HL7 FHIR Guide Template
0.0.4-uscorepatient - Draft

Please note, this guide is purely for demonstration purposes and should not be used for actual implementation.

4.1. Resource Patient

4.1.1. Scope and Usage

This Resource covers data about patients and animals involved in a wide range of health-related activities, including:

  • Curative activities
  • Psychiatric care
  • Social services
  • Pregnancy care
  • Nursing and assisted living
  • Dietary services
  • Tracking of personal health and exercise data

The data in the Resource covers the "who" information about the patient: its attributes are focused on the demographic information necessary to support the administrative, financial and logistic procedures. A Patient record is generally created and maintained by each organization providing care for a patient. A patient or animal receiving care at multiple organizations may therefore have its information present in multiple Patient Resources.

Not all concepts are included within the base resource (such as race, ethnicity, organ donor status, nationality, etc.), but may be found in profiles defined for specific jurisdictions (e.g., US Meaningful Use Program) or standard extensions. Such fields vary widely between jurisdictions and often have different names and valuesets for the similar concepts, but they are not similar enough to be able to map and exchange.

4.1.1.1. References to this Resource

4.1.2. Resource Content

This is the tree view:
idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionC0..*Extension
modifierExtension?! C0..*Extension
identifierΣ0..*Identifier
activeΣ ?!0..1boolean
nameΣ0..*HumanName
telecomΣ C0..*ContactPoint
genderΣ0..1codeBinding
birthDateΣ0..1date
deceasedBooleanboolean
deceasedDateTimedateTime
addressΣ0..*Address
maritalStatus0..1CodeableConceptBinding
multipleBirthBooleanboolean
multipleBirthIntegerinteger
photoC0..*Attachment
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
relationship0..*CodeableConceptBinding
name0..1HumanName
telecomC0..*ContactPoint
address0..1Address
gender0..1codeBinding
organizationC0..1Reference(Organization)
periodC0..1Period
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
language1..1CodeableConceptBinding
preferred0..1boolean
generalPractitionerC0..*Reference(Organization | Practitioner | PractitionerRole)
managingOrganizationΣ C0..1Reference(Organization)
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
otherΣ C1..1Reference(Patient | RelatedPerson)
typeΣ1..1codeBinding
This is the resource in XML:
<StructureDefinition xmlns="http://hl7.org/fhir">
<id value="Patient" />
<meta>
<lastUpdated value="2019-11-01T09:29:23.356+11:00" />
</meta>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-category">
<valueString value="Base.Individuals" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="normative" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
<valueCode value="4.0.0" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="5" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category">
<valueCode value="patient" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="pa" />
</extension>
<url value="http://hl7.org/fhir/StructureDefinition/Patient" />
<version value="4.0.1" />
<name value="Patient" />
<status value="active" />
<date value="2019-11-01T09:29:23+11:00" />
<publisher value="Health Level Seven International (Patient Administration)" />
<contact>
<telecom>
<system value="url" />
<value value="http://hl7.org/fhir" />
</telecom>
</contact>
<contact>
<telecom>
<system value="url" />
<value value="http://www.hl7.org/Special/committees/pafm/index.cfm" />
</telecom>
</contact>
<description value="Demographics and other administrative information about an individual or animal receiving care or other health-related services." />
<purpose value="Tracking patient is the center of the healthcare process." />
<fhirVersion value="4.0.1" />
<mapping>
<identity value="rim" />
<uri value="http://hl7.org/v3" />
<name value="RIM Mapping" />
</mapping>
<mapping>
<identity value="cda" />
<uri value="http://hl7.org/v3/cda" />
<name value="CDA (R2)" />
</mapping>
<mapping>
<identity value="w5" />
<uri value="http://hl7.org/fhir/fivews" />
<name value="FiveWs Pattern Mapping" />
</mapping>
<mapping>
<identity value="v2" />
<uri value="http://hl7.org/v2" />
<name value="HL7 v2 Mapping" />
</mapping>
<mapping>
<identity value="loinc" />
<uri value="http://loinc.org" />
<name value="LOINC code for the element" />
</mapping>
<kind value="resource" />
<abstract value="false" />
<type value="Patient" />
<baseDefinition value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
<derivation value="specialization" />
<snapshot>
<element id="Patient">
<path value="Patient" />
<short value="Information about an individual or animal receiving health care services" />
<definition value="Demographics and other administrative information about an individual or animal receiving care or other health-related services." />
<alias value="SubjectOfCare Client Resident" />
<min value="0" />
<max value="*" />
<base>
<path value="Patient" />
<min value="0" />
<max value="*" />
</base>
<constraint>
<key value="dom-2" />
<severity value="error" />
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
<expression value="contained.contained.empty()" />
<xpath value="not(parent::f:contained and f:contained)" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-3" />
<severity value="error" />
<human value="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" />
<expression value="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()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-4" />
<severity value="error" />
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-5" />
<severity value="error" />
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
<expression value="contained.meta.security.empty()" />
<xpath value="not(exists(f:contained/*/f:meta/f:security))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
<valueBoolean value="true" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
<key value="dom-6" />
<severity value="warning" />
<human value="A resource should have narrative for robust management" />
<expression value="text.`div`.exists()" />
<xpath value="exists(f:text/h:div)" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="Entity. Role, or Act" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Patient[classCode=PAT]" />
</mapping>
<mapping>
<identity value="cda" />
<map value="ClinicalDocument.recordTarget.patientRole" />
</mapping>
</element>
<element id="Patient.id">
<path value="Patient.id" />
<short value="Logical id of this artifact" />
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="true" />
</element>
<element id="Patient.meta">
<path value="Patient.meta" />
<short value="Metadata about the resource" />
<definition value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.meta" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Meta" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
</element>
<element id="Patient.implicitRules">
<path value="Patient.implicitRules" />
<short value="A set of rules under which this content was created" />
<definition value="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." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.implicitRules" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="uri" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
<isSummary value="true" />
</element>
<element id="Patient.language">
<path value="Patient.language" />
<short value="Language of the resource content" />
<definition value="The base language in which the resource is written." />
<comment value="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)." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.language" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="preferred" />
<description value="A human language." />
<valueSet value="http://hl7.org/fhir/ValueSet/languages" />
</binding>
</element>
<element id="Patient.text">
<path value="Patient.text" />
<short value="Text summary of the resource, for human interpretation" />
<definition value="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." />
<comment value="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." />
<alias value="narrative" />
<alias value="html" />
<alias value="xhtml" />
<alias value="display" />
<min value="0" />
<max value="1" />
<base>
<path value="DomainResource.text" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Narrative" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="Act.text?" />
</mapping>
</element>
<element id="Patient.contained">
<path value="Patient.contained" />
<short value="Contained, inline Resources" />
<definition value="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." />
<comment value="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." />
<alias value="inline resources" />
<alias value="anonymous resources" />
<alias value="contained resources" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.contained" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Resource" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Patient.extension">
<path value="Patient.extension" />
<short value="Additional content defined by implementations" />
<definition value="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." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Patient.modifierExtension">
<path value="Patient.modifierExtension" />
<short value="Extensions that cannot be ignored" />
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Patient.identifier">
<path value="Patient.identifier" />
<short value="An identifier for this patient" />
<definition value="An identifier for this patient." />
<requirements value="Patients are almost always assigned specific numerical identifiers." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.identifier" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Identifier" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.identifier" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PID-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value="id" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".id" />
</mapping>
</element>
<element id="Patient.active">
<path value="Patient.active" />
<short value="Whether this patient's record is in active use" />
<definition value="Whether this patient record is in active use. \nMany 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.\n\nIt is often used to filter patient lists to exclude inactive patients\n\nDeceased patients may also be marked as inactive for the same reasons, but may be active for some time after death." />
<comment value="If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient." />
<requirements value="Need to be able to mark a patient record as not to be used because it was created in error." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.active" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<meaningWhenMissing value="This resource is generally assumed to be active if no value is provided for the active element" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid" />
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.status" />
</mapping>
<mapping>
<identity value="rim" />
<map value="statusCode" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.name">
<path value="Patient.name" />
<short value="A name associated with the patient" />
<definition value="A name associated with the individual." />
<comment value="A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns." />
<requirements value="Need to be able to track the patient by multiple names. Examples are your official name and a partner name." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.name" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="HumanName" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-5, PID-9" />
</mapping>
<mapping>
<identity value="rim" />
<map value="name" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.name" />
</mapping>
</element>
<element id="Patient.telecom">
<path value="Patient.telecom" />
<short value="A contact detail for the individual" />
<definition value="A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted." />
<comment value="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)." />
<requirements value="People have (primary) ways to contact them in some way such as phone, email." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.telecom" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="ContactPoint" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-13, PID-14, PID-40" />
</mapping>
<mapping>
<identity value="rim" />
<map value="telecom" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".telecom" />
</mapping>
</element>
<element id="Patient.gender">
<path value="Patient.gender" />
<short value="male | female | other | unknown" />
<definition value="Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes." />
<comment value="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." />
<requirements value="Needed for identification of the individual, in combination with (at least) name and birth date." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.gender" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdministrativeGender" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="required" />
<description value="The gender of a person used for administrative purposes." />
<valueSet value="http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1" />
</binding>
<mapping>
<identity value="v2" />
<map value="PID-8" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.administrativeGenderCode" />
</mapping>
</element>
<element id="Patient.birthDate">
<path value="Patient.birthDate" />
<short value="The date of birth for the individual" />
<definition value="The date of birth for the individual." />
<comment value="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)." />
<requirements value="Age of the individual drives many clinical processes." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.birthDate" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="date" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-7" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.birthTime" />
</mapping>
<mapping>
<identity value="loinc" />
<map value="21112-8" />
</mapping>
</element>
<element id="Patient.deceased[x]">
<path value="Patient.deceased[x]" />
<short value="Indicates if the individual is deceased or not" />
<definition value="Indicates if the individual is deceased or not." />
<comment value="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." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.deceased[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<type>
<code value="dateTime" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different." />
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-30 (bool) and PID-29 (datetime)" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.address">
<path value="Patient.address" />
<short value="An address for the individual" />
<definition value="An address for the individual." />
