Extensions

Introduction

In this module you will learn more about Extensions. We will use Forge, the official HL7®FHIR® profile editor, to edit our profiles. You can download Forge here.

The topics covered in this module are:

The use of extensions
Guidelines for adding extensions
Types of extensions
Extensions in Forge

Reading material

1. The use of extensions

It is common for specific implementations to have valid requirements that are not part of the core FHIR Specification. Incorporating all valid requirements would make the FHIR spec very cumbersome and difficult to implement. Instead, the specification expects that such additional requirements will be implemented as extensions.

Extensions are a way to extend an element or resource to include additional elements not present in the original, e.g. adding a birth place in addition to the date on the Patient resource. At first glance this appears to conflict with the concept of constraining resources as you are adding an element to the resource. However, in FHIR all resources and elements have the option to be extended by default unless someone specified otherwise.

Extensions are created using the StructureDefinition resource, the same building block used for resources and profiles. At the bare minimum the extension must be given a canonical url to be able to idenitify it (e.g. http://hl7.org/fhir/StructureDefinition/birthPlace) and the data type of the elements value must be specified (in this case a string). You should also fill in the definition and purpose as good practice to allow for easy re-use of extensions.

After you've made your extension, you can plug it into your profile for use. In section 4 below we'll show how to define and add extensions using Forge.

2. Types of extensions

2.1 Modifier extensions

If an extension significantly modifies the clinical meaning of a resource - meaning that not understanding it is not an option - it shall be marked with isModifier. The reason is for clinical safety: if a system doesn't understand a normal extension in a resource, it may still process it - but not if the extension is a modifier one. If it is a modifier, the system must know the meaning of the extension before it can process it, and this, for example, allows you to use extensions that negate the meaning of a value safely.

Here is what the FHIR spec has to say about this:

Applications SHALL always check for modifier extensions when processing the data from any element that can carry one
If a Modifier Extension that an application does not understand is present, the application SHALL refuse to process the resource or affected element, or SHALL provide an appropriate warning to its users

2.2 Complex extensions

An extension that adds more than one value is called complex extension, as it's defined by a tree of nested extensions. As an example, consider extending a patient with an opt-in status for a clinical trial containing three fields: clinical trial number, period of involvement and a reason for enrollment.

<Patient>
  <extension url="http://hl7.org/fhir/StructureDefinition/patient-clinicalTrial" >
    <extension url="NCT" >
      <valueString value="123456789" />
    </extension>
    <extension url="period" >
      <valuePeriod>
        <start value="2009-03-14" />
      </valuePeriod>
    </extension>
    <extension url="reason" >
      <valueCodeableConcept>
        <coding>
          <system value="http://acme.org/codes/general" />
          <code value="tt14j" />
        </coding>
      </valueCodeableConcept>
    </extension>
  </extension>
  <!-- other data for patient -->
</Patient>

3. Guidelines for using extensions

3.1 When using extended resources

If you choose to use extensions there are a number of guidelines that must be followed:

When sending resources that use extensions, make sure the extensions are defined and published (i.e. on simplifier.net or elsewhere).
When reading, navigating through or searching resources, check whether there are any modifier extensions and make sure your system understands them. If it does not, abort the operation.
If there are non-modifier extensions and you do not understand them, you may skip them.

3.2 Defining extensions and extending resources

Reuse extensions whenever you can. When using extensions, first consult the HL7 FHIR registry, FHIR in-spec registry, or Simplifier.net to find extensions that are already defined and may be suitable for your project.
Once you have checked HL7 and Simplifier for available extensions, you can either add an extension that you have found or create your own extension that may fit your use case better then anything available. It is best to reuse existing material as much as possible. This increases the likelihood of interoperability. For example, say you want to extend your Patient profile with the place of birth -an extension for Place of Birth for a Patient can be found in the in-spec registry.

4. Creating an extension in Forge

If you cannot find a predefined extension, you can build your own. In Forge, go to “New” and click “New Extension” (or Ctrl + E) to create a new extension, where the “Element Tree” section will be open by default. In the Properties section, you can provide context information, a canonical URL, name and other relevant information.

4.1 Context information

When you build a new extension in Forge, Forge will automatically show warning messages in the lower section of your screen highlighting the need to provide context information for this new extension. You can provide this information in “Properties” tab of the extension.

Context Type indicates if the extension extends a resource, data type, mapping, or another extension and it must be filled in. You can then give the exact context by pressing the + symbol after Context. This brings you to a new screen were you can select the specific resource or datatype where the extension needs to be placed. If you extend at the resource level you can click “Select Resource”. If you extend at the element level first select that element and then click “Select Element”. Depending on where the extension will be used, you can add more context information.

