Phd Patient Profile
In Continua uploads the patient information is the only content that is not provided by the PHD. The PHG must obtain this information out of band. In Remote Patient Monitoring there is also a concern about protecting Patient Health Information. Thus one Continua upload option is that a Patient Resource is never generated and no patient information is present on the PHG. Instead, the health care provider gives the PHG the 'logical id' of a Patient Resource that may or may not exist on the destination server. The PHG uses this logical id in the Observation.subject element with the assumption that the server will understand the reference when the Observation is received.
Otherwise, if the PHG is to create the Patient Resource, this profile requires that only the Patient.identifier.system, Patient.identifier.value, Patient.identifer.type.coding.code and Patient.identifer.type.coding.system be populated. The Patient.name element is optional. This approach still affords Patient Health Information protection since the values in the required fields cannot be associated to a person without some kind of dictionary.
The structure definition for the Phd Patient Profile is shown below:
Patient | I | Patient | Element idPatient Information about an individual or animal receiving health care services Alternate namesSubjectOfCare Client Resident DefinitionDemographics and other administrative information about an individual or animal receiving care or other health-related services. Note that the only element that is required to be populated is the identifier which can be made opaque to a third party viewer. PCHA also supports a situation where the PHG can be provided a logical id to a Patient Resource out of band. In this case, the PHG never uploads a Patient Resource, but uses the provided logical id in the Observation resources instead. In this manner, not even the opaque identifiers are sent over the wire. Patient Constraints
| |
id | Σ | 0..1 | id | There are no (further) constraints on this element Element idPatient.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. id Constraints
|
meta | Σ | 1..1 | Meta | There are no (further) constraints on this element Element idPatient.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Meta Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.meta.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.meta.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idPatient.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. id Constraints
|
lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idPatient.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. instant Constraints
|
profile | Σ | 1..* | uri | Element idPatient.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. uri Sliced:Unordered, Open, by http://pchalliance.org/phdfhir/StructureDefinition/phdPatient(Value) Constraints
|
phdProfile | Σ | 1..1 | uriFixed Value | Element idPatient.meta.profile:phdProfile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. uri Constraints
http://pchalliance.org/phdfhir/StructureDefinition/phdPatient
|
security | Σ | 0..* | CodingBinding | There are no (further) constraints on this element Element idPatient.meta.security Security Labels applied to this resource DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. 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. Coding BindingSecurity Labels from the Healthcare Privacy and Security Classification System. ?? (extensible)Constraints
|
tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idPatient.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. 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. Coding BindingCodes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones" ?? (example)Constraints
|
implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idPatient.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. uri Constraints
|
language | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.language Language of the resource content DefinitionThe base language in which the resource is written. 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). code BindingA human language. ?? (extensible)Constraints
| |
text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idPatient.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource, and may 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. 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 in formation is added later. Narrative Constraints
|
contained | 0..* | Resource | There are no (further) constraints on this element Element idPatient.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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. Resource Mappings
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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. Usually modifier elements provide negation or qualification. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
identifier | Σ | 1..* | Identifier | Element idPatient.identifier An identifier for this patient DefinitionAn identifier for this patient. Patients are almost always assigned specific numerical identifiers. Identifier Sliced:Unordered, Open, by type.coding.system(Value) Constraints
|
phdIdentifier | Σ | 1..1 | Identifier | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier An identifier for this patient DefinitionAn identifier for this patient. Patients are almost always assigned specific numerical identifiers. Identifier Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.use usual | official | temp | secondary (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. code BindingIdentifies the purpose for this identifier, if known . ?? (required)Constraints
|
type | Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. 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. CodeableConcept BindingA coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ?? (extensible)Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
coding | Σ | 1..* | Coding | Element idPatient.identifier:phdIdentifier.type.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. It is highly recommended that this element be populated. Coding Sliced:Ordered, Open, by system(Value) Constraints
|
v2Coding | Σ | 0..1 | Coding | Element idPatient.identifier:phdIdentifier.type.coding:v2Coding Code defined by http://www.hl7.org/fhir/v2/0203 DefinitionA code using the V2 http://www.hl7.org/fhir/v2/0203/ system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. This HL7 V2 coding system identifies many possible types of identifiers. Coding Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.coding:v2Coding.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.coding:v2Coding.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
