EPAPatient

Das EPAPatient-Profil wird verwendet, um grundlegende Informationen über den Patienten, wie Name, Anrede oder Geburtsdatum zu erfassen. Ein Instanz dieses Profils kann ausschließlich durch den Kostenträger in den Patient Information Service eingestellt sowie aktualisiert werden. Es wird verwendet, um Versicherteninformationen in der Geschäftslogik zu verarbeiten und beispielsweise Medikationspläne korrekt zusammenzustellen. Wichtig dabei ist, dass die Versicherteninformationen nicht vom Medication Service selbst erhoben oder direkt abgerufen werden können. Stattdessen werden sie intern genutzt, um spezifische FHIR-Operationen auszuführen.

Im Anwendungfall des Medikationsplandokuments wird die Patient-Ressource innerhalb des Medication Service intern in der Geschäftslogik herangezogen. Dies dient dazu, das Medikationsplan-Bundle zusammenzustellen und sicherzustellen, dass alle relevanten Informationen korrekt und vollständig in den Medikationsplan integriert werden.

Profile

EPA Patient

idS Σ0..1string
id0..1string
extensionI0..*Extension
versionIdS Σ0..1id
lastUpdatedS Σ0..1instant
sourceΣ0..1uri
profileΣ0..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
KVNRS Σ1..1IdentifierKvid10
activeS Σ ?!0..1boolean
id0..1string
extensionI0..*Extension
useS Σ ?!1..1codeBindingPattern
textΣ0..1string
id0..1string
namenszusatzS I0..1Extension(string)
nachnameS I0..1Extension(string)
vorsatzwortS I0..1Extension(string)
value0..1System.String
givenS Σ1..*string
id0..1string
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueCodecode
value0..1System.String
suffixΣ0..*string
periodΣ I0..1Period
id0..1string
extensionI0..*Extension
useS Σ ?!1..1codeBindingPattern
textΣ0..1string
id0..1string
namenszusatzS I0..1Extension(string)
nachnameS I0..1Extension(string)
vorsatzwortS I0..1Extension(string)
value0..1System.String
givenΣ0..0string
suffixΣ0..0string
periodΣ I0..1Period
telecomΣ I0..*ContactPoint
id0..1string
other-amtlichI0..1Extension(Coding)
value0..1System.String
birthDateS Σ1..1date
deceasedBooleanboolean
deceasedDateTimedateTime
addressΣ0..*Address
maritalStatus0..1CodeableConceptBinding
multipleBirthBooleanboolean
multipleBirthIntegerinteger
photoI0..*Attachment
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
relationship0..*CodeableConceptBinding
name0..1HumanName
telecomI0..*ContactPoint
address0..1Address
gender0..1codeBinding
organizationI0..1Reference(Organization)
periodI0..1Period
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
language1..1CodeableConceptBinding
preferred0..1boolean
generalPractitionerI0..*Reference(Organization | Practitioner | PractitionerRole)
managingOrganizationΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
otherΣ I1..1Reference(Patient | RelatedPerson)
typeΣ1..1codeBinding
Patient
DefinitionDemographics and other administrative information about an individual or animal receiving care or other health-related services.
Cardinality0...*
AliasSubjectOfCare Client Resident
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • pat-de-1: Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist
    gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
Mappings
  • rim: Entity. Role, or Act
  • rim: Patient[classCode=PAT]
  • cda: ClinicalDocument.recordTarget.patientRole
Patient.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
Must SupportTrue
SummaryTrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Patient.meta
DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality0...1
TypeMeta
Must SupportTrue
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.meta.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.meta.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.meta.versionId
DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Cardinality0...1
Typeid
Must SupportTrue
SummaryTrue
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.meta.lastUpdated
DefinitionWhen the resource last changed - e.g. when the version changed.
Cardinality0...1
Typeinstant
Must SupportTrue
SummaryTrue
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.meta.source
DefinitionA uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
Cardinality0...1
Typeuri
SummaryTrue
Comments

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.meta.profile
DefinitionA list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).
Cardinality0...*
Typecanonical(StructureDefinition)
SummaryTrue
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.meta.security
DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Cardinality0...*
TypeCoding
Binding

Security Labels from the Healthcare Privacy and Security Classification System.