<comment value="Patient may have multiple addresses with different uses or applicable periods." />
<requirements value="May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.address" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Address" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-11" />
</mapping>
<mapping>
<identity value="rim" />
<map value="addr" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".addr" />
</mapping>
</element>
<element id="Patient.maritalStatus">
<path value="Patient.maritalStatus" />
<short value="Marital (civil) status of a patient" />
<definition value="This field contains a patient's most recent marital (civil) status." />
<requirements value="Most, if not all systems capture it." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.maritalStatus" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MaritalStatus" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="extensible" />
<description value="The domestic partnership status of a person." />
<valueSet value="http://hl7.org/fhir/ValueSet/marital-status" />
</binding>
<mapping>
<identity value="v2" />
<map value="PID-16" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN]/maritalStatusCode" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.maritalStatusCode" />
</mapping>
</element>
<element id="Patient.multipleBirth[x]">
<path value="Patient.multipleBirth[x]" />
<short value="Whether patient is part of a multiple birth" />
<definition value="Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer)." />
<comment value="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)." />
<requirements value="For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.multipleBirth[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<type>
<code value="integer" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="PID-24 (bool), PID-25 (integer)" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.photo">
<path value="Patient.photo" />
<short value="Image of the patient" />
<definition value="Image of the patient." />
<comment value="Guidelines:\n* Use id photos, not clinical photos.\n* Limit dimensions to thumbnail.\n* Keep byte count low to ease resource updates." />
<requirements value="Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.photo" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Attachment" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="OBX-5 - needs a profile" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact">
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
<valueString value="Contact" />
</extension>
<path value="Patient.contact" />
<short value="A contact party (e.g. guardian, partner, friend) for the patient" />
<definition value="A contact party (e.g. guardian, partner, friend) for the patient." />
<comment value="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." />
<requirements value="Need to track people you can contact about the patient." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.contact" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="BackboneElement" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="pat-1" />
<severity value="error" />
<human value="SHALL at least contain a contact's details or a reference to an organization" />
<expression value="name.exists() or telecom.exists() or address.exists() or organization.exists()" />
<xpath value="exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization)" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.id">
<path value="Patient.contact.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.extension">
<path value="Patient.contact.extension" />
<short value="Additional content defined by implementations" />
<definition value="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." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.modifierExtension">
<path value="Patient.contact.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Patient.contact.relationship">
<path value="Patient.contact.relationship" />
<short value="The kind of relationship" />
<definition value="The nature of the relationship between the patient and the contact person." />
<requirements value="Used to determine which contact person is the most relevant to approach, depending on circumstances." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.contact.relationship" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ContactRelationship" />
</extension>
<strength value="extensible" />
<description value="The nature of the relationship between a patient and a contact person for that patient." />
<valueSet value="http://hl7.org/fhir/ValueSet/patient-contactrelationship" />
</binding>
<mapping>
<identity value="v2" />
<map value="NK1-7, NK1-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value="code" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.name">
<path value="Patient.contact.name" />
<short value="A name associated with the contact person" />
<definition value="A name associated with the contact person." />
<requirements value="Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.contact.name" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="HumanName" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="NK1-2" />
</mapping>
<mapping>
<identity value="rim" />
<map value="name" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.telecom">
<path value="Patient.contact.telecom" />
<short value="A contact detail for the person" />
<definition value="A contact detail for the person, e.g. a telephone number or an email address." />
<comment value="Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification." />
<requirements value="People have (primary) ways to contact them in some way such as phone, email." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.contact.telecom" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="ContactPoint" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="NK1-5, NK1-6, NK1-40" />
</mapping>
<mapping>
<identity value="rim" />
<map value="telecom" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.address">
<path value="Patient.contact.address" />
<short value="Address for the contact person" />
<definition value="Address for the contact person." />
<requirements value="Need to keep track where the contact person can be contacted per postal mail or visited." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.contact.address" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Address" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="NK1-4" />
</mapping>
<mapping>
<identity value="rim" />
<map value="addr" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.gender">
<path value="Patient.contact.gender" />
<short value="male | female | other | unknown" />
<definition value="Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes." />
<requirements value="Needed to address the person correctly." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.contact.gender" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdministrativeGender" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="required" />
<description value="The gender of a person used for administrative purposes." />
<valueSet value="http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1" />
</binding>
<mapping>
<identity value="v2" />
<map value="NK1-15" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.organization">
<path value="Patient.contact.organization" />
<short value="Organization that is associated with the contact" />
<definition value="Organization on behalf of which the contact is acting or for which the contact is working." />
<requirements value="For guardians or business related contacts, the organization is relevant." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.contact.organization" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
</type>
<condition value="pat-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="NK1-13, NK1-30, NK1-31, NK1-32, NK1-41" />
</mapping>
<mapping>
<identity value="rim" />
<map value="scoper" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.period">
<path value="Patient.contact.period" />
<short value="The period during which this contact person or organization is valid to be contacted relating to this patient" />
<definition value="The period during which this contact person or organization is valid to be contacted relating to this patient." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.contact.period" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Period" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="effectiveTime" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.communication">
<path value="Patient.communication" />
<short value="A language which may be used to communicate with the patient about his or her health" />
<definition value="A language which may be used to communicate with the patient about his or her health." />
<comment value="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." />
<requirements value="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." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.communication" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="BackboneElement" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="LanguageCommunication" />
</mapping>
<mapping>
<identity value="cda" />
<map value="patient.languageCommunication" />
</mapping>
</element>
<element id="Patient.communication.id">
<path value="Patient.communication.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.communication.extension">
<path value="Patient.communication.extension" />
<short value="Additional content defined by implementations" />
<definition value="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." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.communication.modifierExtension">
<path value="Patient.communication.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Patient.communication.language">
<path value="Patient.communication.language" />
<short value="The language which can be used to communicate with the patient about his or her health" />
<definition value="The 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." />
<comment value="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." />
<requirements value="Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect." />
<min value="1" />
<max value="1" />
<base>
<path value="Patient.communication.language" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="preferred" />
<description value="A human language." />
<valueSet value="http://hl7.org/fhir/ValueSet/languages" />
</binding>
<mapping>
<identity value="v2" />
<map value="PID-15, LAN-2" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".languageCode" />
</mapping>
</element>
<element id="Patient.communication.preferred">
<path value="Patient.communication.preferred" />
<short value="Language preference indicator" />
<definition value="Indicates whether or not the patient prefers this language (over other languages he masters up a certain level)." />
<comment value="This language is specifically identified for communicating healthcare information." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.communication.preferred" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="PID-15" />
</mapping>
<mapping>
<identity value="rim" />
<map value="preferenceInd" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".preferenceInd" />
</mapping>
</element>
<element id="Patient.generalPractitioner">
<path value="Patient.generalPractitioner" />
<short value="Patient's nominated primary care provider" />
<definition value="Patient's nominated care provider." />
<comment value="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.\nMultiple 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.\n\nJurisdictions may decide that they can profile this down to 1 if desired, or 1 per type." />
<alias value="careProvider" />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.generalPractitioner" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="v2" />
<map value="PD1-4" />
</mapping>
<mapping>
<identity value="rim" />
<map value="subjectOf.CareEvent.performer.AssignedEntity" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.managingOrganization">
<path value="Patient.managingOrganization" />
<short value="Organization that is the custodian of the patient record" />
<definition value="Organization that is the custodian of the patient record." />
<comment value="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)." />
<requirements value="Need to know who recognizes this patient record, manages and updates it." />
<min value="0" />
<max value="1" />
<base>
<path value="Patient.managingOrganization" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="scoper" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".providerOrganization" />
</mapping>
</element>
<element id="Patient.link">
<path value="Patient.link" />
<short value="Link to another patient resource that concerns the same actual person" />
<definition value="Link to another patient resource that concerns the same actual patient." />
<comment value="There is no assumption that linked patient records have mutual links." />
<requirements value="There are multiple use cases: \n\n* Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and \n* Distribution of patient information across multiple servers." />
<min value="0" />
<max value="*" />
<base>
<path value="Patient.link" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="BackboneElement" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="outboundLink" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.link.id">
<path value="Patient.link.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.link.extension">
<path value="Patient.link.extension" />
<short value="Additional content defined by implementations" />
<definition value="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." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.link.modifierExtension">
<path value="Patient.link.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Patient.link.other">
<path value="Patient.link.other" />
<short value="The other patient or related person resource that the link refers to" />
<definition value="The other patient resource that the link refers to." />
<comment value="Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual." />
<min value="1" />
<max value="1" />
<base>
<path value="Patient.link.other" />
<min value="1" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy">
<valueBoolean value="false" />
</extension>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-3, MRG-1" />
</mapping>
<mapping>
<identity value="rim" />
<map value="id" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.link.type">
<path value="Patient.link.type" />
<short value="replaced-by | replaces | refer | seealso" />
<definition value="The type of link between this patient resource and another patient resource." />
<min value="1" />
<max value="1" />
<base>
<path value="Patient.link.type" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="LinkType" />
</extension>
<strength value="required" />
<description value="The type of link between this patient resource and another patient resource." />