system | Σ | 1..1 | uriFixed Value | Element idPatient.identifier:phdIdentifier.type.coding:v2Coding.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. In this case the system is http://hl7.org/fhir/v2/0203 Need to be unambiguous about the source of the definition of the symbol. HL7 defines several codes that can be used in the http://hl7.org/fhir/v2/0203 system. For a list of the possible codes in this system see http://www.hl7.org/fhir/STU3/v2/0203/index.html. uri Constraints
http://hl7.org/fhir/v2/0203
|
version | Σ | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.coding:v2Coding.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. 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. string Constraints
|
code | Σ | 1..1 | code | Element idPatient.identifier:phdIdentifier.type.coding:v2Coding.code a code from http://hl7.org/fhir/v2/0203 DefinitionA symbol defined by the http://www.hl7.org/fhir/v2/0203 coding system. For example, the code 'MR' indicates the identifier is a Medical Record Number. 'SS' indicates that the identifier value is a US social security number and 'SR' indicates a state registry id. Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size code Constraints
|
display | Σ | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.coding:v2Coding.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
|
userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.coding:v2Coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). 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. boolean Constraints
|
text | Σ | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.type.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. 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. Very often the text is the same as a displayName of one of the codings. string Constraints
|
system | Σ | 1..1 | uri | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. 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. see http://en.wikipedia.org/wiki/Uniform_resource_identifier uri Constraints
General http://www.acme.com/identifiers/patient Mappings
|
value | Σ | 1..1 | string | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. 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. string Constraints
General 123456 Mappings
|
period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration. Period Constraints
|
assigner | Σ I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Organization) | There are no (further) constraints on this element Element idPatient.identifier:phdIdentifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. 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. Reference(http://hl7.org/fhir/StructureDefinition/Organization) Constraints
|
active | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element idPatient.active Whether this patient's record is in active use DefinitionWhether this patient record is in active use. Need to be able to mark a patient record as not to be used because it was created in error. Default is true. If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient This element is labeled as a modifier because when the patient record is marked as not active it is not expected to be used/referenced without being changed back to active. boolean Constraints
true
|
name | Σ | 0..* | HumanName | There are no (further) constraints on this element Element idPatient.name A name associated with the patient DefinitionA name associated with the individual. Need to be able to track the patient by multiple names. Examples are your official name and a partner name. 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. HumanName Constraints
|
telecom | Σ I | 0..* | ContactPoint | There are no (further) constraints on this element Element idPatient.telecom A contact detail for the individual DefinitionA contact detail (e.g. a telephone number or an email address) by which the individual may be contacted. People have (primary) ways to contact them in some way such as phone, email. 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 may 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). ContactPoint Constraints
|
gender | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.gender male | female | other | unknown DefinitionAdministrative Gender - the gender that the patient is considered to have for administration and record keeping purposes. Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes. The gender may 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 M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, 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, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error. code BindingThe gender of a person used for administrative purposes. ?? (required)Constraints
|
birthDate | Σ | 0..1 | date | There are no (further) constraints on this element Element idPatient.birthDate The date of birth for the individual DefinitionThe date of birth for the individual. Age of the individual drives many clinical processes. 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 maternaty/infant care systems). date Constraints
|
deceased[x] | Σ ?! | 0..1 | There are no (further) constraints on this element Element idPatient.deceased[x] Indicates if the individual is deceased or not DefinitionIndicates if the individual is deceased or not. 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. 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. This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
| |
deceasedBoolean | boolean | There are no (further) constraints on this element Data type boolean | ||
deceasedDateTime | dateTime | There are no (further) constraints on this element Data type dateTime | ||
address | Σ | 0..* | Address | There are no (further) constraints on this element Element idPatient.address Addresses for the individual DefinitionAddresses for the individual. May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification. Patient may have multiple addresses with different uses or applicable periods. Address Constraints
|
maritalStatus | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.maritalStatus Marital (civil) status of a patient DefinitionThis field contains a patient's most recent marital (civil) status. Most, if not all systems capture it. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. CodeableConcept BindingThe domestic partnership status of a person. ?? (extensible)Constraints
| |
multipleBirth[x] | 0..1 | There are no (further) constraints on this element Element idPatient.multipleBirth[x] Whether patient is part of a multiple birth DefinitionIndicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer). For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs. Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in tripplets would be valueInteger=2 and the third born would have valueInteger=3 If a bool value was provided for this tripplets examle, then all 3 patient records would have valueBool=true (the ordering is not indicated).
