BGHMCPatient (Patient) | I | | Patient | There are no (further) constraints on this element Element idShort description Information about an individual or animal receiving health care services Alternate names SubjectOfCare Client Resident Definition Demographics and other administrative information about an individual or animal receiving care or other health-related services.
Data type Patient Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.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-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-6: A resource should have narrative for robust management
text.`div`.exists() - dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty()
Mappings- rim: Entity. Role, or Act
- rim: Patient[classCode=PAT]
- cda: ClinicalDocument.recordTarget.patientRole
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Data type string |
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idShort description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Data type Meta Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idShort description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Data type uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idShort description Language of the resource content Definition The base language in which the resource is written.
Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Data type code Binding CommonLanguages (preferred)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
text | | 0..1 | Narrative | There are no (further) constraints on this element Element idShort description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Data type Narrative Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- rim: N/A
- rim: Act.text?
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contained | | 0..* | Resource | There are no (further) constraints on this element Element idShort description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Data type Resource Mappings- rim: Entity. Role, or Act
- rim: N/A
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
Mappings |
modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
Mappings |
identifier | S Σ | 1..1 | Identifier | There are no (further) constraints on this element Element idShort description An identifier for this patient Definition An identifier for this patient.
Requirements Patients are almost always assigned specific numerical identifiers.
Data type Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
- servd: Identifier
- w5: FiveWs.identifier
- v2: PID-3
- rim: id
- cda: .id
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id | | 0..1 | string | There are no (further) constraints on this element Element idShort description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Data type string Mappings |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.identifier.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
Mappings |
use | Σ ?! | 0..0 | codeBinding | There are no (further) constraints on this element Element idShort description usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Data type code Binding Identifies the purpose for this identifier, if known .
IdentifierUse (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: N/A
- rim: Role.code or implied by context
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type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idShort description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements Allows users to make use of identifiers when the identifier system is not known.
Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Data type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Identifier Type Codes (extensible)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: CX.5
- rim: Role.code or implied by context
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id | | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier.type.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Data type string Mappings |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.identifier.type.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
Mappings |
coding | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idPatient.identifier.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system.
Requirements Allows for alternative encodings within a code system, and translations to other code systems.
Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Data type Coding Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
- v2: C*E.1-8, C*E.10-22
- rim: union(., ./translation)
- orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
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id | | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier.type.coding.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Data type string Mappings |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.identifier.type.coding.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
Mappings |
system | Σ | 1..1 | uriFixed Value | Element idPatient.identifier.type.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code.
Requirements Need to be unambiguous about the source of the definition of the symbol.
Comments 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.
Data type uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value http://terminology.hl7.org/CodeSystem/v2-0203 Mappings- rim: n/a
- v2: C*E.3
- rim: ./codeSystem
- orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
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version | Σ | 0..0 | string | There are no (further) constraints on this element Element idPatient.identifier.type.coding.version Short description Version of the system - if relevant Definition The 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.
Comments 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.
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: C*E.7
- rim: ./codeSystemVersion
- orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
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code | Σ | 1..1 | codeFixed Value | Element idPatient.identifier.type.coding.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Requirements Need to refer to a particular code in the system.
Comments Note that FHIR strings SHALL NOT exceed 1MB in size
Data type code Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value Mappings- rim: n/a
- v2: C*E.1
- rim: ./code
- orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
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display | Σ | 1..1 | stringFixed Value | Element idPatient.identifier.type.coding.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system.
Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Comments Note that FHIR strings SHALL NOT exceed 1MB in size
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value Mappings- rim: n/a
- v2: C*E.2 - but note this is not well followed
- rim: CV.displayName
- orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
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userSelected | Σ | 0..0 | boolean | There are no (further) constraints on this element Element idPatient.identifier.type.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Requirements 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.
Comments 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.
Data type boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- 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 ]
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text | Σ | 1..1 | stringFixed Value | Element idPatient.identifier.type.text Short description Plain text representation of the concept Definition A 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.
Requirements 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.
Comments Very often the text is the same as a displayName of one of the codings.
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Fixed value Mappings- rim: n/a
- 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
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system | Σ | 0..0 | uri | There are no (further) constraints on this element Element idPatient.identifier.system Short description The namespace for the identifier value 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.
Comments Identifier.system is always case sensitive.
Data type uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Examples Generalhttp://www.acme.com/identifiers/patient Mappings- rim: n/a
- v2: CX.4 / EI-2-4
- rim: II.root or Role.id.root
- servd: ./IdentifierType
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value | Σ | 1..1 | string | There are no (further) constraints on this element Element idShort description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Examples Mappings- rim: n/a
- 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
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period | Σ I | 0..0 | Period | There are no (further) constraints on this element Element idPatient.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
Comments 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").
Period is not used for a duration (a measure of elapsed time). See Duration.