All Security Labels (extensible)
SummaryTrue
Comments

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
Patient.meta.tag
DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Cardinality0...*
TypeCoding
Binding

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

CommonTags (example)
SummaryTrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
Patient.implicitRules
DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.text
DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Patient.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Patient.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.identifier
DefinitionAn identifier for this patient.
Cardinality1...*
TypeIdentifier
Must SupportTrue
SummaryTrue
Requirements

Patients are almost always assigned specific numerical identifiers.

SlicingUnordered, Open, by system(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: PID-3
  • rim: id
  • cda: .id
Patient.identifier:KVNR
DefinitionAn identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Cardinality1...1
TypeIdentifierKvid10
Must SupportTrue
SummaryTrue
Requirements

Patients are almost always assigned specific numerical identifiers.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: PID-3
  • rim: id
  • cda: .id
Patient.active
DefinitionWhether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Cardinality0...1
Typeboolean
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Need to be able to mark a patient record as not to be used because it was created in error.

Comments

If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • rim: statusCode
  • cda: n/a
Patient.name
DefinitionA name associated with the individual.
Cardinality1...*
TypeHumanName
Must SupportTrue
SummaryTrue
Requirements

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

Comments

In order to maintain the differentiations of name parts as given in the VSDM dataset or qualify prefixes as academic titles, vendors can opt to support the extensions specified in the German HumanName Base Profile https://simplifier.net/basisprofil-de-r4/humannamedebasis This is however not required within the scope of this specification.

SlicingUnordered, Open, by $this(Pattern)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: PID-5, PID-9
  • rim: name
  • cda: .patient.name
Patient.name:Name
DefinitionPersonenname mit in Deutschland üblichen Erweiterungen
Cardinality1...1
TypeHumannameDeBasis
Must SupportTrue
SummaryTrue
Requirements

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

Comments

Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden
    family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
  • hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden
    family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
  • hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden
    family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
  • hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden
    prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
Pattern

{
  "use": "official"
}

Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: PID-5, PID-9
  • rim: name
  • cda: .patient.name
Patient.name:Name.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.name:Name.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Name.use
DefinitionIdentifies the purpose for this name.
Cardinality1...1
Typecode
Binding

The use of a human name.

NameUse (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Allows the appropriate name for a particular context of use to be selected from among a set of names.

Comments

Applications can assume that a name is current unless it explicitly says that it is temporary or old.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Pattern

official

Mappings
  • rim: n/a
  • v2: XPN.7, but often indicated by which field contains the name
  • rim: unique(./use)
  • servd: ./NamePurpose
Patient.name:Name.text
DefinitionSpecifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
Cardinality0...1
Typestring
SummaryTrue
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: implied by XPN.11
  • rim: ./formatted
Patient.name:Name.family
DefinitionDer vollständige Familienname, einschließlich aller Vorsatz- und Zusatzwörter, mit Leerzeichen getrennt.
Cardinality1...1
Typestring
Must SupportTrue
SummaryTrue
Aliassurname
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN.1/FN.1
  • rim: ./part[partType = FAM]
  • servd: ./FamilyName
Patient.name:Name.family.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.name:Name.family.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Name.family.extension:namenszusatz
DefinitionNamenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert. Beispiele: Gräfin, Prinz oder Fürst
Cardinality0...1
TypeExtension(string)
Must SupportTrue
Aliasextensions, user content
Comments

Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt. Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Name.family.extension:nachname
DefinitionNachname ohne Vor- und Zusätze. Dient z.B. der alphabetischen Einordnung des Namens.
Cardinality0...1
TypeExtension(string)
Must SupportTrue
Aliasextensions, user content
Comments