<valueSet value="http://hl7.org/fhir/ValueSet/link-type|4.0.1" />
</binding>
<mapping>
<identity value="rim" />
<map value="typeCode" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
</snapshot>
<differential>
<element id="Patient">
<path value="Patient" />
<short value="Information about an individual or animal receiving health care services" />
<definition value="Demographics and other administrative information about an individual or animal receiving care or other health-related services." />
<alias value="SubjectOfCare Client Resident" />
<min value="0" />
<max value="*" />
<mapping>
<identity value="rim" />
<map value="Patient[classCode=PAT]" />
</mapping>
<mapping>
<identity value="cda" />
<map value="ClinicalDocument.recordTarget.patientRole" />
</mapping>
</element>
<element id="Patient.identifier">
<path value="Patient.identifier" />
<short value="An identifier for this patient" />
<definition value="An identifier for this patient." />
<requirements value="Patients are almost always assigned specific numerical identifiers." />
<min value="0" />
<max value="*" />
<type>
<code value="Identifier" />
</type>
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.identifier" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PID-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value="id" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".id" />
</mapping>
</element>
<element id="Patient.active">
<path value="Patient.active" />
<short value="Whether this patient's record is in active use" />
<definition value="Whether this patient record is in active use. \nMany 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.\n\nIt is often used to filter patient lists to exclude inactive patients\n\nDeceased patients may also be marked as inactive for the same reasons, but may be active for some time after death." />
<comment value="If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient." />
<requirements value="Need to be able to mark a patient record as not to be used because it was created in error." />
<min value="0" />
<max value="1" />
<type>
<code value="boolean" />
</type>
<meaningWhenMissing value="This resource is generally assumed to be active if no value is provided for the active element" />
<isModifier value="true" />
<isModifierReason value="This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid" />
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.status" />
</mapping>
<mapping>
<identity value="rim" />
<map value="statusCode" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.name">
<path value="Patient.name" />
<short value="A name associated with the patient" />
<definition value="A name associated with the individual." />
<comment value="A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns." />
<requirements value="Need to be able to track the patient by multiple names. Examples are your official name and a partner name." />
<min value="0" />
<max value="*" />
<type>
<code value="HumanName" />
</type>
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-5, PID-9" />
</mapping>
<mapping>
<identity value="rim" />
<map value="name" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.name" />
</mapping>
</element>
<element id="Patient.telecom">
<path value="Patient.telecom" />
<short value="A contact detail for the individual" />
<definition value="A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted." />
<comment value="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)." />
<requirements value="People have (primary) ways to contact them in some way such as phone, email." />
<min value="0" />
<max value="*" />
<type>
<code value="ContactPoint" />
</type>
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-13, PID-14, PID-40" />
</mapping>
<mapping>
<identity value="rim" />
<map value="telecom" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".telecom" />
</mapping>
</element>
<element id="Patient.gender">
<path value="Patient.gender" />
<short value="male | female | other | unknown" />
<definition value="Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes." />
<comment value="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." />
<requirements value="Needed for identification of the individual, in combination with (at least) name and birth date." />
<min value="0" />
<max value="1" />
<type>
<code value="code" />
</type>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdministrativeGender" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="required" />
<description value="The gender of a person used for administrative purposes." />
<valueSet value="http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1" />
</binding>
<mapping>
<identity value="v2" />
<map value="PID-8" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.administrativeGenderCode" />
</mapping>
</element>
<element id="Patient.birthDate">
<path value="Patient.birthDate" />
<short value="The date of birth for the individual" />
<definition value="The date of birth for the individual." />
<comment value="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)." />
<requirements value="Age of the individual drives many clinical processes." />
<min value="0" />
<max value="1" />
<type>
<code value="date" />
</type>
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-7" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.birthTime" />
</mapping>
<mapping>
<identity value="loinc" />
<map value="21112-8" />
</mapping>
</element>
<element id="Patient.deceased[x]">
<path value="Patient.deceased[x]" />
<short value="Indicates if the individual is deceased or not" />
<definition value="Indicates if the individual is deceased or not." />
<comment value="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." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<type>
<code value="boolean" />
</type>
<type>
<code value="dateTime" />
</type>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different." />
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-30 (bool) and PID-29 (datetime)" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.address">
<path value="Patient.address" />
<short value="An address for the individual" />
<definition value="An address for the individual." />
<comment value="Patient may have multiple addresses with different uses or applicable periods." />
<requirements value="May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification." />
<min value="0" />
<max value="*" />
<type>
<code value="Address" />
</type>
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-11" />
</mapping>
<mapping>
<identity value="rim" />
<map value="addr" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".addr" />
</mapping>
</element>
<element id="Patient.maritalStatus">
<path value="Patient.maritalStatus" />
<short value="Marital (civil) status of a patient" />
<definition value="This field contains a patient's most recent marital (civil) status." />
<requirements value="Most, if not all systems capture it." />
<min value="0" />
<max value="1" />
<type>
<code value="CodeableConcept" />
</type>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MaritalStatus" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="extensible" />
<description value="The domestic partnership status of a person." />
<valueSet value="http://hl7.org/fhir/ValueSet/marital-status" />
</binding>
<mapping>
<identity value="v2" />
<map value="PID-16" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN]/maritalStatusCode" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".patient.maritalStatusCode" />
</mapping>
</element>
<element id="Patient.multipleBirth[x]">
<path value="Patient.multipleBirth[x]" />
<short value="Whether patient is part of a multiple birth" />
<definition value="Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer)." />
<comment value="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)." />
<requirements value="For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs." />
<min value="0" />
<max value="1" />
<type>
<code value="boolean" />
</type>
<type>
<code value="integer" />
</type>
<mapping>
<identity value="v2" />
<map value="PID-24 (bool), PID-25 (integer)" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.photo">
<path value="Patient.photo" />
<short value="Image of the patient" />
<definition value="Image of the patient." />
<comment value="Guidelines:\n* Use id photos, not clinical photos.\n* Limit dimensions to thumbnail.\n* Keep byte count low to ease resource updates." />
<requirements value="Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too." />
<min value="0" />
<max value="*" />
<type>
<code value="Attachment" />
</type>
<mapping>
<identity value="v2" />
<map value="OBX-5 - needs a profile" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact">
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
<valueString value="Contact" />
</extension>
<path value="Patient.contact" />
<short value="A contact party (e.g. guardian, partner, friend) for the patient" />
<definition value="A contact party (e.g. guardian, partner, friend) for the patient." />
<comment value="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." />
<requirements value="Need to track people you can contact about the patient." />
<min value="0" />
<max value="*" />
<type>
<code value="BackboneElement" />
</type>
<constraint>
<key value="pat-1" />
<severity value="error" />
<human value="SHALL at least contain a contact's details or a reference to an organization" />
<expression value="name.exists() or telecom.exists() or address.exists() or organization.exists()" />
<xpath value="exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization)" />
</constraint>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.relationship">
<path value="Patient.contact.relationship" />
<short value="The kind of relationship" />
<definition value="The nature of the relationship between the patient and the contact person." />
<requirements value="Used to determine which contact person is the most relevant to approach, depending on circumstances." />
<min value="0" />
<max value="*" />
<type>
<code value="CodeableConcept" />
</type>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ContactRelationship" />
</extension>
<strength value="extensible" />
<description value="The nature of the relationship between a patient and a contact person for that patient." />
<valueSet value="http://hl7.org/fhir/ValueSet/patient-contactrelationship" />
</binding>
<mapping>
<identity value="v2" />
<map value="NK1-7, NK1-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value="code" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.name">
<path value="Patient.contact.name" />
<short value="A name associated with the contact person" />
<definition value="A name associated with the contact person." />
<requirements value="Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person." />
<min value="0" />
<max value="1" />
<type>
<code value="HumanName" />
</type>
<mapping>
<identity value="v2" />
<map value="NK1-2" />
</mapping>
<mapping>
<identity value="rim" />
<map value="name" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.telecom">
<path value="Patient.contact.telecom" />
<short value="A contact detail for the person" />
<definition value="A contact detail for the person, e.g. a telephone number or an email address." />
<comment value="Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification." />
<requirements value="People have (primary) ways to contact them in some way such as phone, email." />
<min value="0" />
<max value="*" />
<type>
<code value="ContactPoint" />
</type>
<mapping>
<identity value="v2" />
<map value="NK1-5, NK1-6, NK1-40" />
</mapping>
<mapping>
<identity value="rim" />
<map value="telecom" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.address">
<path value="Patient.contact.address" />
<short value="Address for the contact person" />
<definition value="Address for the contact person." />
<requirements value="Need to keep track where the contact person can be contacted per postal mail or visited." />
<min value="0" />
<max value="1" />
<type>
<code value="Address" />
</type>
<mapping>
<identity value="v2" />
<map value="NK1-4" />
</mapping>
<mapping>
<identity value="rim" />
<map value="addr" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.gender">
<path value="Patient.contact.gender" />
<short value="male | female | other | unknown" />
<definition value="Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes." />
<requirements value="Needed to address the person correctly." />
<min value="0" />
<max value="1" />
<type>
<code value="code" />
</type>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdministrativeGender" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="required" />
<description value="The gender of a person used for administrative purposes." />
<valueSet value="http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1" />
</binding>
<mapping>
<identity value="v2" />
<map value="NK1-15" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.organization">
<path value="Patient.contact.organization" />
<short value="Organization that is associated with the contact" />
<definition value="Organization on behalf of which the contact is acting or for which the contact is working." />
<requirements value="For guardians or business related contacts, the organization is relevant." />
<min value="0" />
<max value="1" />
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
</type>
<condition value="pat-1" />
<mapping>
<identity value="v2" />
<map value="NK1-13, NK1-30, NK1-31, NK1-32, NK1-41" />
</mapping>
<mapping>
<identity value="rim" />
<map value="scoper" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.contact.period">
<path value="Patient.contact.period" />
<short value="The period during which this contact person or organization is valid to be contacted relating to this patient" />
<definition value="The period during which this contact person or organization is valid to be contacted relating to this patient." />
<min value="0" />
<max value="1" />
<type>
<code value="Period" />
</type>
<mapping>
<identity value="rim" />
<map value="effectiveTime" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.communication">
<path value="Patient.communication" />
<short value="A language which may be used to communicate with the patient about his or her health" />
<definition value="A language which may be used to communicate with the patient about his or her health." />
<comment value="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." />
<requirements value="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." />
<min value="0" />
<max value="*" />
<type>
<code value="BackboneElement" />
</type>
<mapping>
<identity value="rim" />
<map value="LanguageCommunication" />
</mapping>
<mapping>
<identity value="cda" />
<map value="patient.languageCommunication" />
</mapping>
</element>
<element id="Patient.communication.language">
<path value="Patient.communication.language" />
<short value="The language which can be used to communicate with the patient about his or her health" />
