Notice
- Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
- This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from the NHS England Genomics Unit.
StructureDefinition UKCore-RelatedPerson
Used for linking Patients with other participants of a test order, e.g. in the case of proband and consultand within duo and trio testing.
For instances where clinical/demographic information for the related person are required, a Patient resource for the related person (consultand) SHOULD be included, with the Patient.link field referencing the RelatedPerson resource for the same individual. Elements duplicated across both the Patient and RelatedPerson for the same individual SHOULD in this case be captured within the Patient resource only. The RelatedPerson resource then references the proband Patient resource through the RelatedPerson.patient field.
A diagram illustrating the links between resources is provided below (Duo Scenario):
Further use cases surrounding the use of RelatedPerson are pending further Duo/Trio scenarios.
| Profile url | FHIR Module | Normative Status |
|---|---|---|
| https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson | UKCore | trial-use |
| UKCoreRelatedPerson (RelatedPerson) | I | RelatedPerson | There are no (further) constraints on this element Element idRelatedPerson A person that is related to a patient, but who is not a direct target of care DefinitionInformation about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idRelatedPerson.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. |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idRelatedPerson.meta Metadata about the resource DefinitionThe 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.
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idRelatedPerson.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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. 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.
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idRelatedPerson.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). A human language.
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idRelatedPerson.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 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. 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.
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idRelatedPerson.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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idRelatedPerson.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. 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| contactPreference | I | 0..1 | Extension(Complex) | Element idRelatedPerson.extension:contactPreference The preferred method of contact, contact times and written communication format given by a Patient or Related Person. Alternate namesextensions, user content DefinitionThe preferred method of contact, contact times and written communication format given by a Patient or Related Person. 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(Complex) Extension URLhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ContactPreference Constraints
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| copyCorrespondenceIndicator | I | 0..1 | Extension(boolean) | Element idRelatedPerson.extension:copyCorrespondenceIndicator Indicates that a Patient contact or RelatedPerson must be copied in to Patient correspondence. Alternate namesextensions, user content DefinitionExtension carrying a boolean indicator showing that a patient's contact or related person SHALL be copied in to patient correspondence. 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. https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CopyCorrespondenceIndicator Constraints
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| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idRelatedPerson.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 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idRelatedPerson.identifier A human identifier for this person DefinitionIdentifier for a person within a particular scope. People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.
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| active | S Σ ?! | 0..1 | boolean | Element idRelatedPerson.active Whether this related person's record is in active use. DefinitionWhether this related person record is in active use. Need to be able to mark a related person record as not to be used, such as if it was created in error. This element is labeled as a modifier because it may be used to mark that the resource was created in error. This resource is generally assumed to be active if no value is provided for the active element
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| patient | S Σ I | 1..1 | Reference(Patient) | Element idRelatedPerson.patient The patient this person is related to. DefinitionThe patient this person is related to. We need to know which patient this RelatedPerson is related to. 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.
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| relationship | S Σ | 0..* | CodeableConceptBinding | Element idRelatedPerson.relationship The nature of the relationship. DefinitionThe nature of the relationship between a patient and the related person. We need to know the relationship with the patient since it influences the interpretation of the information attributed to this person. 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. The nature of the relationship between a patient and the related person.
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| name | S Σ | 0..* | HumanName | Element idRelatedPerson.name A name associated with the person. DefinitionA name associated with the person. Related persons need to be identified by name, but it is uncommon to need details about multiple other names for that 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 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.
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| telecom | S Σ I | 0..* | ContactPoint | Element idRelatedPerson.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. Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
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| id | 0..1 | string | There are no (further) constraints on this element Element idRelatedPerson.telecom.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idRelatedPerson.telecom.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. 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | Σ I | 0..1 | codeBinding | There are no (further) constraints on this element Element idRelatedPerson.telecom.system phone | fax | email | pager | url | sms | other DefinitionTelecommunications form for contact point - what communications system is required to make use of the contact. Note that FHIR strings SHALL NOT exceed 1MB in size Telecommunications form for contact point.
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| id | 0..1 | string | There are no (further) constraints on this element Element idRelatedPerson.telecom.system.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idRelatedPerson.telecom.system.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. 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| otherContactSystem | I | 0..1 | Extension(CodeableConcept) | Element idRelatedPerson.telecom.system.extension:otherContactSystem Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`. Alternate namesextensions, user content DefinitionOther contact system value which extends the system element in the ContactPoint datatype. 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. https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OtherContactSystem Constraints
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| value | 0..1 | System.String | There are no (further) constraints on this element Element idRelatedPerson.telecom.system.value Primitive value for code DefinitionPrimitive value for code System.String Maximum string length1048576 | |
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element idRelatedPerson.telecom.value The actual contact point details DefinitionThe actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). Need to support legacy numbers that are not in a tightly controlled format. Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.
