identification of the individual, in combination with (at least) name and birth date.

Comments

The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

42. Patient.birthDate
Definition

The date of birth for the individual.

Control0..1
Typedate
Must Supporttrue
Requirements

Age of the individual drives many clinical processes.

Comments

At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

LOINC Code21112-8
43. Patient.deceased[x]
Definition

Indicates if the individual is deceased or not.

Control0..1
TypeChoice of: boolean, dateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifiertrue
Must Supporttrue
Requirements

The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

Comments

If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

44. Patient.address
Definition

An address for the individual.

Control0..*
TypeAddress
Must Supporttrue
Requirements

May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

Comments

Patient may have multiple addresses with different uses or applicable periods.

45. Patient.address.id
Definition

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

Control0..1
Typestring
46. Patient.address.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

47. Patient.address.use
Definition

The purpose of this address.

Control0..1
BindingThe use of an address.
The codes SHALL be taken from AddressUse
Typecode
Is Modifiertrue
Requirements

Allows an appropriate address to be chosen from a list of many.

Comments

Applications can assume that an address is current unless it explicitly says that it is temporary or old.

48. Patient.address.type
Definition

Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

Control0..1
BindingThe type of an address (physical / postal).
The codes SHALL be taken from AddressType
Typecode
Comments

The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

49. Patient.address.text
Definition

Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

Control0..1
Typestring
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

50. Patient.address.line
Definition

This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

Control0..*
Typestring
Must Supporttrue
51. Patient.address.city
Definition

The name of the city, town, suburb, village or other community or delivery center.

Control0..1
Typestring
Must Supporttrue
Alternate NamesMunicpality
52. Patient.address.district
Definition

The name of the administrative area (county).

Control0..1
Typestring
Alternate NamesCounty
Comments

District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

53. Patient.address.state
Definition

Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

Control0..1
BindingTwo Letter USPS alphabetic codes.
The codes SHALL be taken from USPS Two Letter Alphabetic Codes; other codes may be used where these codes are not suitable
Typestring
Must Supporttrue
Alternate NamesProvince, Territory
54. Patient.address.postalCode
Definition

A postal code designating a region defined by the postal service.

Control0..1
Typestring
Must Supporttrue
Alternate NamesZip, Zip Code
55. Patient.address.country
Definition

Country - a nation as commonly understood or generally accepted.

Control0..1
Typestring
Comments

ISO 3166 3 letter codes can be used in place of a human readable country name.

56. Patient.address.period
Definition

Time period when address was/is in use.

Control0..1
TypePeriod
Requirements

Allows addresses to be placed in historical context.

57. Patient.maritalStatus
Definition

This field contains a patient's most recent marital (civil) status.

Control0..1
BindingThe domestic partnership status of a person.
The codes SHALL be taken from Marital Status Codes
TypeCodeableConcept
Requirements

Most, if not all systems capture it.

58. Patient.multipleBirth[x]
Definition

Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

Control0..1
TypeChoice of: boolean, integer
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

Comments

Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

59. Patient.photo
Definition

Image of the patient.

Control0..*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

Comments

Guidelines:

  • Use id photos, not clinical photos.
  • Limit dimensions to thumbnail.
  • Keep byte count low to ease resource updates.
60. Patient.contact
Definition

A contact party (e.g. guardian, partner, friend) for the patient.

Control0..*
TypeBackboneElement
Requirements

Need to track people you can contact about the patient.

Comments

Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
pat-1: 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())
61. Patient.contact.id
Definition

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

Control0..1
Typestring
62. Patient.contact.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

63. Patient.contact.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

64. Patient.contact.relationship
Definition

The nature of the relationship between the patient and the contact person.

Control0..*
BindingThe nature of the relationship between a patient and a contact person for that patient.
The codes SHALL be taken from PatientContactRelationship; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Used to determine which contact person is the most relevant to approach, depending on circumstances.

65. Patient.contact.name
Definition

A name associated with the contact person.

Control0..1
TypeHumanName
Requirements

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

66. Patient.contact.telecom
Definition

A contact detail for the person, e.g. a telephone number or an email address.

Control0..*
TypeContactPoint
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

67. Patient.contact.address
Definition

Address for the contact person.

Control0..1
TypeAddress
Requirements

Need to keep track where the contact person can be contacted per postal mail or visited.

68. Patient.contact.gender
Definition

Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.

Control0..1
BindingThe gender of a person used for administrative purposes.
The codes SHALL be taken from AdministrativeGender
Typecode
Requirements

Needed to address the person correctly.

69. Patient.contact.organization
Definition

Organization on behalf of which the contact is acting or for which the contact is working.

Control0..1 This element is affected by the following invariants: pat-1
TypeReference(USCoreOrganizationProfile)
Requirements

For guardians or business related contacts, the organization is relevant.

70. Patient.contact.period
Definition

The period during which this contact person or organization is valid to be contacted relating to this patient.

Control0..1
TypePeriod
71. Patient.communication
Definition

A language which may be used to communicate with the patient about his or her health.

Control0..*
TypeBackboneElement
Must Supporttrue
Requirements

If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

Comments

If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
72. Patient.communication.id
Definition

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

Control0..1
Typestring
73. Patient.communication.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

74. Patient.communication.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

75. Patient.communication.language
Definition

The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.

Control1..1
BindingThe codes SHALL be taken from Language codes with language and optionally a region modifier; other codes may be used where these codes are not suitable
Max Binding: Language codes with language and optionally a region modifier
TypeCodeableConcept
Must Supporttrue
Requirements

Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

76. Patient.communication.preferred
Definition

Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

Control0..1
Typeboolean
Requirements

People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

Comments

This language is specifically identified for communicating healthcare information.

77. Patient.generalPractitioner
Definition

Patient's nominated care provider.

Control0..*
TypeReference(USCoreOrganizationProfile | USCorePractitionerProfile)
Alternate NamescareProvider
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

78. Patient.managingOrganization
Definition

Organization that is the custodian of the patient record.

Control0..1
TypeReference(USCoreOrganizationProfile)
Requirements

Need to know who recognizes this patient record, manages and updates it.

Comments

There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

79. Patient.link
Definition

Link to another patient resource that concerns the same actual patient.

Control0..*
TypeBackboneElement
Is Modifiertrue
Requirements

There are multiple use cases:

  • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
  • Distribution of patient information across multiple servers.
Comments

There is no assumption that linked patient records have mutual links.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
80. Patient.link.id
Definition

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

Control0..1
Typestring
81. Patient.link.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

82. Patient.link.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

83. Patient.link.other
Definition

The other patient resource that the link refers to.

Control1..1
TypeReference(Patient)
Comments

Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

84. Patient.link.type
Definition

The type of link between this patient resource and another patient resource.

Control1..1
BindingThe type of link between this patient resource and another patient resource.
The codes SHALL be taken from LinkType
Typecode