NHSDigital-Patient

Profile uri FHIR Module Maturity Level
https://fhir.nhs.uk/StructureDefinition/NHSDigital-Patient Administration normative


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medicalApplianceSupplierS0..1Extension
nominatedPharmacyS0..Extension
preferredDispenserOrganizationS0..1Extension
identifierS
systemS
use
familyS
givenS..5
telecomS
genderS
birthDateS
deceased[x]S
addressKeyS0..1
use
line
multipleBirth[x]
contactS
communicationS
system1..
value1..
systemFixed Value
systemFixed Value
systemFixed Value

from
Command 'link' could not render: File was not found for 'https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient'


medicalApplianceSupplierS0..1Extension
nominatedPharmacyS0..Extension
preferredDispenserOrganizationS0..1Extension
identifierS
systemS
use
familyS
givenS..5
telecomS
genderS
birthDateS
deceased[x]S
addressKeyS0..1
use
line
multipleBirth[x]
contactS
communicationS
system1..
value1..
systemFixed Value
systemFixed Value
systemFixed Value

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    - PDS Example - Jane Smith
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Constraint Profiles

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This profile is designed around Patient Demographics Services and PDS may be used as the source of this data. Use of PDS is not mandatory for Patient resources, Patient Administration Systems (PAS) and Master Patient Index (MPI) may be used instead. Only traced NHS Number SHOULD be used with this resource unless explicitly stated. Within NHS Trusts the inclusion of MRN (Medical Record Numbers) identifiers is highly recommended.


Definition

Demographics and other administrative information about an individual or animal receiving care or other health-related services.

Constraints

  • patient-nhs (ERROR) Supplied NHS Number is outside the English and Welsh NHS Number range or length of the number is wrong.

extension:birthPlace.url

Element Id Patient.extension:birthPlace.url
Cardinality 1..1
Fixed Value http://hl7.org/fhir/StructureDefinition/patient-birthPlace
type http://hl7.org/fhirpath/System.String

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

extension:cadavericDonor.url

Element Id Patient.extension:cadavericDonor.url
Cardinality 1..1
Fixed Value http://hl7.org/fhir/StructureDefinition/patient-cadavericDonor
type http://hl7.org/fhirpath/System.String

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

extension:patientReligion.url

Element Id Patient.extension:patientReligion.url
Cardinality 1..1
Fixed Value http://hl7.org/fhir/StructureDefinition/patient-religion
type http://hl7.org/fhirpath/System.String

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

extension:patientInterpreterRequired.url

Element Id Patient.extension:patientInterpreterRequired.url
Cardinality 1..1
Fixed Value http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired
type http://hl7.org/fhirpath/System.String

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

extension:medicalApplianceSupplier

Element Id Patient.extension:medicalApplianceSupplier
Cardinality 0..1
Slice Name medicalApplianceSupplier
type Extension(ExtensionUKCoreMedicalApplianceSupplier)

Definition

{
           "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-PreferredDispenserOrganization",
           "valueReference": {
               "identifier": {
                   "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                   "value": "Y23456"
               }
           }
       }

extension:nominatedPharmacy

Element Id Patient.extension:nominatedPharmacy
Cardinality 0..*
Slice Name nominatedPharmacy
type Extension(ExtensionUKCoreNominatedPharmacy)

Definition

A patient can choose up to three nominated dispensers to cover different contractor types:

  • Community Pharmacy
  • Appliance Contractor
  • Dispensing Doctor

Each of those nominations is held in an Extension.

All require a ODS/ANANA code from Organisation Data Services. This contains download CSV files for these organisations, for API access please see Organisation Data Service - FHIR API

nominatedPharmacy (extension nominatedPharmacy)

"extension":  [
        {
            "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NominatedPharmacy",
            "valueReference": {
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                    "value": "Y12345"
                }
            }
        },

extension:preferredDispenserOrganization

Element Id Patient.extension:preferredDispenserOrganization
Cardinality 0..1
Slice Name preferredDispenserOrganization
type Extension(ExtensionUKCorePreferredDispenserOrganization)

Definition

{
           "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicalApplianceSupplier",
           "valueReference": {
               "identifier": {
                   "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                   "value": "Y34567"
               }
           }
       }

identifier

Element Id Patient.identifier
Cardinality 0..*
Slicing OPEN discriminator - VALUE system
type Identifier

Definition

At least one patient identifier, MUST be provided.

Where a traced NHS number is available for a patient this MUST be included. In general an untraced NHS Number MUST not be used, if an untracted NHS Number is used the extension https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus MUST be used.