<definition value="The 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." />
<comment value="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." />
<requirements value="Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect." />
<min value="1" />
<max value="1" />
<type>
<code value="CodeableConcept" />
</type>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="preferred" />
<description value="A human language." />
<valueSet value="http://hl7.org/fhir/ValueSet/languages" />
</binding>
<mapping>
<identity value="v2" />
<map value="PID-15, LAN-2" />
</mapping>
<mapping>
<identity value="rim" />
<map value="player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".languageCode" />
</mapping>
</element>
<element id="Patient.communication.preferred">
<path value="Patient.communication.preferred" />
<short value="Language preference indicator" />
<definition value="Indicates whether or not the patient prefers this language (over other languages he masters up a certain level)." />
<comment value="This language is specifically identified for communicating healthcare information." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<type>
<code value="boolean" />
</type>
<mapping>
<identity value="v2" />
<map value="PID-15" />
</mapping>
<mapping>
<identity value="rim" />
<map value="preferenceInd" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".preferenceInd" />
</mapping>
</element>
<element id="Patient.generalPractitioner">
<path value="Patient.generalPractitioner" />
<short value="Patient's nominated primary care provider" />
<definition value="Patient's nominated care provider." />
<comment value="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.\nMultiple 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.\n\nJurisdictions may decide that they can profile this down to 1 if desired, or 1 per type." />
<alias value="careProvider" />
<min value="0" />
<max value="*" />
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
</type>
<mapping>
<identity value="v2" />
<map value="PD1-4" />
</mapping>
<mapping>
<identity value="rim" />
<map value="subjectOf.CareEvent.performer.AssignedEntity" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.managingOrganization">
<path value="Patient.managingOrganization" />
<short value="Organization that is the custodian of the patient record" />
<definition value="Organization that is the custodian of the patient record." />
<comment value="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)." />
<requirements value="Need to know who recognizes this patient record, manages and updates it." />
<min value="0" />
<max value="1" />
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
</type>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="scoper" />
</mapping>
<mapping>
<identity value="cda" />
<map value=".providerOrganization" />
</mapping>
</element>
<element id="Patient.link">
<path value="Patient.link" />
<short value="Link to another patient resource that concerns the same actual person" />
<definition value="Link to another patient resource that concerns the same actual patient." />
<comment value="There is no assumption that linked patient records have mutual links." />
<requirements value="There are multiple use cases: \n\n* Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and \n* Distribution of patient information across multiple servers." />
<min value="0" />
<max value="*" />
<type>
<code value="BackboneElement" />
</type>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="outboundLink" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.link.other">
<path value="Patient.link.other" />
<short value="The other patient or related person resource that the link refers to" />
<definition value="The other patient resource that the link refers to." />
<comment value="Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual." />
<min value="1" />
<max value="1" />
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy">
<valueBoolean value="false" />
</extension>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
</type>
<isSummary value="true" />
<mapping>
<identity value="v2" />
<map value="PID-3, MRG-1" />
</mapping>
<mapping>
<identity value="rim" />
<map value="id" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
<element id="Patient.link.type">
<path value="Patient.link.type" />
<short value="replaced-by | replaces | refer | seealso" />
<definition value="The type of link between this patient resource and another patient resource." />
<min value="1" />
<max value="1" />
<type>
<code value="code" />
</type>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="LinkType" />
</extension>
<strength value="required" />
<description value="The type of link between this patient resource and another patient resource." />
<valueSet value="http://hl7.org/fhir/ValueSet/link-type|4.0.1" />
</binding>
<mapping>
<identity value="rim" />
<map value="typeCode" />
</mapping>
<mapping>
<identity value="cda" />
<map value="n/a" />
</mapping>
</element>
</differential>
</StructureDefinition>
This is the resource in JSON:
{
"resourceType": "StructureDefinition",
"id": "Patient",
"meta": {
"lastUpdated": "2019-11-01T09:29:23.356+11:00"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
"valueString": "Base.Individuals"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 5
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category",
"valueCode": "patient"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "pa"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/Patient",
"version": "4.0.1",
"name": "Patient",
"status": "active",
"date": "2019-11-01T09:29:23+11:00",
"publisher": "Health Level Seven International (Patient Administration)",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "http://hl7.org/fhir"
}
]
},
{
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/pafm/index.cfm"
}
]
}
],
"description": "Demographics and other administrative information about an individual or animal receiving care or other health-related services.",
"purpose": "Tracking patient is the center of the healthcare process.",
"fhirVersion": "4.0.1",
"mapping": [
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM Mapping"
},
{
"identity": "cda",
"uri": "http://hl7.org/v3/cda",
"name": "CDA (R2)"
},
{
"identity": "w5",
"uri": "http://hl7.org/fhir/fivews",
"name": "FiveWs Pattern Mapping"
},
{
"identity": "v2",
"uri": "http://hl7.org/v2",
"name": "HL7 v2 Mapping"
},
{
"identity": "loinc",
"uri": "http://loinc.org",
"name": "LOINC code for the element"
}
],
"kind": "resource",
"abstract": false,
"type": "Patient",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"derivation": "specialization",
"snapshot": {
"element": [
{
"id": "Patient",
"path": "Patient",
"short": "Information about an individual or animal receiving health care services",
"definition": "Demographics and other administrative information about an individual or animal receiving care or other health-related services.",
"alias": [
"SubjectOfCare Client Resident"
],
"min": 0,
"max": "*",
"base": {
"path": "Patient",
"min": 0,
"max": "*"
},
"constraint": [
{
"key": "dom-2",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression": "contained.contained.empty()",
"xpath": "not(parent::f:contained and f:contained)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-3",
"severity": "error",
"human": "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",
"expression": "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()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-4",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-5",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression": "contained.meta.security.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:security))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
"key": "dom-6",
"severity": "warning",
"human": "A resource should have narrative for robust management",
"expression": "text.`div`.exists()",
"xpath": "exists(f:text/h:div)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "rim",
"map": "Patient[classCode=PAT]"
},
{
"identity": "cda",
"map": "ClinicalDocument.recordTarget.patientRole"
}
]
},
{
"id": "Patient.id",
"path": "Patient.id",
"short": "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.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": true
},
{
"id": "Patient.meta",
"path": "Patient.meta",
"short": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.meta",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Meta"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true
},
{
"id": "Patient.implicitRules",
"path": "Patient.implicitRules",
"short": "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.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true
},
{
"id": "Patient.language",
"path": "Patient.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"comment": "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).",
"min": 0,
"max": "1",
"base": {
"path": "Resource.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "preferred",
"description": "A human language.",
"valueSet": "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id": "Patient.text",
"path": "Patient.text",
"short": "Text summary of the resource, for human interpretation",
"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.",
"comment": "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.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Narrative"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"id": "Patient.contained",
"path": "Patient.contained",
"short": "Contained, inline 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.",
"comment": "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.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Patient.extension",
"path": "Patient.extension",
"short": "Additional content defined by implementations",
"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.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Patient.modifierExtension",
"path": "Patient.modifierExtension",
"short": "Extensions that cannot be ignored",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Patient.identifier",
"path": "Patient.identifier",
"short": "An identifier for this patient",
"definition": "An identifier for this patient.",
"requirements": "Patients are almost always assigned specific numerical identifiers.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.identifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Identifier"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.identifier"
},
{
"identity": "v2",
"map": "PID-3"
},
{
"identity": "rim",
"map": "id"
},
{
"identity": "cda",
"map": ".id"
}
]
},
{
"id": "Patient.active",
"path": "Patient.active",
"short": "Whether this patient's record is in active use",
"definition": "Whether this patient record is in active use. \nMany 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.\n\nIt is often used to filter patient lists to exclude inactive patients\n\nDeceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.",
"comment": "If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.",
"requirements": "Need to be able to mark a patient record as not to be used because it was created in error.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.active",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
],
"meaningWhenMissing": "This resource is generally assumed to be active if no value is provided for the active element",
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid",
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.status"
},
{
"identity": "rim",
"map": "statusCode"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.name",
"path": "Patient.name",
"short": "A name associated with the patient",
"definition": "A name associated with the individual.",
"comment": "A patient may have multiple names with different uses or applicable periods. For animals, the name is a \"HumanName\" in the sense that is assigned and used by humans and has the same patterns.",
"requirements": "Need to be able to track the patient by multiple names. Examples are your official name and a partner name.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.name",
"min": 0,
"max": "*"
},
"type": [
{
"code": "HumanName"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-5, PID-9"
},
{
"identity": "rim",
"map": "name"
},
{
"identity": "cda",
"map": ".patient.name"
}
]
},
{
"id": "Patient.telecom",
"path": "Patient.telecom",
"short": "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.",
"comment": "A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).",
"requirements": "People have (primary) ways to contact them in some way such as phone, email.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.telecom",
"min": 0,
"max": "*"
},
"type": [
{
"code": "ContactPoint"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-13, PID-14, PID-40"
},
{
"identity": "rim",
"map": "telecom"
},
{
"identity": "cda",
"map": ".telecom"
}
]
},
{
"id": "Patient.gender",
"path": "Patient.gender",
"short": "male | female | other | unknown",
"definition": "Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.",
"comment": "The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a \"hard\" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.",
"requirements": "Needed for identification of the individual, in combination with (at least) name and birth date.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.gender",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdministrativeGender"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "required",
"description": "The gender of a person used for administrative purposes.",
"valueSet": "http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1"
},
"mapping": [
{
"identity": "v2",
"map": "PID-8"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender"
},
{
"identity": "cda",
"map": ".patient.administrativeGenderCode"
}
]
},
{
"id": "Patient.birthDate",
"path": "Patient.birthDate",
"short": "The date of birth for the individual",
"definition": "The date of birth for the individual.",
"comment": "At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension \"patient-birthTime\" available that should be used where Time is required (such as in maternity/infant care systems).",
"requirements": "Age of the individual drives many clinical processes.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.birthDate",
"min": 0,
"max": "1"
},
"type": [
{
"code": "date"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-7"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime"
},
{
"identity": "cda",
"map": ".patient.birthTime"
},
{
"identity": "loinc",
"map": "21112-8"
}
]
},
{
"id": "Patient.deceased[x]",
"path": "Patient.deceased[x]",
"short": "Indicates if the individual is deceased or not",
"definition": "Indicates if the individual is deceased or not.",
"comment": "If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.",
"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.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.deceased[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
},
{
"code": "dateTime"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.",