If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
  • v2: FN.3
  • rim: ENXP where Qualifiers = (BR)
Patient.name:Name.family.extension:vorsatzwort
DefinitionVorsatzwort wie z.B.: von, van, zu Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
Cardinality0...1
TypeExtension(string)
Must SupportTrue
Aliasextensions, user content
Comments

An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
  • v2: FN.2
  • rim: ENXP where Qualifiers = (VV, R)
Patient.name:Name.family.value
DefinitionPrimitive value for string
Cardinality0...1
TypeSystem.String
Patient.name:Name.given
DefinitionVorname der Person
Cardinality1...*
Typestring
Must SupportTrue
SummaryTrue
Aliasfirst name, middle name
Comments

If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN.2 + XPN.3
  • rim: ./part[partType = GIV]
  • servd: ./GivenNames
Patient.name:Name.prefix
DefinitionNamensteile vor dem Vornamen, z.B. akademischer Titel.
Cardinality0...*
Typestring
Must SupportTrue
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN.5
  • rim: ./part[partType = PFX]
  • servd: ./TitleCode
Patient.name:Name.prefix.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.name:Name.prefix.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Name.prefix.extension:prefix-qualifier
DefinitionSpezialisierung der Art des Präfixes, z.B. "AC" für Akademische Titel
Cardinality0...1
TypeExtension(code)
Must SupportTrue
Aliasextensions, user content
Comments

Used to indicate additional information about the name part and how it should be used.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
  • rim: ENXP.qualifier
Patient.name:Name.prefix.extension:prefix-qualifier.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.name:Name.prefix.extension:prefix-qualifier.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Name.prefix.extension:prefix-qualifier.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

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

Fixed Value

http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier

Mappings
  • rim: N/A
Patient.name:Name.prefix.extension:prefix-qualifier.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
Typecode
Binding

A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type.

EntityNamePartQualifier (required)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Fixed Value

AC

Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Name.prefix.value
DefinitionPrimitive value for string
Cardinality0...1
TypeSystem.String
Patient.name:Name.suffix
DefinitionNamensteile nach dem Nachnamen
Cardinality0...*
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN/4
  • rim: ./part[partType = SFX]
Patient.name:Name.period
DefinitionIndicates the period of time when this name was valid for the named person.
Cardinality0...1
TypePeriod
SummaryTrue
Requirements

Allows names to be placed in historical context.

Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: XPN.13 + XPN.14
  • rim: ./usablePeriod[type="IVL<TS>"]
  • servd: ./StartDate and ./EndDate
Patient.name:Geburtsname
DefinitionPersonenname mit in Deutschland üblichen Erweiterungen
Cardinality0...1
TypeHumannameDeBasis
Must SupportTrue
SummaryTrue
Requirements

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

Comments

Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden
    family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
  • hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden
    family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
  • hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden
    family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
  • hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden
    prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
Pattern

{
  "use": "maiden"
}

Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: PID-5, PID-9
  • rim: name
  • cda: .patient.name
Patient.name:Geburtsname.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.name:Geburtsname.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Geburtsname.use
DefinitionIdentifies the purpose for this name.
Cardinality1...1
Typecode
Binding

The use of a human name.

NameUse (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Allows the appropriate name for a particular context of use to be selected from among a set of names.

Comments

Applications can assume that a name is current unless it explicitly says that it is temporary or old.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Pattern

maiden

Mappings
  • rim: n/a
  • v2: XPN.7, but often indicated by which field contains the name
  • rim: unique(./use)
  • servd: ./NamePurpose
Patient.name:Geburtsname.text
DefinitionSpecifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
Cardinality0...1
Typestring
SummaryTrue
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: implied by XPN.11
  • rim: ./formatted
Patient.name:Geburtsname.family
DefinitionDer vollständige Familienname, einschließlich aller Vorsatz- und Zusatzwörter, mit Leerzeichen getrennt.
Cardinality1...1
Typestring
Must SupportTrue
SummaryTrue
Aliassurname
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN.1/FN.1
  • rim: ./part[partType = FAM]
  • servd: ./FamilyName
Patient.name:Geburtsname.family.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.name:Geburtsname.family.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Geburtsname.family.extension:namenszusatz
DefinitionNamenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert. Beispiele: Gräfin, Prinz oder Fürst
Cardinality0...1
TypeExtension(string)
Must SupportTrue
Aliasextensions, user content
Comments

Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt. Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Geburtsname.family.extension:nachname
DefinitionNachname ohne Vor- und Zusätze. Dient z.B. der alphabetischen Einordnung des Namens.
Cardinality0...1
TypeExtension(string)
Must SupportTrue
Aliasextensions, user content
Comments

If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
  • v2: FN.3
  • rim: ENXP where Qualifiers = (BR)
Patient.name:Geburtsname.family.extension:vorsatzwort
DefinitionVorsatzwort wie z.B.: von, van, zu Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
Cardinality0...1
TypeExtension(string)
Must SupportTrue
Aliasextensions, user content
Comments

An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
  • v2: FN.2
  • rim: ENXP where Qualifiers = (VV, R)
Patient.name:Geburtsname.family.value
DefinitionPrimitive value for string
Cardinality0...1
TypeSystem.String
Patient.name:Geburtsname.given
DefinitionVorname der Person
Cardinality0...0
Typestring
SummaryTrue
Aliasfirst name, middle name
Comments

If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN.2 + XPN.3
  • rim: ./part[partType = GIV]
  • servd: ./GivenNames
Patient.name:Geburtsname.prefix
DefinitionNamensteile vor dem Vornamen, z.B. akademischer Titel.
Cardinality0...0
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN.5
  • rim: ./part[partType = PFX]
  • servd: ./TitleCode
Patient.name:Geburtsname.prefix.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.name:Geburtsname.prefix.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.name:Geburtsname.prefix.extension:prefix-qualifier
DefinitionSpezialisierung der Art des Präfixes, z.B. "AC" für Akademische Titel
Cardinality0...1
TypeExtension(code)
Aliasextensions, user content
Comments

Used to indicate additional information about the name part and how it should be used.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
  • rim: ENXP.qualifier
Patient.name:Geburtsname.prefix.value
DefinitionPrimitive value for string
Cardinality0...1
TypeSystem.String
Patient.name:Geburtsname.suffix
DefinitionNamensteile nach dem Nachnamen
Cardinality0...0
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN/4
  • rim: ./part[partType = SFX]
Patient.name:Geburtsname.period
DefinitionIndicates the period of time when this name was valid for the named person.
Cardinality0...1
TypePeriod
SummaryTrue
Requirements

Allows names to be placed in historical context.

Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: XPN.13 + XPN.14
  • rim: ./usablePeriod[type="IVL<TS>"]
  • servd: ./StartDate and ./EndDate
Patient.telecom
DefinitionA contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Cardinality0...*
TypeContactPoint
SummaryTrue
Requirements

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

Comments

A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: PID-13, PID-14, PID-40
  • rim: telecom
  • cda: .telecom
Patient.gender
DefinitionAdministrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Cardinality0...1
Typecode
Binding

The gender of a person used for administrative purposes.

AdministrativeGender (required)
Must SupportTrue
SummaryTrue
Requirements

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

Comments

The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-8
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
  • cda: .patient.administrativeGenderCode
Patient.gender.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.gender.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.gender.extension:other-amtlich
DefinitionOptional Extension Element - found in all resources.
Cardinality0...1
TypeExtension(Coding)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.gender.value
DefinitionPrimitive value for code
Cardinality0...1
TypeSystem.String
Patient.birthDate
DefinitionThe date of birth for the individual.
Cardinality1...1
Typedate
Must SupportTrue
SummaryTrue
Requirements

Age of the individual drives many clinical processes.