| ||
multipleBirthBoolean | boolean | There are no (further) constraints on this element Data type boolean | ||
multipleBirthInteger | integer | There are no (further) constraints on this element Data type integer | ||
photo | I | 0..* | Attachment | There are no (further) constraints on this element Element idPatient.photo Image of the patient DefinitionImage of the patient. Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too. When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Attachment". Attachment Constraints
|
contact | I | 0..* | BackboneElement | There are no (further) constraints on this element Element idPatient.contact A contact party (e.g. guardian, partner, friend) for the patient DefinitionA contact party (e.g. guardian, partner, friend) for the patient. Need to track people you can contact about the patient. 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. BackboneElement Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.contact.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.contact.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.contact.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. 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. Extension Constraints
|
relationship | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.contact.relationship The kind of relationship DefinitionThe nature of the relationship between the patient and the contact person. Used to determine which contact person is the most relevant to approach, depending on circumstances. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. CodeableConcept BindingThe nature of the relationship between a patient and a contact person for that patient. ?? (extensible)Constraints
| |
name | 0..1 | HumanName | There are no (further) constraints on this element Element idPatient.contact.name A name associated with the contact person DefinitionA name associated with the contact person. Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person. Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely. HumanName Constraints
| |
telecom | I | 0..* | ContactPoint | There are no (further) constraints on this element Element idPatient.contact.telecom A contact detail for the person DefinitionA contact detail for the person, e.g. a telephone number or an email address. People have (primary) ways to contact them in some way such as phone, email. 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. ContactPoint Constraints
|
address | 0..1 | Address | There are no (further) constraints on this element Element idPatient.contact.address Address for the contact person DefinitionAddress for the contact person. Need to keep track where the contact person can be contacted per postal mail or visited. Note: address is for postal addresses, not physical locations. Address Constraints
| |
gender | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.contact.gender male | female | other | unknown DefinitionAdministrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes. Needed to address the person correctly. Note that FHIR strings may not exceed 1MB in size code BindingThe gender of a person used for administrative purposes. ?? (required)Constraints
| |
organization | I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Organization) | There are no (further) constraints on this element Element idPatient.contact.organization Organization that is associated with the contact DefinitionOrganization on behalf of which the contact is acting or for which the contact is working. For guardians or business related contacts, the organization is relevant. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/Organization) Constraints
|
period | I | 0..1 | Period | There are no (further) constraints on this element Element idPatient.contact.period The period during which this contact person or organization is valid to be contacted relating to this patient DefinitionThe period during which this contact person or organization is valid to be contacted relating to this patient. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration. Period Constraints
|
animal | Σ ?! | 0..1 | BackboneElement | There are no (further) constraints on this element Element idPatient.animal This patient is known to be an animal (non-human) DefinitionThis patient is known to be an animal. Many clinical systems are extended to care for animal patients as well as human. The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal). BackboneElement Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.animal.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.animal.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.animal.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. 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. Extension Constraints
|
species | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idPatient.animal.species E.g. Dog, Cow DefinitionIdentifies the high level taxonomic categorization of the kind of animal. Need to know what kind of animal. If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.). CodeableConcept BindingThe species of an animal. ?? (example)Constraints
|
breed | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idPatient.animal.breed E.g. Poodle, Angus DefinitionIdentifies the detailed categorization of the kind of animal. May need to know the specific kind within the species. Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type. CodeableConcept BindingThe breed of an animal. ?? (example)Constraints
|
genderStatus | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idPatient.animal.genderStatus E.g. Neutered, Intact DefinitionIndicates the current state of the animal's reproductive organs. Gender status can affect housing and animal behavior. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. CodeableConcept BindingThe state of the animal's reproductive organs. ?? (example)Constraints
|