Data type Period Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - per-1: If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings- rim: n/a
- v2: DR
- rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2: CX.7 + CX.8
- rim: Role.effectiveTime or implied by context
- servd: ./StartDate and ./EndDate
|
assigner | Σ I | 0..0 | Reference(Organization) | There are no (further) constraints on this element Element idPatient.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Data type Reference(Organization) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- 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
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active | S Σ ?! | 1..1 | boolean | There are no (further) constraints on this element Element idShort description Whether this patient's record is in active use Definition Whether this patient record is in active use.
Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.
It is often used to filter patient lists to exclude inactive patients
Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Requirements Need to be able to mark a patient record as not to be used because it was created in error.
Comments If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Meaning when missing This resource is generally assumed to be active if no value is provided for the active element
Data type boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- w5: FiveWs.status
- rim: statusCode
- cda: n/a
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name | S Σ | 1..1 | BaseHumanName | Element idShort description Name of a human - parts and usage Definition A human's name with the ability to identify parts and usage.
Requirements Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Comments 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 might or might 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.
Data type BaseHumanName Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: XPN
- rim: EN (actually, PN)
- servd: ProviderName
- v2: PID-5, PID-9
- rim: name
- cda: .patient.name
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telecom | Σ I | 0..* | ContactPoint | Element idShort description A contact detail for the individual Definition A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Requirements People have (primary) ways to contact them in some way such as phone, email.
Comments A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
Data type ContactPoint Sliced: Unordered, Open, by system(Value) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - cpt-2: A system is required if a value is provided.
value.empty() or system.exists()
Mappings- rim: n/a
- v2: XTN
- rim: TEL
- servd: ContactPoint
- v2: PID-13, PID-14, PID-40
- rim: telecom
- cda: .telecom
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mobile | Σ I | 0..* | MobileContactPoint | Element idShort description Details of a Technology mediated contact point (phone, fax, email, etc.) Definition Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.
Requirements People have (primary) ways to contact them in some way such as phone, email.
Comments A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
Data type MobileContactPoint Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - cpt-2: A system is required if a value is provided.
value.empty() or system.exists()
Mappings- rim: n/a
- v2: XTN
- rim: TEL
- servd: ContactPoint
- v2: PID-13, PID-14, PID-40
- rim: telecom
- cda: .telecom
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email | Σ I | 0..* | EmailContactPoint | Element idShort description Details of a Technology mediated contact point (phone, fax, email, etc.) Definition Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.
Requirements People have (primary) ways to contact them in some way such as phone, email.
Comments A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
Data type EmailContactPoint Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - cpt-2: A system is required if a value is provided.
value.empty() or system.exists()
Mappings- rim: n/a
- v2: XTN
- rim: TEL
- servd: ContactPoint
- v2: PID-13, PID-14, PID-40
- rim: telecom
- cda: .telecom
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landline | Σ I | 0..* | LandlineContactPoint | Element idShort description Details of a Technology mediated contact point (phone, fax, email, etc.) Definition Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.
Requirements People have (primary) ways to contact them in some way such as phone, email.
Comments A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
Data type LandlineContactPoint Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - cpt-2: A system is required if a value is provided.
value.empty() or system.exists()
Mappings- rim: n/a
- v2: XTN
- rim: TEL
- servd: ContactPoint
- v2: PID-13, PID-14, PID-40
- rim: telecom
- cda: .telecom
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gender | S Σ | 1..1 | codeBinding | There are no (further) constraints on this element Element idShort description male | female | other | unknown Definition Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Requirements Needed for identification of the individual, in combination with (at least) name and birth date.
Comments The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
Data type code Binding The gender of a person used for administrative purposes.
AdministrativeGender (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: PID-8
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
- cda: .patient.administrativeGenderCode
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birthDate | S Σ | 1..1 | date | There are no (further) constraints on this element Element idShort description The date of birth for the individual Definition The date of birth for the individual.
Requirements Age of the individual drives many clinical processes.
Comments At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).
Data type date Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: PID-7
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime
- cda: .patient.birthTime
- loinc: 21112-8
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deceased[x] | Σ ?! | 0..0 | | There are no (further) constraints on this element Element idShort description Indicates if the individual is deceased or not Definition Indicates if the individual is deceased or not.
Requirements The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
Comments If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.
Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: PID-30 (bool) and PID-29 (datetime)
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime
- cda: n/a
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address | Σ | 0..* | Address | Element idShort description An address for the individual Definition An address for the individual.
Requirements May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Comments Patient may have multiple addresses with different uses or applicable periods.
Data type Address Sliced: Unordered, Open, by $this(Value) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: XAD
- rim: AD
- servd: Address
- v2: PID-11
- rim: addr
- cda: .addr
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permanent | Σ | 0..1 | PermanentAddress | Element idPatient.address:permanent Short description An address expressed using postal conventions (as opposed to GPS or other location definition formats) Definition An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.
Requirements May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
Data type PermanentAddress Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: XAD
- rim: AD
- servd: Address
- v2: PID-11
- rim: addr
- cda: .addr
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temporary | Σ | 0..1 | TemporaryAddress | Element idPatient.address:temporary Short description An address expressed using postal conventions (as opposed to GPS or other location definition formats) Definition An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.