Comments

At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-7
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime
  • cda: .patient.birthTime
  • loinc: 21112-8
Patient.deceased[x]
DefinitionIndicates if the individual is deceased or not.
Cardinality0...1
Typeboolean
ModifierTrue
SummaryTrue
Requirements

The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

Comments

If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-30 (bool) and PID-29 (datetime)
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime
  • cda: n/a
Patient.address
DefinitionAn address for the individual.
Cardinality0...*
TypeAddress
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: PID-11
  • rim: addr
  • cda: .addr
Patient.maritalStatus
DefinitionThis field contains a patient's most recent marital (civil) status.
Cardinality0...1
TypeCodeableConcept
Binding

The domestic partnership status of a person.

Marital Status Codes (extensible)
Requirements

Most, if not all systems capture it.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: PID-16
  • rim: player[classCode=PSN]/maritalStatusCode
  • cda: .patient.maritalStatusCode
Patient.multipleBirth[x]
DefinitionIndicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Cardinality0...1
Typeboolean
Requirements

For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

Comments

Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-24 (bool), PID-25 (integer)
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber
  • cda: n/a
Patient.photo
DefinitionImage of the patient.
Cardinality0...*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

Comments

Guidelines:

  • Use id photos, not clinical photos.
  • Limit dimensions to thumbnail.
  • Keep byte count low to ease resource updates.
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • att-1: If the Attachment has data, it SHALL have a contentType
    data.empty() or contentType.exists()
Mappings
  • rim: n/a
  • v2: ED/RP
  • rim: ED
  • v2: OBX-5 - needs a profile
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc
  • cda: n/a
Patient.contact
DefinitionA contact party (e.g. guardian, partner, friend) for the patient.
Cardinality0...*
TypeBackboneElement
Requirements

Need to track people you can contact about the patient.

Comments

Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • pat-1: SHALL at least contain a contact's details or a reference to an organization
    name.exists() or telecom.exists() or address.exists() or organization.exists()
Mappings
  • rim: n/a
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
  • cda: n/a
Patient.contact.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.contact.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.relationship
DefinitionThe nature of the relationship between the patient and the contact person.
Cardinality0...*
TypeCodeableConcept
Binding

The nature of the relationship between a patient and a contact person for that patient.

PatientContactRelationship (extensible)
Requirements

Used to determine which contact person is the most relevant to approach, depending on circumstances.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: NK1-7, NK1-3
  • rim: code
  • cda: n/a
Patient.contact.name
DefinitionA name associated with the contact person.
Cardinality0...1
TypeHumanName
Requirements

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

Comments

Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: NK1-2
  • rim: name
  • cda: n/a
Patient.contact.telecom
DefinitionA contact detail for the person, e.g. a telephone number or an email address.
Cardinality0...*
TypeContactPoint
Requirements

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

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: NK1-5, NK1-6, NK1-40
  • rim: telecom
  • cda: n/a
Patient.contact.address
DefinitionAddress for the contact person.
Cardinality0...1
TypeAddress
Requirements

Need to keep track where the contact person can be contacted per postal mail or visited.

Comments

Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: NK1-4
  • rim: addr
  • cda: n/a
Patient.contact.gender
DefinitionAdministrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Cardinality0...1
Typecode
Binding

The gender of a person used for administrative purposes.

AdministrativeGender (required)
Requirements

Needed to address the person correctly.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: NK1-15
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
  • cda: n/a
Patient.contact.organization
DefinitionOrganization on behalf of which the contact is acting or for which the contact is working.
Cardinality0...1
TypeReference(Organization)
Requirements

For guardians or business related contacts, the organization is relevant.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: NK1-13, NK1-30, NK1-31, NK1-32, NK1-41
  • rim: scoper
  • cda: n/a
Patient.contact.period
DefinitionThe period during which this contact person or organization is valid to be contacted relating to this patient.
Cardinality0...1
TypePeriod
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • rim: effectiveTime
  • cda: n/a
Patient.communication
DefinitionA language which may be used to communicate with the patient about his or her health.
Cardinality0...*
TypeBackboneElement
Requirements

If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

Comments

If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: LanguageCommunication
  • cda: patient.languageCommunication
Patient.communication.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.communication.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.language
DefinitionThe ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
Cardinality1...1
TypeCodeableConcept
Binding

A human language.