4.2 Value[X]

A new extension starts with one element containing a “Value[X]”. A “Value[X]” can contain all datatypes, most likely this needs to be constrained to a more specific datatype. In Forge, this can be done in the Element Properties tab by selecting only the wanted datatypes.

4.3 Complex extensions

In Forge, elements can be added and removed from the extension profile with the use of the Add and Remove buttons. When adding an element, it will be placed at a level lower than the selected element. Internally, in the selected (parent) element, the cardinality of the value[x] element will be set to 0 since it will not (and cannot) be used. The Extension.extension element is sliced by URL, and each slice is defined with a fixed relative URI.

5. Adding an extension to your profile

In Forge, you can connect your extension to your profile when you have it opened in your session explorer. Select the element in the Element Tree of your profile where you want to add the extension. Then, click the paperclip icon with the name “Extend” which is shown in the tool section above the element tree. If you are extending the profile then position your cursor on the backbone element and then click extend. Forge shows a warning highlighting that the extension element is empty and it should be associated with an extension definition. This is done by selecting the newly made extension element and click the dropdown menu in the Element Properties section under Extension. All of the defined extensions in your session explorer will be available. Click the desired extension definition. It is also possible to provide extension's canonical URL here if you do not have the extension available in Forge.

Real-life examples

Here below are examples of customers that we helped building profiles.

Stichting Koppeltaal

Stichting Koppeltaal is a Dutch organization that enables FHIR-based exchange of data between e-health applications in the care sector. The example below shows the KoppeltaalPatient profile, which is derived from the nl-core-patient profile.

This profile has the following extensions:

preferredPharmacy (derived from the base profile nl-core-patient)
nationality (derived from the base profile nl-core-patient)
person-age (added in the KoppeltaalPatient profile)