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-30 (bool) and PID-29 (datetime)"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.address",
"path": "Patient.address",
"short": "An address for the individual",
"definition": "An address for the individual.",
"comment": "Patient may have multiple addresses with different uses or applicable periods.",
"requirements": "May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.address",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Address"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-11"
},
{
"identity": "rim",
"map": "addr"
},
{
"identity": "cda",
"map": ".addr"
}
]
},
{
"id": "Patient.maritalStatus",
"path": "Patient.maritalStatus",
"short": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.maritalStatus",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MaritalStatus"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "extensible",
"description": "The domestic partnership status of a person.",
"valueSet": "http://hl7.org/fhir/ValueSet/marital-status"
},
"mapping": [
{
"identity": "v2",
"map": "PID-16"
},
{
"identity": "rim",
"map": "player[classCode=PSN]/maritalStatusCode"
},
{
"identity": "cda",
"map": ".patient.maritalStatusCode"
}
]
},
{
"id": "Patient.multipleBirth[x]",
"path": "Patient.multipleBirth[x]",
"short": "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).",
"comment": "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).",
"requirements": "For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.multipleBirth[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
},
{
"code": "integer"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "PID-24 (bool), PID-25 (integer)"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.photo",
"path": "Patient.photo",
"short": "Image of the patient",
"definition": "Image of the patient.",
"comment": "Guidelines:\n* Use id photos, not clinical photos.\n* Limit dimensions to thumbnail.\n* Keep byte count low to ease resource updates.",
"requirements": "Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.photo",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Attachment"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "OBX-5 - needs a profile"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Contact"
}
],
"path": "Patient.contact",
"short": "A contact party (e.g. guardian, partner, friend) for the patient",
"definition": "A contact party (e.g. guardian, partner, friend) for the patient.",
"comment": "Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.",
"requirements": "Need to track people you can contact about the patient.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.contact",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "pat-1",
"severity": "error",
"human": "SHALL at least contain a contact's details or a reference to an organization",
"expression": "name.exists() or telecom.exists() or address.exists() or organization.exists()",
"xpath": "exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization)"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.id",
"path": "Patient.contact.id",
"representation": [
"xmlAttr"
],
"short": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.extension",
"path": "Patient.contact.extension",
"short": "Additional content defined by implementations",
"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.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.modifierExtension",
"path": "Patient.contact.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Patient.contact.relationship",
"path": "Patient.contact.relationship",
"short": "The kind of relationship",
"definition": "The nature of the relationship between the patient and the contact person.",
"requirements": "Used to determine which contact person is the most relevant to approach, depending on circumstances.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.contact.relationship",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ContactRelationship"
}
],
"strength": "extensible",
"description": "The nature of the relationship between a patient and a contact person for that patient.",
"valueSet": "http://hl7.org/fhir/ValueSet/patient-contactrelationship"
},
"mapping": [
{
"identity": "v2",
"map": "NK1-7, NK1-3"
},
{
"identity": "rim",
"map": "code"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.name",
"path": "Patient.contact.name",
"short": "A name associated with the contact person",
"definition": "A name associated with the contact person.",
"requirements": "Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.contact.name",
"min": 0,
"max": "1"
},
"type": [
{
"code": "HumanName"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "NK1-2"
},
{
"identity": "rim",
"map": "name"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.telecom",
"path": "Patient.contact.telecom",
"short": "A contact detail for the person",
"definition": "A contact detail for the person, e.g. a telephone number or an email address.",
"comment": "Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.",
"requirements": "People have (primary) ways to contact them in some way such as phone, email.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.contact.telecom",
"min": 0,
"max": "*"
},
"type": [
{
"code": "ContactPoint"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "NK1-5, NK1-6, NK1-40"
},
{
"identity": "rim",
"map": "telecom"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.address",
"path": "Patient.contact.address",
"short": "Address for the contact person",
"definition": "Address for the contact person.",
"requirements": "Need to keep track where the contact person can be contacted per postal mail or visited.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.contact.address",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Address"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "NK1-4"
},
{
"identity": "rim",
"map": "addr"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.gender",
"path": "Patient.contact.gender",
"short": "male | female | other | unknown",
"definition": "Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.",
"requirements": "Needed to address the person correctly.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.contact.gender",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdministrativeGender"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "required",
"description": "The gender of a person used for administrative purposes.",
"valueSet": "http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1"
},
"mapping": [
{
"identity": "v2",
"map": "NK1-15"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.organization",
"path": "Patient.contact.organization",
"short": "Organization that is associated with the contact",
"definition": "Organization on behalf of which the contact is acting or for which the contact is working.",
"requirements": "For guardians or business related contacts, the organization is relevant.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.contact.organization",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"condition": [
"pat-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "NK1-13, NK1-30, NK1-31, NK1-32, NK1-41"
},
{
"identity": "rim",
"map": "scoper"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.period",
"path": "Patient.contact.period",
"short": "The period during which this contact person or organization is valid to be contacted relating to this patient",
"definition": "The period during which this contact person or organization is valid to be contacted relating to this patient.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.contact.period",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Period"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "effectiveTime"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.communication",
"path": "Patient.communication",
"short": "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.",
"comment": "If no language is specified, this *implies* that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.",
"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.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.communication",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "LanguageCommunication"
},
{
"identity": "cda",
"map": "patient.languageCommunication"
}
]
},
{
"id": "Patient.communication.id",
"path": "Patient.communication.id",
"representation": [
"xmlAttr"
],
"short": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Patient.communication.extension",
"path": "Patient.communication.extension",
"short": "Additional content defined by implementations",
"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.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Patient.communication.modifierExtension",
"path": "Patient.communication.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Patient.communication.language",
"path": "Patient.communication.language",
"short": "The language which can be used to communicate with the patient about his or her health",
"definition": "The 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.",
"comment": "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.",
"requirements": "Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.",
"min": 1,
"max": "1",
"base": {
"path": "Patient.communication.language",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "preferred",
"description": "A human language.",
"valueSet": "http://hl7.org/fhir/ValueSet/languages"
},
"mapping": [
{
"identity": "v2",
"map": "PID-15, LAN-2"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code"
},
{
"identity": "cda",
"map": ".languageCode"
}
]
},
{
"id": "Patient.communication.preferred",
"path": "Patient.communication.preferred",
"short": "Language preference indicator",
"definition": "Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).",
"comment": "This language is specifically identified for communicating healthcare information.",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.communication.preferred",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "PID-15"
},
{
"identity": "rim",
"map": "preferenceInd"
},
{
"identity": "cda",
"map": ".preferenceInd"
}
]
},
{
"id": "Patient.generalPractitioner",
"path": "Patient.generalPractitioner",
"short": "Patient's nominated primary care provider",
"definition": "Patient's nominated care provider.",
"comment": "This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.\nMultiple 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.\n\nJurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.",
"alias": [
"careProvider"
],
"min": 0,
"max": "*",
"base": {
"path": "Patient.generalPractitioner",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole"
]
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "v2",
"map": "PD1-4"
},
{
"identity": "rim",
"map": "subjectOf.CareEvent.performer.AssignedEntity"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.managingOrganization",
"path": "Patient.managingOrganization",
"short": "Organization that is the custodian of the patient record",
"definition": "Organization that is the custodian of the patient record.",
"comment": "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).",
"requirements": "Need to know who recognizes this patient record, manages and updates it.",
"min": 0,
"max": "1",
"base": {
"path": "Patient.managingOrganization",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "scoper"
},
{
"identity": "cda",
"map": ".providerOrganization"
}
]
},
{
"id": "Patient.link",
"path": "Patient.link",
"short": "Link to another patient resource that concerns the same actual person",
"definition": "Link to another patient resource that concerns the same actual patient.",
"comment": "There is no assumption that linked patient records have mutual links.",
"requirements": "There are multiple use cases: \n\n* Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and \n* Distribution of patient information across multiple servers.",
"min": 0,
"max": "*",
"base": {
"path": "Patient.link",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "outboundLink"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.link.id",
"path": "Patient.link.id",
"representation": [
"xmlAttr"
],
"short": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Patient.link.extension",
"path": "Patient.link.extension",
"short": "Additional content defined by implementations",
"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.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Patient.link.modifierExtension",
"path": "Patient.link.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Patient.link.other",
"path": "Patient.link.other",
"short": "The other patient or related person resource that the link refers to",
"definition": "The other patient resource that the link refers to.",
"comment": "Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.",
"min": 1,
"max": "1",
"base": {
"path": "Patient.link.other",
"min": 1,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy",
"valueBoolean": false
}
],
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-3, MRG-1"
},
{
"identity": "rim",
"map": "id"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.link.type",
"path": "Patient.link.type",
"short": "replaced-by | replaces | refer | seealso",
"definition": "The type of link between this patient resource and another patient resource.",
"min": 1,
"max": "1",
"base": {
"path": "Patient.link.type",
"min": 1,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "LinkType"
}
],
"strength": "required",
"description": "The type of link between this patient resource and another patient resource.",
"valueSet": "http://hl7.org/fhir/ValueSet/link-type|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "typeCode"
},
{
"identity": "cda",
"map": "n/a"
}
]
}
]
},
"differential": {
"element": [
{
"id": "Patient",
"path": "Patient",
"short": "Information about an individual or animal receiving health care services",
"definition": "Demographics and other administrative information about an individual or animal receiving care or other health-related services.",
"alias": [
"SubjectOfCare Client Resident"
],
"min": 0,
"max": "*",
"mapping": [
{
"identity": "rim",
"map": "Patient[classCode=PAT]"
},
{
"identity": "cda",
"map": "ClinicalDocument.recordTarget.patientRole"
}
]
},
{
"id": "Patient.identifier",
"path": "Patient.identifier",
"short": "An identifier for this patient",
"definition": "An identifier for this patient.",
"requirements": "Patients are almost always assigned specific numerical identifiers.",
"min": 0,
"max": "*",
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.identifier"
},
{
"identity": "v2",
"map": "PID-3"
},
{
"identity": "rim",
"map": "id"
},
{
"identity": "cda",
"map": ".id"
}
]
},
{
"id": "Patient.active",
"path": "Patient.active",
"short": "Whether this patient's record is in active use",
"definition": "Whether this patient record is in active use. \nMany 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.\n\nIt is often used to filter patient lists to exclude inactive patients\n\nDeceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.",
"comment": "If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.",