CommonLanguages (preferred)
Requirements

Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: PID-15, LAN-2
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code
  • cda: .languageCode
Patient.communication.preferred
DefinitionIndicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Cardinality0...1
Typeboolean
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.

Comments

This language is specifically identified for communicating healthcare information.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-15
  • rim: preferenceInd
  • cda: .preferenceInd
Patient.generalPractitioner
DefinitionPatient's nominated care provider.
Cardinality0...*
TypeReference(Organization | Practitioner | PractitionerRole)
AliascareProvider
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: PD1-4
  • rim: subjectOf.CareEvent.performer.AssignedEntity
  • cda: n/a
Patient.managingOrganization
DefinitionOrganization that is the custodian of the patient record.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Requirements

Need to know who recognizes this patient record, manages and updates it.

Comments

There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: scoper
  • cda: .providerOrganization
Patient.link
DefinitionLink to another patient resource that concerns the same actual patient.
Cardinality0...*
TypeBackboneElement
ModifierTrue
SummaryTrue
Requirements

There are multiple use cases:

  • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
  • Distribution of patient information across multiple servers.
Comments

There is no assumption that linked patient records have mutual links.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: outboundLink
  • cda: n/a
Patient.link.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.link.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.link.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.link.other
DefinitionThe other patient resource that the link refers to.
Cardinality1...1
TypeReference(Patient | RelatedPerson)
SummaryTrue
Comments

Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: PID-3, MRG-1
  • rim: id
  • cda: n/a
Patient.link.type
DefinitionThe type of link between this patient resource and another patient resource.
Cardinality1...1
Typecode
Binding

The type of link between this patient resource and another patient resource.