Patient		0..*	Patient	There are no (further) constraints on this element Element Id Patient Short description Patient Alternate names SubjectOfCare Client Resident, Patiënt Definition Demographics and other administrative information about an individual or animal receiving care or other health-related services. Data Type Patient Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1:If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.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 `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` Mappings rim:Entity. Role, or Act rim:Patient[classCode=PAT] cda:ClinicalDocument.recordTarget.patientRole w5:administrative.individual hcim-patient-v2.0.1-2015EN:NL-CM:0.1.1 hcim-patient-v3.0-2016EN:NL-CM:0.1.1 hcim-patient-v3.1-2017EN:NL-CM:0.1.1
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
preferredPharmacy		0..1	Extension(Reference(nl-core-organization))	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy Short description References a patient's preferered pharmacy Alternate names extensions, user content, Verwijst naar de voorkeursapotheek van de patiënt Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(Reference(nl-core-organization)) Extension URL http://fhir.nl/fhir/StructureDefinition/nl-core-preferred-pharmacy Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://fhir.nl/fhir/StructureDefinition/nl-core-preferred-pharmacy Mappings rim:n/a rim:N/A
valueReference		0..1	KoppeltaalReference(KoppeltaalOrganization)	Element Id Patient.extension:preferredPharmacy.value[x] Short description A reference from one resource to another Definition A reference from one resource to another. 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. Data Type KoppeltaalReference(KoppeltaalOrganization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:N/A rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
reference	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 rim:.identifier
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
reference-identifier-resource-type		1..1	Extension	Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.extension:reference-identifier-resource-type Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://ggz.koppeltaal.nl/fhir/StructureDefinition/reference-identifier-resource-type Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding identifier-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding identifier-type (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.extension:preferredPharmacy.value[x]:valueReference.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
nationality		0..*	ExtensionBinding	There are no (further) constraints on this element Element Id Patient.extension:nationality Short description Nationality Alternate names extensions, user content, Nationaliteit Definition The nationality of the patient. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/patient-nationality Binding NationaliteitCodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-nationality-v2.0-2015EN:NL-CM:7.6.3 hcim-nationality-v3.0-2016EN:NL-CM:7.6.3 hcim-nationality-v3.0-2017EN:NL-CM:7.6.3
legalStatus		0..2	Extension(CodeableConcept)	There are no (further) constraints on this element Element Id Patient.extension:legalStatus Short description legalStatus Alternate names extensions, user content Definition The legal situation that applies to the patient during the intervention. The code of the legal status is based on the Vektis/AZR code list COD232-VEKT Legal Status. Comments The concept LegalStatus of the HCIM FreedomRestrictingMeasures plays an importand role in the context of mental healthcare (GGZ). This concept will become an independent HCIM with the next release of HCIM (2018 release). The LegalStatus concept and associated valueset will be split in two: legalstatus and guardianship. These concept are currently captured in one valueset. It is possible to have a legalstatus AND a representative. Therefore, we allow this extension to have a cardinality of 0..2. Data Type Extension(CodeableConcept) Extension URL http://nictiz.nl/fhir/StructureDefinition/zib-patient-legalstatus Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-freedomrestrictingmeasures-v3.1-2017EN:NL-CM:14.3.2
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://nictiz.nl/fhir/StructureDefinition/zib-patient-legalstatus Mappings rim:n/a rim:N/A
valueCodeableConcept		1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept Short description LegalStatus Alternate names JuridischeStatus Definition The legal situation that applies to the patient during the intervention. The code of the legal status is based on the Vektis/AZR code list COD232-VEKT Legal Status. Comments A stream of bytes, base64 encoded Data Type CodeableConcept Binding JuridischeStatusCodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
coding	Σ	1..*	Coding	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	1..1	uri	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	1..1	code	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings may not exceed 1MB in size Data Type code Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.extension:legalStatus.value[x]:valueCodeableConcept.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
person-age		0..*	ExtensionBinding	Element Id Patient.extension:person-age Short description Nationality Alternate names extensions, user content Definition The nationality of the patient. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://ggz.koppeltaal.nl/fhir/StructureDefinition/person-age Binding ?? (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 zib-nationaliteit:NL-CM:7.6.3
identifier	Σ	1..*	Identifier	There are no (further) constraints on this element Element Id Patient.identifier Short description PatientIdentificationNumber Alternate names Identificatienummer Definition The Burgerservicenummer or BSN, as one of the possible patient identification numbers, should at least be sent unless there is a reason not to. Reasons for not sending the burgerservicenummer include but are not limited to, research and apps without a contract for processing data (Dutch: bewerkingsovereenkomst). Requirements Patients are almost always assigned specific numerical identifiers. Data Type Identifier Sliced: Unordered, Open, by system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 v2:PID-3 rim:id cda:.id w5:id hcim-patient-v2.0.1-2015EN:NL-CM:0.1.7 hcim-patient-v3.0-2016EN:NL-CM:0.1.7 hcim-patient-v3.1-2017EN:NL-CM:0.1.7