"requirements": "Need to be able to mark a patient record as not to be used because it was created in error.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
}
],
"meaningWhenMissing": "This resource is generally assumed to be active if no value is provided for the active element",
"isModifier": true,
"isModifierReason": "This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid",
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.status"
},
{
"identity": "rim",
"map": "statusCode"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.name",
"path": "Patient.name",
"short": "A name associated with the patient",
"definition": "A name associated with the individual.",
"comment": "A patient may have multiple names with different uses or applicable periods. For animals, the name is a \"HumanName\" in the sense that is assigned and used by humans and has the same patterns.",
"requirements": "Need to be able to track the patient by multiple names. Examples are your official name and a partner name.",
"min": 0,
"max": "*",
"type": [
{
"code": "HumanName"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-5, PID-9"
},
{
"identity": "rim",
"map": "name"
},
{
"identity": "cda",
"map": ".patient.name"
}
]
},
{
"id": "Patient.telecom",
"path": "Patient.telecom",
"short": "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.",
"comment": "A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).",
"requirements": "People have (primary) ways to contact them in some way such as phone, email.",
"min": 0,
"max": "*",
"type": [
{
"code": "ContactPoint"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-13, PID-14, PID-40"
},
{
"identity": "rim",
"map": "telecom"
},
{
"identity": "cda",
"map": ".telecom"
}
]
},
{
"id": "Patient.gender",
"path": "Patient.gender",
"short": "male | female | other | unknown",
"definition": "Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.",
"comment": "The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a \"hard\" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.",
"requirements": "Needed for identification of the individual, in combination with (at least) name and birth date.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdministrativeGender"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "required",
"description": "The gender of a person used for administrative purposes.",
"valueSet": "http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1"
},
"mapping": [
{
"identity": "v2",
"map": "PID-8"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender"
},
{
"identity": "cda",
"map": ".patient.administrativeGenderCode"
}
]
},
{
"id": "Patient.birthDate",
"path": "Patient.birthDate",
"short": "The date of birth for the individual",
"definition": "The date of birth for the individual.",
"comment": "At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension \"patient-birthTime\" available that should be used where Time is required (such as in maternity/infant care systems).",
"requirements": "Age of the individual drives many clinical processes.",
"min": 0,
"max": "1",
"type": [
{
"code": "date"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-7"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime"
},
{
"identity": "cda",
"map": ".patient.birthTime"
},
{
"identity": "loinc",
"map": "21112-8"
}
]
},
{
"id": "Patient.deceased[x]",
"path": "Patient.deceased[x]",
"short": "Indicates if the individual is deceased or not",
"definition": "Indicates if the individual is deceased or not.",
"comment": "If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.",
"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.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
},
{
"code": "dateTime"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.",
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-30 (bool) and PID-29 (datetime)"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.address",
"path": "Patient.address",
"short": "An address for the individual",
"definition": "An address for the individual.",
"comment": "Patient may have multiple addresses with different uses or applicable periods.",
"requirements": "May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.",
"min": 0,
"max": "*",
"type": [
{
"code": "Address"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-11"
},
{
"identity": "rim",
"map": "addr"
},
{
"identity": "cda",
"map": ".addr"
}
]
},
{
"id": "Patient.maritalStatus",
"path": "Patient.maritalStatus",
"short": "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.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MaritalStatus"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "extensible",
"description": "The domestic partnership status of a person.",
"valueSet": "http://hl7.org/fhir/ValueSet/marital-status"
},
"mapping": [
{
"identity": "v2",
"map": "PID-16"
},
{
"identity": "rim",
"map": "player[classCode=PSN]/maritalStatusCode"
},
{
"identity": "cda",
"map": ".patient.maritalStatusCode"
}
]
},
{
"id": "Patient.multipleBirth[x]",
"path": "Patient.multipleBirth[x]",
"short": "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).",
"comment": "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).",
"requirements": "For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
},
{
"code": "integer"
}
],
"mapping": [
{
"identity": "v2",
"map": "PID-24 (bool), PID-25 (integer)"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.photo",
"path": "Patient.photo",
"short": "Image of the patient",
"definition": "Image of the patient.",
"comment": "Guidelines:\n* Use id photos, not clinical photos.\n* Limit dimensions to thumbnail.\n* Keep byte count low to ease resource updates.",
"requirements": "Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.",
"min": 0,
"max": "*",
"type": [
{
"code": "Attachment"
}
],
"mapping": [
{
"identity": "v2",
"map": "OBX-5 - needs a profile"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Contact"
}
],
"path": "Patient.contact",
"short": "A contact party (e.g. guardian, partner, friend) for the patient",
"definition": "A contact party (e.g. guardian, partner, friend) for the patient.",
"comment": "Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.",
"requirements": "Need to track people you can contact about the patient.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "pat-1",
"severity": "error",
"human": "SHALL at least contain a contact's details or a reference to an organization",
"expression": "name.exists() or telecom.exists() or address.exists() or organization.exists()",
"xpath": "exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization)"
}
],
"mapping": [
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.relationship",
"path": "Patient.contact.relationship",
"short": "The kind of relationship",
"definition": "The nature of the relationship between the patient and the contact person.",
"requirements": "Used to determine which contact person is the most relevant to approach, depending on circumstances.",
"min": 0,
"max": "*",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ContactRelationship"
}
],
"strength": "extensible",
"description": "The nature of the relationship between a patient and a contact person for that patient.",
"valueSet": "http://hl7.org/fhir/ValueSet/patient-contactrelationship"
},
"mapping": [
{
"identity": "v2",
"map": "NK1-7, NK1-3"
},
{
"identity": "rim",
"map": "code"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.name",
"path": "Patient.contact.name",
"short": "A name associated with the contact person",
"definition": "A name associated with the contact person.",
"requirements": "Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.",
"min": 0,
"max": "1",
"type": [
{
"code": "HumanName"
}
],
"mapping": [
{
"identity": "v2",
"map": "NK1-2"
},
{
"identity": "rim",
"map": "name"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.telecom",
"path": "Patient.contact.telecom",
"short": "A contact detail for the person",
"definition": "A contact detail for the person, e.g. a telephone number or an email address.",
"comment": "Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.",
"requirements": "People have (primary) ways to contact them in some way such as phone, email.",
"min": 0,
"max": "*",
"type": [
{
"code": "ContactPoint"
}
],
"mapping": [
{
"identity": "v2",
"map": "NK1-5, NK1-6, NK1-40"
},
{
"identity": "rim",
"map": "telecom"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.address",
"path": "Patient.contact.address",
"short": "Address for the contact person",
"definition": "Address for the contact person.",
"requirements": "Need to keep track where the contact person can be contacted per postal mail or visited.",
"min": 0,
"max": "1",
"type": [
{
"code": "Address"
}
],
"mapping": [
{
"identity": "v2",
"map": "NK1-4"
},
{
"identity": "rim",
"map": "addr"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.gender",
"path": "Patient.contact.gender",
"short": "male | female | other | unknown",
"definition": "Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.",
"requirements": "Needed to address the person correctly.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdministrativeGender"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "required",
"description": "The gender of a person used for administrative purposes.",
"valueSet": "http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1"
},
"mapping": [
{
"identity": "v2",
"map": "NK1-15"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.organization",
"path": "Patient.contact.organization",
"short": "Organization that is associated with the contact",
"definition": "Organization on behalf of which the contact is acting or for which the contact is working.",
"requirements": "For guardians or business related contacts, the organization is relevant.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"condition": [
"pat-1"
],
"mapping": [
{
"identity": "v2",
"map": "NK1-13, NK1-30, NK1-31, NK1-32, NK1-41"
},
{
"identity": "rim",
"map": "scoper"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.contact.period",
"path": "Patient.contact.period",
"short": "The period during which this contact person or organization is valid to be contacted relating to this patient",
"definition": "The period during which this contact person or organization is valid to be contacted relating to this patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Period"
}
],
"mapping": [
{
"identity": "rim",
"map": "effectiveTime"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.communication",
"path": "Patient.communication",
"short": "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.",
"comment": "If no language is specified, this *implies* that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.",
"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.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"mapping": [
{
"identity": "rim",
"map": "LanguageCommunication"
},
{
"identity": "cda",
"map": "patient.languageCommunication"
}
]
},
{
"id": "Patient.communication.language",
"path": "Patient.communication.language",
"short": "The language which can be used to communicate with the patient about his or her health",
"definition": "The 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.",
"comment": "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.",
"requirements": "Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.",
"min": 1,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "preferred",
"description": "A human language.",
"valueSet": "http://hl7.org/fhir/ValueSet/languages"
},
"mapping": [
{
"identity": "v2",
"map": "PID-15, LAN-2"
},
{
"identity": "rim",
"map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code"
},
{
"identity": "cda",
"map": ".languageCode"
}
]
},
{
"id": "Patient.communication.preferred",
"path": "Patient.communication.preferred",
"short": "Language preference indicator",
"definition": "Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).",
"comment": "This language is specifically identified for communicating healthcare information.",
"requirements": "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.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
}
],
"mapping": [
{
"identity": "v2",
"map": "PID-15"
},
{
"identity": "rim",
"map": "preferenceInd"
},
{
"identity": "cda",
"map": ".preferenceInd"
}
]
},
{
"id": "Patient.generalPractitioner",
"path": "Patient.generalPractitioner",
"short": "Patient's nominated primary care provider",
"definition": "Patient's nominated care provider.",
"comment": "This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.\nMultiple 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.\n\nJurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.",
"alias": [
"careProvider"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole"
]
}
],
"mapping": [
{
"identity": "v2",
"map": "PD1-4"
},
{
"identity": "rim",
"map": "subjectOf.CareEvent.performer.AssignedEntity"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.managingOrganization",
"path": "Patient.managingOrganization",
"short": "Organization that is the custodian of the patient record",
"definition": "Organization that is the custodian of the patient record.",
"comment": "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).",
"requirements": "Need to know who recognizes this patient record, manages and updates it.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "scoper"
},
{
"identity": "cda",
"map": ".providerOrganization"
}
]
},
{
"id": "Patient.link",
"path": "Patient.link",
"short": "Link to another patient resource that concerns the same actual person",
"definition": "Link to another patient resource that concerns the same actual patient.",
"comment": "There is no assumption that linked patient records have mutual links.",
"requirements": "There are multiple use cases: \n\n* Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and \n* Distribution of patient information across multiple servers.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "outboundLink"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.link.other",
"path": "Patient.link.other",
"short": "The other patient or related person resource that the link refers to",
"definition": "The other patient resource that the link refers to.",
"comment": "Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.",
"min": 1,
"max": "1",
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy",
"valueBoolean": false
}
],
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "PID-3, MRG-1"
},
{
"identity": "rim",
"map": "id"
},
{
"identity": "cda",
"map": "n/a"
}
]
},
{
"id": "Patient.link.type",
"path": "Patient.link.type",
"short": "replaced-by | replaces | refer | seealso",
"definition": "The type of link between this patient resource and another patient resource.",
"min": 1,
"max": "1",
"type": [
{
"code": "code"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "LinkType"
}
],
"strength": "required",
"description": "The type of link between this patient resource and another patient resource.",
"valueSet": "http://hl7.org/fhir/ValueSet/link-type|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "typeCode"
},
{
"identity": "cda",
"map": "n/a"
}
]
}
]
}
}