LinkType (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: typeCode
  • cda: n/a
<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="epa-patient" />
    <url value="https://gematik.de/fhir/epa/StructureDefinition/epa-patient" />
    <version value="1.1.0" />
    <name value="EPAPatient" />
    <title value="EPA Patient" />
    <status value="active" />
    <experimental value="false" />
    <date value="2024-08-14" />
    <publisher value="gematik GmbH" />
    <description value="Defines the data structure for the patient profile in the ePA system." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Patient" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Patient" />
    <derivation value="constraint" />
    <differential>
        <element id="Patient">
            <path value="Patient" />
            <constraint>
                <key value="pat-de-1" />
                <severity value="error" />
                <human value="Die amtliche Differenzierung der Geschlechtsangabe &#39;other&#39; darf nur gef&#252;llt sein, wenn das Geschlecht &#39;other&#39; angegeben ist" />
                <expression value="gender.exists() and gender=&#39;other&#39; implies gender.extension(&#39;http://fhir.de/StructureDefinition/gender-amtlich-de&#39;).exists()" />
                <source value="https://gematik.de/fhir/epa/StructureDefinition/epa-patient" />
            </constraint>
        </element>
        <element id="Patient.id">
            <path value="Patient.id" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.meta">
            <path value="Patient.meta" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.meta.versionId">
            <path value="Patient.meta.versionId" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.meta.lastUpdated">
            <path value="Patient.meta.lastUpdated" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.identifier">
            <path value="Patient.identifier" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <rules value="open" />
            </slicing>
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.identifier:KVNR">
            <path value="Patient.identifier" />
            <sliceName value="KVNR" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="Identifier" />
                <profile value="http://fhir.de/StructureDefinition/identifier-kvid-10" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Patient.active">
            <path value="Patient.active" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name">
            <path value="Patient.name" />
            <slicing>
                <discriminator>
                    <type value="pattern" />
                    <path value="$this" />
                </discriminator>
                <rules value="open" />
            </slicing>
            <comment value="In order to maintain the differentiations of name parts as given in the VSDM dataset or qualify prefixes as academic titles, vendors can opt to support the extensions specified in the German HumanName Base Profile https://simplifier.net/basisprofil-de-r4/humannamedebasis\nThis is however not required within the scope of this specification." />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name">
            <path value="Patient.name" />
            <sliceName value="Name" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="HumanName" />
                <profile value="http://fhir.de/StructureDefinition/humanname-de-basis" />
            </type>
            <patternHumanName>
                <use value="official" />
            </patternHumanName>
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.use">
            <path value="Patient.name.use" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.family">
            <path value="Patient.name.family" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.family.extension:namenszusatz">
            <path value="Patient.name.family.extension" />
            <sliceName value="namenszusatz" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.family.extension:nachname">
            <path value="Patient.name.family.extension" />
            <sliceName value="nachname" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.family.extension:vorsatzwort">
            <path value="Patient.name.family.extension" />
            <sliceName value="vorsatzwort" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.given">
            <path value="Patient.name.given" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.prefix">
            <path value="Patient.name.prefix" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.prefix.extension:prefix-qualifier">
            <path value="Patient.name.prefix.extension" />
            <sliceName value="prefix-qualifier" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Name.prefix.extension:prefix-qualifier.value[x]">
            <path value="Patient.name.prefix.extension.value[x]" />
            <fixedCode value="AC" />
        </element>
        <element id="Patient.name:Geburtsname">
            <path value="Patient.name" />
            <sliceName value="Geburtsname" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="HumanName" />
                <profile value="http://fhir.de/StructureDefinition/humanname-de-basis" />
            </type>
            <patternHumanName>
                <use value="maiden" />
            </patternHumanName>
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Geburtsname.use">
            <path value="Patient.name.use" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Geburtsname.family">
            <path value="Patient.name.family" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Geburtsname.family.extension:namenszusatz">
            <path value="Patient.name.family.extension" />
            <sliceName value="namenszusatz" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Geburtsname.family.extension:nachname">
            <path value="Patient.name.family.extension" />
            <sliceName value="nachname" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Geburtsname.family.extension:vorsatzwort">
            <path value="Patient.name.family.extension" />
            <sliceName value="vorsatzwort" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name:Geburtsname.given">
            <path value="Patient.name.given" />
            <max value="0" />
        </element>
        <element id="Patient.name:Geburtsname.prefix">
            <path value="Patient.name.prefix" />
            <max value="0" />
        </element>
        <element id="Patient.name:Geburtsname.suffix">
            <path value="Patient.name.suffix" />
            <max value="0" />
        </element>
        <element id="Patient.gender">
            <path value="Patient.gender" />
            <mustSupport value="true" />
        </element>
        <element id="Patient.gender.extension:other-amtlich">
            <path value="Patient.gender.extension" />
            <sliceName value="other-amtlich" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="http://fhir.de/StructureDefinition/gender-amtlich-de" />
            </type>
        </element>
        <element id="Patient.birthDate">
            <path value="Patient.birthDate" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>
{
    "resourceType": "StructureDefinition",