BSN	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id Patient.identifier:BSN Short description BSN Alternate names BSN Definition An identifier for this patient. Requirements Patients are almost always assigned specific numerical identifiers. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 v2:PID-3 rim:id cda:.id w5:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.identifier:BSN.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding identifier-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.identifier:BSN.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding identifier-type (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.identifier:BSN.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://fhir.nl/fhir/NamingSystem/bsn Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Patient.identifier:BSN.value Short description BSN (Burgerservicenummer (Dutch person identification number)) Alternate names BSN Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Example of a burgerservicenummer 123456782 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.identifier:BSN.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ	0..1	Reference(http://hl7.org/fhir/StructureDefinition/KoppeltaalOrganization)	Element Id Patient.identifier:BSN.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(http://hl7.org/fhir/StructureDefinition/KoppeltaalOrganization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
active	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element Id Patient.active Short description Whether this patient's record is in active use Definition This field determines the status of the 'patient' record in the context of the organization that owns the record. Note that the record is not the medical record, but rather the actual patient 'resource'. Obviously when the patient 'resource' is not active, then by extension his medical record might also be inactive. Patient.active='false' may be used discourage use of the record, but that it is kept beause there is (medical) data attached to it. Another use case is a patient moving to a different GP practice. Patient.active would be 'false' in the system of the previous GP. Requirements Need to be able to mark a patient record as not to be used because it was created in error. Comments Default is true. If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient This element is labeled as a modifier because when the patient record is marked as not active it is not expected to be used/referenced without being changed back to active. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Default value true Mappings rim:n/a rim:statusCode cda:n/a w5:status
name	Σ	0..*	nl-core-humanname	There are no (further) constraints on this element Element Id Patient.name Short description NameInformation Alternate names Naamgegevens Definition A human's name with the ability to identify parts and usage. Requirements Need to be able to track the patient by multiple names. Examples are your official name and a partner name. Comments Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts 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. A Dutch HumanName is a proper FHIR HumanName. Systems that do not understand any of the extensions, will be able to render and work with a Dutch name. Dutch names make certain name parts seaprately communicable. These parts are required for use in true Dutch systems when dealing with Dutch names, but may not have value for international systems when information gets sent abroad. To have true compatibility an implementer SHOULD use the core HumanName parts as intended. To have names work for Dutch context, the implementer SHOULD in addition use the extension elements. The extension elements cover birth name (NL: eigennaam / geslachtsnaam) and partner/spouse name. Both may have a prefix (NL: voorvoegsel). When a person marries, he or she may keep their own name, assume the partner name, append the partner name to their own name, or the other way around. For this reason, there are extensions for marking each part for what it is. Example: miss Irma Jongeneel marries mister de Haas and assumes the name Irma Jongeneel-de Haas family = "Jongeneel-de Haas" given = "Irma" humanname-own-name = "Jongeneel" humanname-partner-prefix = "de " humanname-partner-name = "Haas" Data Type nl-core-humanname Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` nl-core-humanname-1:if you specify a prefix for an own name then an own name is also expected `name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty().not()` nl-core-humanname-2:if you specify a voorvoegsel for a partner name then a partner name is also expected `name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-name').empty().not()` Examples General { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode": "NL4" } ], "use": "official", "family": "Jongeneel-de Haas", "_family": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString": "Jongeneel" }, { "url": "http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix", "valueString": "de" }, { "url": "http://hl7.org/fhir/StructureDefinition/humanname-partner-name", "valueString": "Haas" } ] }, "given": [ "Irma", "I." ], "_given": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier", "valueCode": "CL" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier", "valueCode": "IN" } ] } ] } Mappings rim:n/a v2:XPN rim:EN (actually, PN) servd:ProviderName v2:PID-5, PID-9 rim:name cda:.patient.name hcim-nameinformation-v2.0.1-2015EN:NL-CM:0.1.6 hcim-nameinformation-v3.0-2016EN:NL-CM:0.1.6 hcim-nameinformation-v1.0.1-2017EN:NL-CM:20.4.1 BRP:02 Naam hcim-patient-v2.0.1-2015EN:NL-CM:0.1.6 hcim-patient-v3.0-2016EN:NL-CM:0.1.6 hcim-patient-v3.1-2017EN:NL-CM:0.1.6 hcim-payer-v1.2-2015EN:NL-CM:1.1.5 hcim-payer-v3.0-2016EN:NL-CM:1.1.5 hcim-payer-v3.1-2017EN:NL-CM:1.1.5
telecom	Σ	0..*	ContactPoint	There are no (further) constraints on this element Element Id Patient.telecom Short description ContactInformation Alternate names Contactgegevens Definition A contact detail for the individual. Note that there is no support for multiple use values like 'mobile business'. 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 may not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone). Data Type ContactPoint Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` cpt-2:A system is required if a value is provided. `value.empty() or system.exists()` Examples Mobile phone number { "system": "phone", "value": "+31611234567", "use": "mobile" } Private email address { "system": "email", "value": "giesput@myweb.nl", "use": "home" } Mappings rim:n/a v2:XTN rim:TEL servd:ContactPoint v2:PID-13, PID-14, PID-40 rim:telecom cda:.telecom hcim-patient-v2.0.1-2015EN:NL-CM:0.1.5 hcim-patient-v3.0-2016EN:NL-CM:0.1.5 hcim-patient-v3.1-2017EN:NL-CM:0.1.5 hcim-payer-v1.2-2015EN:NL-CM:1.1.12 hcim-payer-v3.0-2016EN:NL-CM:1.1.12 hcim-payer-v3.1-2017EN:NL-CM:1.1.12