4.1.2.1. Terminology bindings

4.1.2.2. Constraints

Notes:

  • multipleBirth can be either expressed as a Boolean (just indicating whether the patient is part of a multiple birth) or as an integer, indicating the actual birth order.
  • Patient records may only be in one of two statuses: in use (active=true) and not in use (active=false). A normal record is active, i.e. it is in use. Active is set to 'false' when a record is created as a duplicate or in error. A record does not need to be linked to be inactivated.
  • The link element is used to assert that two or more Patient resources are both about the same actual patient. See below for further discussion
  • There should be only one preferred language (Language.preference = true) per mode of expression.
  • The Contact for a Patient has an element organization, this is for use with guardians or business related contacts where just the organization is relevant.

4.1.3. Patient ids and Patient resource ids

A Patient record's [Resource Id][] can never change. For this reason, the identifiers with which humans are concerned (often called MRN - Medical Record Number, or UR - Unit Record) should not be used for the resource's id, since MRN's may change, i.e. as a result of having duplicate records of the same patient. Instead they should be represented in the Patient.identifier list where they can be managed. This is also useful for the case of institutions that have acquired multiple numbers because of mergers of patient record systems over time.

Where there is a need to implement an automated MRN Identifier created for a patient record, this could be achieved by providing an identifier in the patient with an appropriate assigner, MRN Type and/or system but with no value assigned. Internal business rules can then detect this and replace/populate this identifier with 1 or more identifiers (as required).

4.1.4. Linking Patients

The link element is used to assert that patient resources refer to the same patient. This element is used to support the following scenarios where multiple patient records exist:

4.1.4.1. Duplicate Patient records

Managing Patient registration is a well-known difficult problem. Around 2% of registrations are in error, mostly duplicate records. Sometimes the duplicate record is caught fairly quickly and retired before much data is accumulated. In other cases, substantial amounts of data may accumulate. By using a link of type 'replaced-by', the record containing such a link is marked as a duplicate and the link points forward to a record that should be used instead. Note that the record pointed to may in its turn have been identified as created in error and forward to yet another Patient resource. Records that replace another record may use a link type of 'replaces' pointing to the old record.

4.1.4.2. Patient record in a Patient index

A Patient record may be present in a system that acts as a Patient Index: it maintains a (summary of) patient data and a list of one or more servers that are known to hold a more comprehensive and/or authoritative record of the same patient. The link type 'refer' is used to denote such a link. Note that linked records may contain contradictory information. The record referred to does not point back to the referring record.

4.1.4.3. Distributed Patient record

In a distributed architecture, multiple systems keep separate patient records concerning the same patient. These records are not considered duplicates, but contain a distributed, potentially overlapping view of the patient's data. Each such record may have its own focus or maintaining organization and there need not be a sense of one record being more complete or more authoritative than another. In such cases, links of type 'see also' can be used to point to other patient records. It is not a requirement that such links are bilateral.

The Person resource on the surface appears to be very similar to the Patient resource, and the usage for it is very similar to using the Patient.Link capability.
The intention of the Person resource is to be able to link instances of resources together that are believed to be the same individual. This includes across resource types, such as RelatedPerson, Practitioner, Patient and even other Person resources.
The Patient Link however is only intended to be used for Patient resources.

The primary use case for the Person resource is to be able to support person registries that do not necessarily have a healthcare context, and are able to identify and quantify confidence levels that this is the same person.
This could include consumer portals where the maintainer of the person information is the actual person themselves.
A system could use the Person entry to cross check changes to information applied to one part of a record to values in another system; e.g., when moving, a consumer updates his contact numbers and address in his person record, and then a Patient Administration system is able to see that this data is changed and prompt the organization to follow up with the patient that was linked to the person record if they want their details updated, or if they no longer need services and they should be cancelled, as they've moved from the area.

The Linkage resource and the Patient.link property conceptually perform similar functions in FHIR, both provide an assertion of linkages between multiple resource instances that are referring to the same underlying individual.
When a Patient resource is linked/merged then it needs to have an internal indication that there is another patient resource that should be considered when referencing other records, which is achieved using the patient.link property.
Not detecting/checking for a potential linkage could mean that related clinical records are not discovered, potentially impacting patient safety. (which is why using the Linkage resource is not appropriate, as its use in this manner would force the use of either another query to potentially locate other patient resources to consider, or use _revinclude)

4.1.6. Patient.contact vs. RelatedPerson

The contact element on the Patient resource should be used for storing the details of people to contact. This information always travels with the Patient resource, and cannot be used as the target of a reference. Where related people need to be referenced by other resources (e.g. CarePlan.participant, Encounter.participant, DocumentReference.author, Appointment.participant), the RelatedPerson resource must be used.

