• 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()

• rim: Entity. Role, or Act
• rim: role

See Mappings

• source-PIR: CONSENT.CONSENT_DIRECTIVE_ID

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

Apply "2025.01.1". This indicates the FHIR specs as of year Jan 2025.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

Updated: Relax the previously crossed-out elements.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

Apply "http://ehealth.bc.ca/fhir/StructureDefinition/bc-bcyimmunizationdistribution/RelatedPerson"

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

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).

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Act.text?

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.

• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

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.

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• w5: FiveWs.identifier
• v2: NK1-33
• rim: .id

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

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

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

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: N/A
• rim: Role.code or implied by context

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

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: CX.5
• rim: Role.code or implied by context

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.

Identifier.system is always case sensitive.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: CX.4 / EI-2-4
• rim: II.root or Role.id.root
• servd: ./IdentifierType

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: CX.1 / EI.1
• rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
• servd: ./Value

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: CX.7 + CX.8
• rim: Role.effectiveTime or implied by context
• servd: ./StartDate and ./EndDate

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: CX.4 / (CX.4,CX.9,CX.10)
• rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
• servd: ./IdentifierIssuingAuthority

Need to be able to mark a related person record as not to be used, such as if it was created in error.

This element is labeled as a modifier because it may be used to mark that the resource was created in error.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• w5: FiveWs.status
• rim: .statusCode

We need to know which patient this RelatedPerson is related to.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: PID-3
• rim: scoper[classCode=PSN|ANM and determinerCode='INSTANCE']/playedRole[classCode='PAT']/id

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

See Mappings

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: N/A
• source-PIR: fullURL + "Patient/" + (Patient ID)

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: N/A

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: .identifier

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: N/A

We need to know the relationship with the patient since it influences the interpretation of the information attributed to this person.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• w5: FiveWs.class
• v2: NK1-3
• rim: code

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

Allows for alternative encodings within a code system, and translations to other code systems.

See Mappings

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: C*E.1-8, C*E.10-22
• rim: union(., ./translation)
• orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
• source-PIR-Other: Code: CONSENT.CONSENT_DIRECTIVE.WHO_GAVE_RLTNSHP_CODE_CNCPT_ID
• source-PIR-RelatedClient: Text: CONSENT.CONSENT_DIRECTIVE.WHO_GAVE_RELATIONSHIP_ID

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

Need to be unambiguous about the source of the definition of the symbol.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: C*E.3
• rim: ./codeSystem
• orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: C*E.7
• rim: ./codeSystemVersion
• orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

Need to refer to a particular code in the system.

Refer to IMMS Codeset spreadsheet: Consent - ConsentGivenByRelationship. See Mappings.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: C*E.1
• rim: ./code
• orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
• source-PIR: CONSENT.CONSENT_DIRECTIVE.WHO_GAVE_RLTNSHP_CODE_CNCPT_ID

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Refer to IMMS Codeset spreadsheet: Consent - ConsentGivenByRelationship

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: C*E.2 - but note this is not well followed
• rim: CV.displayName
• orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: Sometimes implied by being first
• rim: CD.codingRationale
• orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

See Mappings: To be applied if PIR Consent Given By = Related Client. WHO_GAVE_RLTNSHP_CODE_CNCPT_ID = null and WHO_GAVE_RELATIONSHIP_ID has a value.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: C*E.9. But note many systems use C*E.2 for this
• rim: ./originalText[mediaType/code="text/plain"]/data
• orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
• source-PIR-RelatedClient: CONSENT.CONSENT_DIRECTIVE.WHO_GAVE_RELATIONSHIP_ID

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

See Mappings. NOT SPECIFIED is applied when both WHO_GAVE_RLTNSHP_CODE_CNCPT_ID = null and WHO_GAVE_RELATIONSHIP_ID = null.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: NK1-2
• rim: name
• source-PIR-Other: CONSENT.CONSENT_DIRECTIVE.WHO_GAVE_CONSENT
• source-PIR-NotSpecified: Not Specified
• source-PIR-relatedClient: CLIENT.SUBJECT_RELATIONSHIP.LEFT_SUBJECT_ID

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

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

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

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: XPN.7, but often indicated by which field contains the name
• rim: unique(./use)
• servd: ./NamePurpose

A renderable, unencoded form.

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: implied by XPN.11
• rim: ./formatted

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

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: XPN.1/FN.1
• rim: ./part[partType = FAM]
• servd: ./FamilyName

FIRST Name sends in first place of Given Name, MIDDLE Name sneds in second place of Given Name

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: XPN.2 + XPN.3
• rim: ./part[partType = GIV]
• servd: ./GivenNames

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: XPN.5
• rim: ./part[partType = PFX]
• servd: ./TitleCode

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: XPN/4
• rim: ./part[partType = SFX]

Allows names to be placed in historical context.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: XPN.13 + XPN.14
• rim: ./usablePeriod[type="IVL<TS>"]
• servd: ./StartDate and ./EndDate

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

Person 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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: NK1-5 / NK1-6 / NK1-40
• rim: telecom

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

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: NK1-15
• rim: administrativeGender

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: player.birthTime

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

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: NK1-4
• rim: addr

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

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: OBX-5 - needs a profile
• rim: player[classCode='PSN' and determinerCode='INSTANCE']/desc

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• w5: FiveWs.done[x]
• rim: .effectiveTime

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

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 RelatedPerson.Communication associations. If the RelatedPerson does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: LanguageCommunication

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

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.

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

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

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code

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.

This language is specifically identified for communicating healthcare information.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: preferenceInd