system	Σ	1..1	codeBinding	There are no (further) constraints on this element Element Id Patient.telecom.system Short description phone \| fax \| email \| pager \| url \| sms \| other Definition Telecommunications form for contact point - what communications system is required to make use of the contact. Comments Note that FHIR strings may not exceed 1MB in size Data Type code Binding contact-point-system (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:XTN.3 rim:./scheme servd:./ContactPointType hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.5
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Patient.telecom.value Short description TelephoneNumber / E-mailAddress Alternate names Telefoonnummer, EmailAdres Definition The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). Requirements Need to support legacy numbers that are not in a tightly controlled format. Comments Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:XTN.1 (or XTN.12) rim:./url servd:./Value hcim-patient-v2.0.1-2015EN:NL-CM:0.1.23 hcim-patient-v3.0-2016EN:NL-CM:0.1.23 hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.4 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.20 hcim-patient-v3.0-2016EN:NL-CM:0.1.20 hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.7
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.telecom.use Short description NumberType / E-mailAddressType Alternate names NummerSoort, EmailSoort Definition Identifies the purpose for the contact point. Requirements Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one. Applications can assume that a contact is current unless it explicitly says that it is temporary or old. Data Type code Binding contact-point-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:XTN.2 - but often indicated by field rim:unique(./use) servd:./ContactPointPurpose hcim-patient-v2.0.1-2015EN:NL-CM:0.1.22 hcim-patient-v3.0-2016EN:NL-CM:0.1.22 hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.6 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.19 hcim-patient-v3.0-2016EN:NL-CM:0.1.19 hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.5 hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.8
rank	Σ	0..1	positiveInt	There are no (further) constraints on this element Element Id Patient.telecom.rank Short description Specify preferred order of use (1 = highest) Definition Specifies a preferred order in which to use a set of contacts. Contacts are ranked with lower values coming before higher values. Comments Note that rank does not necessarily follow the order in which the contacts are represented in the instance. Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:n/a
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.telecom.period Short description Time period when the contact point was/is in use Definition Time period when the contact point was/is in use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() 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:N/A rim:./usablePeriod[type="IVL<TS>"] servd:./StartDate and ./EndDate
gender	Σ	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.gender Short description Gender Alternate names Geslacht Definition Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes. Requirements Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes. Comments The gender may not match the biological sex as determined by genetics, or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error. Data Type code Binding administrative-gender (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:PID-8 rim:player[classCode=PSN\|ANM and determinerCode=INSTANCE]/administrativeGender cda:.patient.administrativeGenderCode hcim-patient-v2.0.1-2015EN:NL-CM:0.1.9 hcim-patient-v3.0-2016EN:NL-CM:0.1.9 hcim-patient-v3.1-2017EN:NL-CM:0.1.9
birthDate	Σ	0..1	date	There are no (further) constraints on this element Element Id Patient.birthDate Short description Patients date of birth. The date of birth is mandatory for a patient. An incomplete date, e.g. only year or only year + month, is permitted. Alternate names Geboortedatum Definition The date of birth for the individual. Requirements Age of the individual drives many clinical processes. Comments At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternaty/infant care systems). Data Type date Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.10 hcim-patient-v3.0-2016EN:NL-CM:0.1.10 hcim-patient-v3.1-2017EN:NL-CM:0.1.10
deceased[x]	Σ ?!	0..1		There are no (further) constraints on this element Element Id Patient.deceased[x] Short description DeathIndicator/DateOfDeath Alternate names Overlijdensindicator/DatumOverlijden Definition Indicates if the individual is deceased or not. Requirements The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive. Comments If there's no value in the instance it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive. This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.32 hcim-patient-v3.0-2016EN:NL-CM:0.1.32 hcim-patient-v3.1-2017EN:NL-CM:0.1.32 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.33 hcim-patient-v3.0-2016EN:NL-CM:0.1.33 hcim-patient-v3.1-2017EN:NL-CM:0.1.33
deceasedBoolean			boolean	There are no (further) constraints on this element Data Type boolean
deceasedDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