It is not expected that these records will be used for recording the primary care provider; this information should be stored in the Patient.generalPractitioner field.

4.1.7. Patient Gender and Sex

Many systems and organizations only provide for a single attribute that aspires to represent all aspects of a patient's gender and sex with a single value. However, there are many considerations around sex and gender documentation and interoperability. Listed below are the various social and biological attributes that are relevant in the healthcare setting, as well as information on how each can be communicated.

  • Administrative Gender - in order to interoperate with systems that use a single generic property, the basic Patient.gender property represents an administrative gender: the gender that the patient is considered to have for administration and record keeping purposes. This property is often used as an input to patient matching algorithms, for example.

In addition to this administrative gender, other kinds of gender or sex properties may be represented:

  • Clinical Sex - a testable observation about a biological property of the patient. There are several different types of clinical sex, including karyotypic/genetic/chromosomal, gonadal, ductal, phenotypic, etc. Clinical sex observations should be represented using Observation, qualified with the appropriate clinical codes from LOINC and/or SNOMED.
  • Clinical Gender - an observation about the patient, often collected as part of social history documentation, and represented as an Observation(example) using, for example, the LOINC code 76691-5. Clinical gender observations can provide both history and confidentiality, where the genderIdentity extension does not.
  • Gender Identity - an indication from the patient about what gender they consider themselves to be. This can influence how the patient prefers to be addressed by care providers and other individuals. The standard genderIdentity extension may be used to communicate this property. This extension is appropriate when the gender identity is openly known.
  • Sex assigned at Birth - the sex assigned at birth, as documented on the birth registration. Some countries allow variations such as not yet determined, unknown, or undifferentiated, while others do not. Some countries also allow birth registration information to be updated. The US realm defines a US specific extension for this property. Alternatively, if you were representing this concept with an observation, you could use the LOINC code 76689-9.
  • Legal Sex - regional and national entities often categorize citizens using a single legal sex value. The legal sex of a patient can vary from region to region and country to country. A single patient may have multiple legal sex values at the same time in different jurisdictions. In case where the Patient.gender administrative property is not sufficient to communicate legal sex, realm specific extensions should be used.

For veterinary use, the animal extension also includes the genderStatus which indicates sterility information.

4.1.8. Mother and newborn relationships

There are several ways to represent the relationship between a mother and a child. This is due to the when it is recorded and the purpose for which it is recorded:

  • To express the family relationship and legal responsibility thereof for administrative purposes: use the Patient/RelatedPerson structure.
    This structure is consistent over time.
  • To relate the encounters of a mother and her baby in a maternity encounter, for administrative and billing purposes: use the encounter.partof property
  • To collect information about the patient's relatives that might be relevant to the patient's medical condition: use the FamilyMemberHistory resource

During a maternity encounter, the Patient and Encounter resources for the mother will be present. After the child is born, new Patient, Encounter and RelatedPerson (for the mother) records will be created. The Child's encounter should reference the Mother's encounter using the partOf property.
The Patient/RelatedPerson structure should also be created for ongoing usage, as shown in this example:

<Patient>
    <id value="child"/>
    <!-- The details of the child -->
</Patient>
<RelatedPerson>
    <id value="rp-mom"/>
    <patient>
        <reference value="Patient/child"/>
    </patient>
</RelatedPerson>
<Patient>
    <id value="pat-mom"/>
    <!-- The details of the mom -->
    <link>
        <other value="rp-mom"/>
        <type value="see-also"/>
    </link>
</Patient>
<Encounter>
    <id value="mom-enc"/>
    <status value="in-progress"/>
    <class value="inpatient"/>
    <patient>
        <reference value="Patient/mom"/>
    </patient>
</Encounter>
<Encounter>
    <id value="child-enc"/>
    <status value="in-progress"/>
    <class value="inpatient"/>
    <patient>
        <reference value="Patient/child"/>
    </patient>
    <partOf>
        <reference value="Encounter/mom-enc"/>
    </partOf>
</Encounter>

4.1.9. Merging records

This specification does not specify merge functionality: if multiple patient records are found to be duplicates, they can be linked together, as described above. These links merely express the relationship between records, and in the case of a replacement link, indicate a "master" record. This specification does not mandate that FHIR servers migrate information between such records on finding such a link. Note:

  • Health information administrators may call the process "merging", but it is often implemented as "linking" at the record level
  • Servers are allowed to implement merging/record migration even though it is not mandated.

Note: We are seeking input from the implementer community on what effect linking/merging/unlinking should have on other functionality such as the GET operation, searching, reverse includes, etc.;
How should an unlink behavior be done?
How will the patient compartment interact with the merge?
This functionality and related behaviors is subject to ongoing experimentation and implementation testing, with a definition to be proposed in a future version of this specification.

Feedback here.

4.1.10. Patient Matching using an MPI

A Master Patient Index (MPI) is a service used to manage patient identification in a context where multiple patient databases exist. Healthcare applications and middleware use the MPI to match patients between the databases, and as new patient details are encountered. MPIs are highly specialized applications, often tailored extensively to the institution's particular mix of patients. MPIs can also be run on a regional and national basis.

To ask an MPI to match a patient, clients call the patient $match operation, which processes a parameters resource containing a complete or fragment of a patient resource, along with some other control parameters.
This provided patient resource does not need to pass full validation (mandatory fields, or invariants) as the resource will not be stored, it does however need to be a parsable instance.
The MPI can then use the properties of the resource as MPI inputs, and process them using an internal MPI algorithm of some kind to determine the most appropriate matches in the patient set. It does not have to use all the properties provided, and may ignore others provided quietly.
A specific profile (with the required fields/invariants) can be used to define what parameters the MPI algorithm requires.

  POST [base]/Patient/$match
  [some headers including content-type xml or json]
  [parameters body with patient resource inside]

The response from an MPI $match operation is a set of patient records, ordered from most likely to least likely. If there are not patient matches, the MPI SHALL return an empty search set with no error, but may include an operation outcome with further advice. All patient records should have a score from 0 to 1, where 1 is the most certain match, along with an extension "match-grade" that indicates the MPI's position on the match quality:

  <entry> 
    <resource>
      <Patient>
        <!-- patient details -->
      </Patient>
    </resource>
    <search>
      <extension url="http://hl7.org/fhir/StructureDefinition/match-grade">
        <valueCode value="probable"/>
      </extension>
      <score value="0.80"/>
    </search>
  </entry>

The match-grade extension has one of the following codes:

The purpose of using an MPI search versus a regular search is that the MPI search is really intended to target and find a specific single patient for recording information about reducing errors through incorrectly selecting the wrong patient. Often MPIs won't return data if there is insufficient search parameter data, such as a partial surname.
This compares to a regular search which can be used for finding lists of patients, such as to locate a group of patients that share a property in common, such as live in a specific location, or fit within an age range for performing population analysis.

A formal definition for the MPI $match operation is published.

4.1.11. Veterinary Care

Veterinary care is very much within the scope of FHIR, and the Patient resource can be used to communicate information about animal patients. To support this, there is a standard patient-animal extension which can be used for recording details about species, breed, and gender status. This extension is not intended to cover all relevant properties for veterinary care, and the use of additional domain-relevant extensions is expected for areas such as laboratory, zoological and livestock care.

The veterinary client ("owner") is represented using the RelatedPerson resource.

4.1.11.1. Search Parameters

nameurltypedescriptionexpression
USCoreEthnicityhttp://hl7.org/fhir/us/core/SearchParameter/us-core-ethnicitytoken

Returns patients with an ethnicity extension matching the specified code.

Patient.extension.where(url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity').extension.value.code
USCorePatientBirthdatehttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-birthdatedate

The patient's date of birth
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
Patient.birthDate
USCorePatientDeathDatehttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-death-datedate

The date of death has been provided and satisfies this search value
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
(Patient.deceased as dateTime)
USCorePatientFamilyhttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-familystring

A portion of the family name of the patient
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
Patient.name.family
USCorePatientGenderhttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-gendertoken

Gender of the patient
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
Patient.gender
USCorePatientGenderIdentityhttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-gender-identitytoken

Returns patients with an gender-identity extension matching the specified code.

Patient.extension.where(url='http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity').value.coding.code
USCorePatientGivenhttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-givenstring

A portion of the given name of the patient
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
Patient.name.given
USCorePatientIdhttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-idtoken

Logical id of this artifact
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
Patient.id
USCorePatientIdentifierhttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-identifiertoken

A patient identifier
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
Patient.identifier
USCorePatientNamehttp://hl7.org/fhir/us/core/SearchParameter/us-core-patient-namestring

A server defined search that may match any of the string fields in the HumanName, including family, give, prefix, suffix, suffix, and/or text
NOTE: This US Core SearchParameter definition extends the usage context of the Conformance expectation extension

  • multipleAnd
  • multipleOr
  • comparator
  • modifier
  • chain
Patient.name
USCoreRacehttp://hl7.org/fhir/us/core/SearchParameter/us-core-racetoken

Returns patients with a race extension matching the specified code.

Patient.extension.where(url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race').extension.value.code