Requirements May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
Data type TemporaryAddress Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: XAD
- rim: AD
- servd: Address
- v2: PID-11
- rim: addr
- cda: .addr
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maritalStatus | S | 1..1 | CodeableConceptBinding | Element idShort description Marital (civil) status of a patient Definition This field contains a patient's most recent marital (civil) status.
Requirements Most, if not all systems capture it.
Comments 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.
Data type CodeableConcept Binding The domestic partnership status of a person.
Marital Status Codes (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: PID-16
- rim: player[classCode=PSN]/maritalStatusCode
- cda: .patient.maritalStatusCode
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id | | 0..1 | string | There are no (further) constraints on this element Element idShort description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Data type string Mappings |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.maritalStatus.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
Mappings |
coding | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idPatient.maritalStatus.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system.
Requirements Allows for alternative encodings within a code system, and translations to other code systems.
Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Data type Coding Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
- v2: C*E.1-8, C*E.10-22
- rim: union(., ./translation)
- orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idPatient.maritalStatus.text Short description Plain text representation of the concept Definition A 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.
Requirements 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.
Comments Very often the text is the same as a displayName of one of the codings.
Data type string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- 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
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multipleBirth[x] | | 0..0 | | There are no (further) constraints on this element Element idShort description Whether patient is part of a multiple birth Definition Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Requirements For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Comments Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: PID-24 (bool), PID-25 (integer)
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber
- cda: n/a
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photo | I | 0..0 | Attachment | There are no (further) constraints on this element Element idShort description Image of the patient Definition Requirements Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Comments Guidelines:
- Use id photos, not clinical photos.
- Limit dimensions to thumbnail.
- Keep byte count low to ease resource updates.
Data type Attachment Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - att-1: If the Attachment has data, it SHALL have a contentType
data.empty() or contentType.exists()
Mappings- rim: n/a
- v2: ED/RP
- rim: ED
- v2: OBX-5 - needs a profile
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc
- cda: n/a
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contact | I | 0..0 | BackboneElement | There are no (further) constraints on this element Element idShort description A contact party (e.g. guardian, partner, friend) for the patient Definition A contact party (e.g. guardian, partner, friend) for the patient.
Requirements Need to track people you can contact about the patient.
Comments Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.
Data type BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - pat-1: SHALL at least contain a contact's details or a reference to an organization
name.exists() or telecom.exists() or address.exists() or organization.exists()
Mappings- rim: n/a
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
- cda: n/a
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communication | | 0..0 | BackboneElement | There are no (further) constraints on this element Element idShort description A language which may be used to communicate with the patient about his or her health 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.
Comments If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
Data type BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- rim: LanguageCommunication
- cda: patient.languageCommunication
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generalPractitioner | I | 0..0 | Reference(Organization | Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idPatient.generalPractitioner Short description Patient's nominated primary care provider Alternate names careProvider Definition Patient's nominated care provider.
Comments This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.
Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.
Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
Data type Reference(Organization | Practitioner | PractitionerRole) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2: PD1-4
- rim: subjectOf.CareEvent.performer.AssignedEntity
- cda: n/a
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managingOrganization | Σ I | 0..0 | Reference(Organization) | There are no (further) constraints on this element Element idPatient.managingOrganization Short description Organization that is the custodian of the patient record Definition Organization that is the custodian of the patient record.
Requirements Need to know who recognizes this patient record, manages and updates it.
Comments There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
Data type Reference(Organization) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- rim: scoper
- cda: .providerOrganization
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link | Σ ?! | 0..* | BackboneElement | There are no (further) constraints on this element Element idShort description Link to another patient resource that concerns the same actual person Definition Link to another patient resource that concerns the same actual patient.
Requirements There are multiple use cases:
- Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
- Distribution of patient information across multiple servers.
Comments There is no assumption that linked patient records have mutual links.
Data type BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- rim: outboundLink
- cda: n/a
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id | | 0..1 | string | There are no (further) constraints on this element Element idShort description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Data type string Mappings |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
Mappings |
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idPatient.link.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Data type Extension Constraints- 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()
Mappings |
other | Σ I | 1..1 | Reference(Patient | RelatedPerson) | There are no (further) constraints on this element Element idShort description The other patient or related person resource that the link refers to Definition The other patient resource that the link refers to.
Comments Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
Data type Reference(Patient | RelatedPerson) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2: PID-3, MRG-1
- rim: id
- cda: n/a
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type | Σ | 1..1 | codeBinding | There are no (further) constraints on this element Element idShort description replaced-by | replaces | refer | seealso Definition The type of link between this patient resource and another patient resource.
Comments Note that FHIR strings SHALL NOT exceed 1MB in size
Data type code Binding The type of link between this patient resource and another patient resource.
LinkType (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- rim: typeCode
- cda: n/a
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