communication | 0..* | BackboneElement | There are no (further) constraints on this element Element idPatient.communication A list of Languages which may be used to communicate with the patient about his or her health DefinitionLanguages which may be used to communicate with the patient about his or her health. If a patient 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 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. BackboneElement Constraints
| |
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.communication.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.communication.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.communication.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. 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. Extension Constraints
|
language | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.communication.language The language which can be used to communicate with the patient about his or her health DefinitionThe 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. 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. CodeableConcept BindingA human language. ?? (extensible)Constraints
| |
preferred | 0..1 | boolean | There are no (further) constraints on this element Element idPatient.communication.preferred Language preference indicator DefinitionIndicates whether or not the patient prefers this language (over other languages he masters up a certain level). 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. boolean Constraints
| |
generalPractitioner | I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/Practitioner) | There are no (further) constraints on this element Element idPatient.generalPractitioner Patient's nominated primary care provider Alternate namescareProvider DefinitionPatient's nominated care provider. This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity 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. Reference(http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/Practitioner) Constraints
|
managingOrganization | Σ I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Organization) | There are no (further) constraints on this element Element idPatient.managingOrganization Organization that is the custodian of the patient record DefinitionOrganization that is the custodian of the patient record. Need to know who recognizes this patient record, manages and updates it. 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). Reference(http://hl7.org/fhir/StructureDefinition/Organization) Constraints
|
link | Σ ?! | 0..* | BackboneElement | There are no (further) constraints on this element Element idPatient.link Link to another patient resource that concerns the same actual person DefinitionLink to another patient resource that concerns the same actual patient. There are multiple usecases:
There is no assumption that linked patient records have mutual links. This element is labelled as a modifier because it may not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'. BackboneElement Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idPatient.link.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.link.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.link.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. 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. Extension Constraints
|
other | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson) | There are no (further) constraints on this element Element idPatient.link.other The other patient or related person resource that the link refers to DefinitionThe other patient resource that the link refers to. Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual. Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson) Constraints
|
type | Σ | 1..1 | codeBinding | There are no (further) constraints on this element Element idPatient.link.type replaced-by | replaces | refer | seealso - type of link DefinitionThe type of link between this patient resource and another patient resource. Note that FHIR strings may not exceed 1MB in size code BindingThe type of link between this patient resource and another patient resource. ?? (required)Constraints
|
Mapping
When a Patient resource for a known patient is to be created by the PHG the following mapping is used:
patient information | FHIR mapping | Description |
---|---|---|
patient identifier | Patient.identifier.value | Generally a code from the health care provider identifying the patient |
health care provider identifier | Patient.identifier.system | Generally a code identifying the health care provider |
code system | Patient.identifer.type.coding.system | "http://hl7.org/fhir/v2/0203 " |
code system code | Patient.identifer.type.coding.code | The code system identifier code such as 'MR' (medical record) or 'L' (local) |
When a Patient is unknown the following mapping is used:
patient information | FHIR mapping | Description |
---|---|---|
patient identifier | Patient.identifier.value | 'U' |
health care provider identifier | Patient.identifier.system | "http://hl7.org/fhir/v2/0004 " |
code system | Patient.identifer.type.coding.system | "http://hl7.org/fhir/v2/0203 " |
code system code | Patient.identifer.type.coding.code | 'U' |
Phd Patient JSON Example
An example patient resource using XDSb type enterprise and patient identifier with optionak name data is shown below.
{ "resourceType": "Patient", "id": "sisansarahId-1.2.3.4.5.6.7.8.10", "meta": { "profile": "placeholder/phdPatient" }, "identifier": [{ "type": { "coding": [{ "system": "http://hl7.org/fhir/v2/0203", "code": "MR" }] }, "system": "urn:oid:1.2.3.4.5.6.7.8.10", "value": "sisansarahId" }], "name": [{ "family": "Longstrump", "given": ["Sisansarah", "Lorianthah"] } } Unknown patient { "resourceType": "Patient", "id": "sisansarahId-1.2.3.4.5.6.7.8.10", "meta": { "profile": "placeholder/phdPatient" }, "identifier": [{ "type": { "coding": [{ "system": "http://hl7.org/fhir/v2/0203", "code": "U" }] }, "system": "http://hl7.org/fhir/v2/0004", "value": "U" }], "name": [{ "family": "Doe", "given": ["Jane"] } }