Name FHIR identifier OID/HL7v3 HL7v2 ITK Format Description
NHS Number https://fhir.nhs.uk/Id/nhs-number 2.16.840.1.113883.2.1.4.1 NHS NNNNNNNNNN NHS Number allocated to the patient in England and Wales
CHI Number 2.16.840.1.113883.2.1.3.2.4.16.53 NNNNNNNNNN CHI Number allocated to the patient in Scotland
NHS Logon ID https://fhir.nhs.uk/Id/nhs-login-sub uuid NHS Login unique identifer which is referred to as sub in NHS Login (OpenID)

Local identifiers such as MRN MUST include a system which identifies NHS provider/assigning authority.

"identifier":  [
        {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9000000009"
        },
        {
            "system": "https://fhir.elmet.nhs.uk/Id/MRN",
            "value": "X54321"
        }
    ],

Requirements

Patients are almost always assigned specific numerical identifiers.

identifier:nhsNumber

Element Id Patient.identifier:nhsNumber
Cardinality 0..1
Slice Name nhsNumber
type Identifier

Definition

An identifier for this patient.

Requirements

Patients are almost always assigned specific numerical identifiers.

identifier:nhsNumber.system

Element Id Patient.identifier:nhsNumber.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/Id/nhs-number
type uri

Definition

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

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.

Comment

Identifier.system is always case sensitive.

name

Element Id Patient.name
Cardinality 0..*
type HumanName

Definition

At least one patient name must be provided. It is recommended a use is provided.

"name":  [
        {
            "family": "Smith",
            "given":  [
                "Jane"
            ],
            "prefix":  [
                "Mrs"
            ],
            "suffix":  [
                "MBE"
            ],
            "use": "usual"
        }
    ]

Requirements

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

Comment

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.

name.family

Element Id Patient.name.family
Cardinality 0..1
type string

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.

Comment

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

name.given

Element Id Patient.name.given
Cardinality 0..5
type string

Definition

Given names, including any middle names.

Comment

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.

telecom

Element Id Patient.telecom
Cardinality 0..*
type ContactPoint

Definition

List of contact points for the patient; for example, phone numbers or email addresses. When a patient tagged as restricted or very restricted is retrieved, all contact points are removed from the response.

"telecom":  [
        {
            "system": "phone",
            "use": "work",
            "value": "01632960587"
        }
    ]

Requirements

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

Comment

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).

gender

Element Id Patient.gender
Cardinality 0..1
Terminology Binding AdministrativeGender (Required)
The gender of a person used for administrative purposes.
type code

Definition

Classification of the gender of a patient. The classification is phenotypical rather than genotypical, i.e. it does not provide codes for medical or scientific purposes. It is the administrative gender that the patient wishes to be known as. In some cases, this may not be the same as the patient’s registered birth gender, or their current clinical gender.

Requirements

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

Comment

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.

birthDate

Element Id Patient.birthDate
Cardinality 0..1
type date

Definition

The date on which the patient was born or is officially deemed to have been born.

It is a date in the format yyyy-mm-dd. Due to data quality issues on a small number of patients yyyy-mm and yyyy format may also be returned.

When a patient tagged as very restricted is retrieved, birth date is removed from the response.

Requirements

Age of the individual drives many clinical processes.

Comment

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).

birthDate.extension:birthTime.url

Element Id Patient.birthDate.extension:birthTime.url
Cardinality 1..1
Fixed Value http://hl7.org/fhir/StructureDefinition/patient-birthTime
type http://hl7.org/fhirpath/System.String

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

deceased[x]

Element Id Patient.deceased[x]
Cardinality 0..1
type booleandateTime

Definition

The date and time on which a person died or is officially deemed to have died, if applicable and known.

It is a datetime in the format yyyy-mm-ddTHH:MM:SS+HH:MM or yyyy-mm-dd. Due to data quality issues on a small number of patients yyyy-mm and yyyy format may also be returned.

When a patient tagged as very restricted is retrieved, death date is removed from the response.

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.

Comment

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.

address

Element Id Patient.address
Cardinality 0..*
type Address

Definition

List of addresses associated with the patient.

These are fully populated on a retrieval or a successful update, only the home address is returned on a search. When a patient tagged as restricted or very restricted is retrieved, all addresses are removed from the response.