address	Σ	0..*	nl-core-address	There are no (further) constraints on this element Element Id Patient.address Short description AddressInformation Alternate names AdresInformatie, Adresgegevens Definition There is a variety of postal address formats defined around the world. This format defines a superset that is the basis for all addresses around the world and adds all relevant components to express Dutch addresses. A Dutch Address is a proper FHIR Address. Systems that do not understand any of the extensions, will be able to render and work with a Dutch address. Dutch addresses make certain address parts separately communicable. These parts are required for use in true Dutch systems when dealing with Dutch addresses, but may not have value for international systems when information gets sent abroad. To have true compatibility an implementer SHOULD use the core Address parts as intended. To have addresses work for Dutch context, the implementer SHOULD in addition use the extension elements. The HCIM defines certain address types in the AdresSoortCodelijst. These do not all have a one to one mapping in the FHIR Address datatype. The following explains how to deal with that. HCIM Postal Address maps to Address.type 'postal'; HCIM Primary Home Address maps to Address.extension:official 'true' + Address.use 'home' + Address.use.extension 'HP'; HCIM Visit Address (Woon-/verblijfadres) maps to Address.use 'home' + Address.type 'physical' + Address.use.extension 'PHYS'; HCIM Temporary Address maps to Address.use 'temp'; HCIM Work Place Address maps to Address.use 'work'; HCIM Vacation Home Address maps to Address.type 'temp' + Address.use.extension 'HV'. If Address.type is "both" then this is to be understood as a dual purpose address (postal and physical). Systems that support importing it like this are encouraged to do so, otherwise they may need to import this as two separate addresses. Requirements May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification. Comments Note: address is for postal addresses, not physical locations. Data Type nl-core-address Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` nl-streetname-if-official-and-other-line-parts:Address.streetName in an official address SHALL have a value if one of houseNumber\|buildingNumberSuffix\|additionalLocator has a value (extension.where(url = 'http://fhir.nl/fhir/StructureDefinition/nl-core-address-official').where(value = true)).empty() or (line.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty().not() and (line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty().not())) Examples Example of a vacation home address { "extension": [ { "url": "http://fhir.nl/fhir/StructureDefinition/nl-core-address-official", "valueBoolean": false } ], "use": "temp", "_use": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-AD-use", "valueCode": "HV" } ] }, "line": [ "Binnenkant 12A Hoog" ], "_line": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString": "Binnenkant" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString": "12" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix", "valueString": "A" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID", "valueString": "Hoog" } ] } ], "city": "Amsterdam", "state": "NH", "postalCode": "1000AA", "country": "NLD" } Example of a primary home address { "extension": [ { "url": "http://fhir.nl/fhir/StructureDefinition/nl-core-address-official", "valueBoolean": true } ], "use": "home", "line": [ "Binnenkant to 10" ], "_line": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString": "Binnenkant" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator", "valueString": "to" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString": "10" } ] } ], "city": "Amsterdam", "state": "NH", "postalCode": "1001AA", "country": "NLD" } Mappings rim:n/a v2:XAD rim:AD servd:Address v2:PID-11 rim:addr cda:.addr hcim-address-v2.0.1-2015EN:NL-CM:0.1.4 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.4 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.1 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.4 hcim-patient-v3.0-2016EN:NL-CM:0.1.4 hcim-patient-v3.1-2017EN:NL-CM:0.1.4 hcim-payer-v1.2-2015EN:NL-CM:1.1.17 hcim-patient-v3.0-2016EN:NL-CM:0.1.17 hcim-patient-v3.1-2017EN:NL-CM:0.1.17
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.address.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
official		0..1	Extension(boolean)	There are no (further) constraints on this element Element Id Patient.address.extension:official Short description Mark an address as an 'officially registered' address. Alternate names extensions, user content, Markeer een adres als een 'officieel geregistreerd adres. Definition Mark an address as an 'officially registered' address. In Dutch context that means it is registered in the Basisregistratie persoonsgegevens (BRP) Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(boolean) Extension URL http://fhir.nl/fhir/StructureDefinition/nl-core-address-official Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-address-v2.0.1-2015EN:NL-CM:0.1.11 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.8
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.extension:official.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://fhir.nl/fhir/StructureDefinition/nl-core-address-official Mappings rim:n/a rim:N/A
valueBoolean		1..1	boolean	There are no (further) constraints on this element Element Id Patient.address.extension:official.value[x]:valueBoolean Short description true if part of an official registry. false if it is not Alternate names true als deze deel is van een officieel register. false indien dat niet het geval is Definition When the value is true, this address is marked to be part of an official registry (Dutch realm: BRP). When the value is false, this address is explicitly marked as not part of an official registry. Comments A stream of bytes, base64 encoded Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A rim:AD/@use[.='OR']
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.address.use Short description home \| work \| temp \| old - purpose of this address Definition Purpose of this address Requirements Allows an appropriate address to be chosen from a list of many. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one. Applications can assume that an address is current unless it explicitly says that it is temporary or old. Data Type code Binding address-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General home Mappings rim:n/a v2:XAD.7 rim:unique(./use) servd:./AddressPurpose hcim-address-v2.0.1-2015EN:NL-CM:0.1.11 hcim-address-v3.0-2016EN:NL-CM:0.1.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.8
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.address.use.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
AD_use		0..1	Extension	There are no (further) constraints on this element Element Id Patient.address.use.extension:AD_use Short description Further define the address use with the exact HCIM code. Alternate names extensions, user content, Precieze definiëring van adressoort op basis van exacte zib-code Definition Further define the address use with the exact HCIM code. Mostly relevant to distinguish between different types of temporasry addresses. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-AD-use Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:AD.use