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| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idRelatedPerson.telecom.use home | work | temp | old | mobile - purpose of this contact point DefinitionIdentifies the purpose for the contact point. Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. Applications can assume that a contact is current unless it explicitly says that it is temporary or old. Use of contact point.
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| rank | Σ | 0..1 | positiveInt | There are no (further) constraints on this element Element idRelatedPerson.telecom.rank Specify preferred order of use (1 = highest) DefinitionSpecifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values. Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
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| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idRelatedPerson.telecom.period Time period when the contact point was/is in use DefinitionTime period when the contact point was/is in use. 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.
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| gender | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idRelatedPerson.gender male | female | other | unknown DefinitionAdministrative Gender - the gender that the person is considered to have for administration and record keeping purposes. Needed for identification of the person, in combination with (at least) name and birth date. Note that FHIR strings SHALL NOT exceed 1MB in size The gender of a person used for administrative purposes.
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| birthDate | Σ | 0..1 | date | There are no (further) constraints on this element Element idRelatedPerson.birthDate The date on which the related person was born DefinitionThe date on which the related person was born.
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| address | S Σ | 0..* | Address | Element idRelatedPerson.address Address where the related person can be contacted or visited. DefinitionAddress where the related person can be contacted or visited. Need to keep track where the related person can be contacted per postal mail or visited. 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).
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| photo | I | 0..* | Attachment | There are no (further) constraints on this element Element idRelatedPerson.photo Image of the person DefinitionImage of the person. Many EHR systems have the capability to capture an image of persons. 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 "Signed Procedure Consent".
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| period | I | 0..1 | Period | There are no (further) constraints on this element Element idRelatedPerson.period Period of time that this relationship is considered valid DefinitionThe period of time during which this relationship is or was active. If there are no dates defined, then the interval is unknown. 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.
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| communication | 0..* | BackboneElement | There are no (further) constraints on this element Element idRelatedPerson.communication A language which may be used to communicate with about the patient's health DefinitionA language which may be used to communicate with about the patient's health. If a related person does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest. If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple RelatedPerson.Communication associations. If the RelatedPerson does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
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| id | 0..1 | string | There are no (further) constraints on this element Element idRelatedPerson.communication.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idRelatedPerson.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. 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idRelatedPerson.communication.modifierExtension Extensions that cannot be ignored even if unrecognized 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 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| language | 1..1 | CodeableConceptBinding | Element idRelatedPerson.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. A language which may be used to communicate with the related person about the patient's health.
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| preferred | 0..1 | boolean | There are no (further) constraints on this element Element idRelatedPerson.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.
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| FHIR | MDS | HL7v2 |
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| RelatedPerson.relationship | Patient - Relationship to proband, Previous genomic report - Patient's relationship to requesting patient | NK1-3 |
Additional Guidance
patient
SHALL be provided. This SHOULD be a reference to the Patient resource and/or the identifier, e.g. NHS number, for the patient constituting the target of the relationship. This can be visualised using the nomenclature:
{Source (identifier)} is the {Relationship type (relationship)} of {Target (patient)}
'Ryanne Boulder' is the 'natural mother' of 'Fetus of Ryanne Boulder'
In this case the fetal identifier should be used in the patient element.
"patient": { "reference": "Patient/Patient-FoetusOfRyanneBoulder-Example", "identifier": { "system": "urn:oid:2.16.840.1.113883.2.1.3.2.4.18.24", "value": "FT-RWT13521", "assigner": { "identifier": { "system": "https://fhir.nhs.uk/Id/ods-organization-code", "value": "RAX" } } } },
identifier
SHALL be provided. This SHOULD be NHS number or local identifier (if NHS number is unavailable e.g. for non UK residents) for the source of the relationship. This can be visualised using the nomenclature:{Source (identifier)} is the {Relationship type (relationship)} of {Target (patient)}
'Ryanne Boulder' is the 'natural mother' of 'Fetus of Ryanne Boulder'
In this case the Ryanne Boulder's identifier should be used for the RelatedPerson.identifier.
If a local identifier is used, an assigner SHALL be provided. The RelatedPerson.identifier field SHALL match the identifier used for a FamilyMemberHistory or Patient resource if these resources are about the same person.
"identifier": [ { "system": "https://fhir.nhs.uk/Id/nhs-number", "value": "9999999999" } ],
relationship
SHOULD use the UK Core bound ValueSet and SHOULD be present in all instances of RelatedPerson wherever possible."relationship": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "code": "SIS", "display": "sister" } ] } ]