"address":  [
        {
            "line":  [
                "1 Trevelyan Square",
                "Boar Lane",
                "City Centre",
                "Leeds",
                "West Yorkshire"
            ],
            "postalCode": "LS1 6AE",
            "use": "home"
        }
    ],

Requirements

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

Comment

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

address.extension:addressKey

Element Id Patient.address.extension:addressKey
Cardinality 0..1
Slice Name addressKey
type Extension(ExtensionUKCoreAddressKey)

Definition

Postal Address File (PAF) key associated with this address formatted as a FHIR extension. Empty if no PAF key for the address is known, or an object specifying the code system of the address key and the value of the address key.

contact

Element Id Patient.contact
Cardinality 0..*
type BackboneElement

Definition

A list of patient contacts. Only emergency contacts are returned and only emergency contacts should be added. Any other contacts should be added to the patients Related Person. Patients designate here any contact number they desire to be used in case of an emergency. Note, while a patient may also desire to record various related persons telecom details, these do not separately allow for a concept of emergency contact; only ranking. See RelatedPerson endpoint. When a patient tagged as restricted or very restricted is retrieved, all contacts are removed from the response.

Requirements

Need to track people you can contact about the patient.

Comment

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.

Constraints

  • pat-1 (ERROR) SHALL at least contain a contact's details or a reference to an organization

communication

Element Id Patient.communication
Cardinality 0..*
type BackboneElement

Definition

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

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.

Comment

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.

communication.extension:proficiency.extension:level.url

Element Id Patient.communication.extension:proficiency.extension:level.url
Cardinality 1..1
Fixed Value level
type uri

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

communication.extension:proficiency.extension:type.url

Element Id Patient.communication.extension:proficiency.extension:type.url
Cardinality 1..1
Fixed Value type
type uri

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

communication.extension:proficiency.url

Element Id Patient.communication.extension:proficiency.url
Cardinality 1..1
Fixed Value http://hl7.org/fhir/StructureDefinition/patient-proficiency
type http://hl7.org/fhirpath/System.String

Definition

Source of the definition for the extension code - a logical name or a URL.

Comment

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

generalPractitioner

Element Id Patient.generalPractitioner
Cardinality 0..*
Slicing OPENATEND discriminator - VALUE identifier.system
type Reference(NHSDigitalPractitioner NHSDigitalPractitionerRole NHSDigitalOrganization)

Definition

GP Surgery SHOULD be provided. It is recommended the patients GP Surgery is the first item in the array and branch surgery is second. It is also suggested type and display (name of practice) is also included.

"generalPractitioner":  [
        {
            "type": "Organization"
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "Y12345"
            },
            "display": "Kirkgate Practice"
        }
    ]

Requirements

GP Surgery SHOULD be provided. It is recommended the patients GP Surgery is the first item in the array and branch surgery is second. It is also suggested type and display (name of practice) is also included.

Comment

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.

Constraints

  • nhsd-5 (WARNING) generalPractitioner - a display name should be provided

generalPractitioner:registeredGPPractice

Element Id Patient.generalPractitioner:registeredGPPractice
Cardinality 0..1
Slice Name registeredGPPractice
type Reference(UKCorePractitioner UKCoreOrganization UKCorePractitionerRole)

Definition

Patient's registered GP Practice. Use V81998 for no registered practice and V81999 for not known as per NHS Data Dictionary guidelines.

Comment

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.

generalPractitioner:registeredGPPractice.identifier.system

Element Id Patient.generalPractitioner:registeredGPPractice.identifier.system
Cardinality 0..1
Fixed Value https://fhir.nhs.uk/Id/ods-organization-code
type uri

Definition

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

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.

Comment

Identifier.system is always case sensitive.

generalPractitioner:registeredGeneralMedicalPractitioner

Element Id Patient.generalPractitioner:registeredGeneralMedicalPractitioner
Cardinality 0..*
Slice Name registeredGeneralMedicalPractitioner
type Reference(UKCorePractitioner UKCoreOrganization UKCorePractitionerRole)

Definition

This is to support legacy use cases where the patients GP is present

Comment

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.

generalPractitioner:registeredGeneralMedicalPractitioner.identifier.system

Element Id Patient.generalPractitioner:registeredGeneralMedicalPractitioner.identifier.system
Cardinality 0..1
Fixed Value https://fhir.nhs.uk/Id/gmp-number
type uri

Definition

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

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.

Comment

Identifier.system is always case sensitive.

managingOrganization.identifier.system

Element Id Patient.managingOrganization.identifier.system
Cardinality 0..1
Fixed Value https://fhir.nhs.uk/Id/ods-organization-code
type uri

Definition

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

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.

Comment

Identifier.system is always case sensitive.