type	Σ	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.address.type Short description postal \| physical \| both Definition Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both. Comments Note that FHIR strings may not exceed 1MB in size Data Type code Binding address-type (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General both Mappings rim:n/a v2:XAD.18 rim:unique(./use) vcard:address type parameter hcim-address-v2.0.1-2015EN:NL-CM:0.1.11 hcim-address-v3.0-2016EN:NL-CM:0.1.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.8
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.address.text Short description Text representation of the address Definition A full text representation of the address. Requirements A renderable, unencoded form. Comments Can provide both a text representation and parts. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 137 Nowhere Street, Erewhon 9132 Mappings rim:n/a v2:XAD.1 + XAD.2 + XAD.3 + XAD.4 + XAD.5 + XAD.6 rim:./formatted vcard:address label parameter
line	Σ	0..*	string	There are no (further) constraints on this element Element Id Patient.address.line Short description Street name, number, direction & P.O. Box etc. Definition This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information. Requirements home \| work \| temp \| old - purpose of this address. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 137 Nowhere Street Mappings rim:n/a v2:XAD.1 + XAD.2 (note: XAD.1 and XAD.2 have different meanings for a company address than for a person address) rim:AD.part[parttype = AL] vcard:street servd:./StreetAddress (newline delimitted)
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.address.line.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
streetName		0..1	Extension	There are no (further) constraints on this element Element Id Patient.address.line.extension:streetName Short description streetName Alternate names extensions, user content Definition Street name. If the address is a P.O. Box then the Dutch word "Postbus" shall be communicated. If the address is an answer number (mailing address where the receiver pays postage) then the Dutch word "Antwoordnummer" shall be communicated. Requirements Basisregistratie Persoonsgegevens 11.10 Straatnaam Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=STR] hcim-address-v2.0.1-2015EN:NL-CM:0.1.12 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.12 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.2 BRP:11.10 Straatnaam
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.line.extension:streetName.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.address.line.extension:streetName.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
houseNumber		0..1	Extension	There are no (further) constraints on this element Element Id Patient.address.line.extension:houseNumber Short description houseNumber Alternate names extensions, user content Definition The element houseNumber shall contain the house number. The house number may contains non-numeric parts that further determine the address, e.g. "23a", but only if the source system cannot discretely communicate those. House letter shall, if possible, be communicated through the element buildingNumberSuffix. Information such as "to" (house boats that do not have their own house number, but are across (tegenover) a house with a house number or "3 hoog achter" are not part of this attribute. This type of information is conveyed elsewhere in the Address datatype. Requirements Basisregistratie Persoonsgegevens 11.20 Huisnummer Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=BNR] hcim-address-v2.0.1-2015EN:NL-CM:0.1.13 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.13 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.12 BRP:11.20 Huisnummer
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.line.extension:houseNumber.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.address.line.extension:houseNumber.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
buildingNumbersuffix		0..*	Extension	There are no (further) constraints on this element Element Id Patient.address.line.extension:buildingNumbersuffix Short description buildingNumberSuffix Alternate names extensions, user content Definition HouseNumberLetter A letter following the house number as assigned by the municipal authorities. HouseNumberAddition The letters or signs needed to locate the mailbox, in addition to the house number and letter. Requirements Basisregistratie Persoonsgegevens 11.30 Huisletter 11.40 Huisnummertoevoeging 12.10 Locatieomschrijving Comments Export If a house letter as well as a house number addition is known: house letter first, followed by a space and finally the house letter suffix. If only a house letter is known send just that. No trailing space is required. If only a house letter suffix is known, communicate that with a leading space. Import If the value of buildingNumberSuffix contains no space, then the whole value is considered to be the house letter If the value of buildingNumberSuffix contains a space, then everything before the first space is considered to be the house letter, and the everything trailing the first space is considered to be the house number suffix Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=BNS] hcim-address-v2.0.1-2015EN:NL-CM:0.1.40 hcim-address-v2.0.1-2015EN:NL-CM:0.1.41 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.40 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.41 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.10 BRP:11.30 Huisletter BRP:11.40 Huisnummertoevoeging
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.line.extension:buildingNumbersuffix.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.address.line.extension:buildingNumbersuffix.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
unitID		0..1	Extension	There are no (further) constraints on this element Element Id Patient.address.line.extension:unitID Short description unitID Alternate names extensions, user content Definition Extra information such as the building name, building number, entrance, route number. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=UNID] hcim-address-v2.0.1-2015EN:NL-CM:0.1.28 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.28 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.7
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.line.extension:unitID.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.address.line.extension:unitID.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