    "id": "epa-patient",
    "url": "https://gematik.de/fhir/epa/StructureDefinition/epa-patient",
    "version": "1.1.0",
    "name": "EPAPatient",
    "title": "EPA Patient",
    "status": "active",
    "experimental": false,
    "date": "2024-08-14",
    "publisher": "gematik GmbH",
    "description": "Defines the data structure for the patient profile in the ePA system.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Patient",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Patient",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Patient",
                "path": "Patient",
                "constraint":  [
                    {
                        "key": "pat-de-1",
                        "human": "Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist",
                        "source": "https://gematik.de/fhir/epa/StructureDefinition/epa-patient",
                        "severity": "error",
                        "expression": "gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()"
                    }
                ]
            },
            {
                "id": "Patient.id",
                "path": "Patient.id",
                "mustSupport": true
            },
            {
                "id": "Patient.meta",
                "path": "Patient.meta",
                "mustSupport": true
            },
            {
                "id": "Patient.meta.versionId",
                "path": "Patient.meta.versionId",
                "mustSupport": true
            },
            {
                "id": "Patient.meta.lastUpdated",
                "path": "Patient.meta.lastUpdated",
                "mustSupport": true
            },
            {
                "id": "Patient.identifier",
                "path": "Patient.identifier",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "rules": "open"
                },
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Patient.identifier:KVNR",
                "path": "Patient.identifier",
                "sliceName": "KVNR",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "Identifier",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/identifier-kvid-10"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Patient.active",
                "path": "Patient.active",
                "mustSupport": true
            },
            {
                "id": "Patient.name",
                "path": "Patient.name",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "pattern",
                            "path": "$this"
                        }
                    ],
                    "rules": "open"
                },
                "comment": "In order to maintain the differentiations of name parts as given in the VSDM dataset or qualify prefixes as academic titles, vendors can opt to support the extensions specified in the German HumanName Base Profile https://simplifier.net/basisprofil-de-r4/humannamedebasis\nThis is however not required within the scope of this specification.",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name",
                "path": "Patient.name",
                "sliceName": "Name",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "HumanName",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/humanname-de-basis"
                        ]
                    }
                ],
                "patternHumanName": {
                    "use": "official"
                },
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.use",
                "path": "Patient.name.use",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.family",
                "path": "Patient.name.family",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.family.extension:namenszusatz",
                "path": "Patient.name.family.extension",
                "sliceName": "namenszusatz",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.family.extension:nachname",
                "path": "Patient.name.family.extension",
                "sliceName": "nachname",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.family.extension:vorsatzwort",
                "path": "Patient.name.family.extension",
                "sliceName": "vorsatzwort",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.given",
                "path": "Patient.name.given",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.prefix",
                "path": "Patient.name.prefix",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.prefix.extension:prefix-qualifier",
                "path": "Patient.name.prefix.extension",
                "sliceName": "prefix-qualifier",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Name.prefix.extension:prefix-qualifier.value[x]",
                "path": "Patient.name.prefix.extension.value[x]",
                "fixedCode": "AC"
            },
            {
                "id": "Patient.name:Geburtsname",
                "path": "Patient.name",
                "sliceName": "Geburtsname",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "HumanName",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/humanname-de-basis"
                        ]
                    }
                ],
                "patternHumanName": {
                    "use": "maiden"
                },
                "mustSupport": true
            },
            {
                "id": "Patient.name:Geburtsname.use",
                "path": "Patient.name.use",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Patient.name:Geburtsname.family",
                "path": "Patient.name.family",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Patient.name:Geburtsname.family.extension:namenszusatz",
                "path": "Patient.name.family.extension",
                "sliceName": "namenszusatz",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Geburtsname.family.extension:nachname",
                "path": "Patient.name.family.extension",
                "sliceName": "nachname",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Geburtsname.family.extension:vorsatzwort",
                "path": "Patient.name.family.extension",
                "sliceName": "vorsatzwort",
                "mustSupport": true
            },
            {
                "id": "Patient.name:Geburtsname.given",
                "path": "Patient.name.given",
                "max": "0"
            },
            {
                "id": "Patient.name:Geburtsname.prefix",
                "path": "Patient.name.prefix",
                "max": "0"
            },
            {
                "id": "Patient.name:Geburtsname.suffix",
                "path": "Patient.name.suffix",
                "max": "0"
            },
            {
                "id": "Patient.gender",
                "path": "Patient.gender",
                "mustSupport": true
            },
            {
                "id": "Patient.gender.extension:other-amtlich",
                "path": "Patient.gender.extension",
                "sliceName": "other-amtlich",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/gender-amtlich-de"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.birthDate",
                "path": "Patient.birthDate",
                "min": 1,
                "mustSupport": true
            }
        ]
    }
}