additionalLocator		0..1	Extension	There are no (further) constraints on this element Element Id Patient.address.line.extension:additionalLocator Short description additionalLocator Alternate names extensions, user content Definition HouseNumberIndication - The indication used for addresses that do not consist of the usual street name and house number. Requirements Basisregistratie Persoonsgegevens 11.50 Aanduiding bij huisnummer Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=ADL] hcim-address-v2.0.1-2015EN:NL-CM:0.1.42 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.42 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.9 BRP:11.50 Aanduiding bij huisnummer
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.line.extension:additionalLocator.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.address.line.extension:additionalLocator.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
city	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.address.city Short description Name of city, town etc. Alternate names Municpality, Municipality, woonplaats Definition The name of the city, town, village or other community or delivery center. Requirements Basisregistratie Persoonsgegevens 11.70 Woonplaatsnaam Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General Erewhon Example city Den Haag Mappings rim:n/a v2:XAD.3 rim:AD.part[parttype = CTY] vcard:locality servd:./Jurisdiction hcim-address-v2.0.1-2015EN:NL-CM:0.1.14 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.14 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.3 BRP:11.70 Woonplaatsnaam
district	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.address.district Short description District name (aka county) Alternate names County, Gemeente Definition The name of the administrative area (county). Requirements Basisregistratie Persoonsgegevens 09.10 Gemeente van inschrijving Comments District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead. In a Dutch address this element is used for the population of a "gemeente" Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General Madison Example district Wateringen Mappings rim:n/a v2:XAD.9 rim:AD.part[parttype = CNT \| CPA] hcim-address-v2.0.1-2015EN:NL-CM:0.1.16 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.16 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.4 BRP:09.10 Gemeente van inschrijving
state	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.address.state Short description Sub-unit of country (abbreviations ok). Alternate names Province, Territory, Provincie Definition Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (i.e. US 2 letter state codes). For Dutch addresses this element should contain the "provincie" code Requirements Some (Dutch) cities have the same name in multiple provinces. Dutch examples include Bergen (Noord-Holland / Limburg) and Geesteren (Gelderland / Overijssel). Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples Example province ZH Mappings rim:n/a v2:XAD.4 rim:AD.part[parttype = STA] vcard:region servd:./Region
postalCode	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.address.postalCode Short description Postal code for area Alternate names Zip, Postcode Definition A postal code designating a region defined by the postal service. Comments Dutch postal codes have pattern '\d{4}[A-Z]{2}' so they do not have spaces. Systems can easily render postal codes with a space if necessary. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` nl-postal-code-pattern:Dutch postal code pattern 'nnnnAA' `(country in 'nl' \| 'nld' \| 'nederland').not() or matches('^\\d{4}[A-Z]{2}$')` Examples General 9132 Example postcode 9132AG Mappings rim:n/a v2:XAD.5 rim:AD.part[parttype = ZIP] vcard:code servd:./PostalIdentificationCode hcim-address-v2.0.1-2015EN:NL-CM:0.1.15 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.15 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.6 BRP:11.60 Postcode
country	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.address.country Short description Country (can be ISO 3166 3 letter code) Alternate names land Definition A country (code) for the address. Comments The FHIR datatype does not properly support coding the country using a CodeableConcept or Coding datatype. If the sender supports coded countries, it SHALL send the coded value using the code-specification extension under Address.country. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples Example country NLD Mappings rim:n/a v2:XAD.6 rim:AD.part[parttype = CNT] vcard:country servd:./Country hcim-address-v2.0.1-2015EN:NL-CM:0.1.17 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.17 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.5
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.address.country.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value), value.coding.system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
LandGBACodelijst		0..1	Extension(CodeableConcept)	There are no (further) constraints on this element Element Id Patient.address.country.extension:LandGBACodelijst Short description LandGBACode Alternate names extensions, user content, Bevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet. Definition Defines a more specific coded value for a code or string. Especially useful for FHIR's required ValueSets. These extensions are primarily used on codes bound to a required value set, where you would like to use a more specific code than the codes in the bounded value set. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(CodeableConcept) Extension URL http://nictiz.nl/fhir/StructureDefinition/code-specification Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.country.extension:LandGBACodelijst.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://nictiz.nl/fhir/StructureDefinition/code-specification Mappings rim:n/a rim:N/A
valueCodeableConcept		1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.address.country.extension:LandGBACodelijst.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type CodeableConcept Binding LandGBACodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
LandISOCodelijst		0..1	Extension(CodeableConcept)	There are no (further) constraints on this element Element Id Patient.address.country.extension:LandISOCodelijst Short description LandISOCode Alternate names extensions, user content, Bevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet. Definition Defines a more specific coded value for a code or string. Especially useful for FHIR's required ValueSets. These extensions are primarily used on codes bound to a required value set, where you would like to use a more specific code than the codes in the bounded value set. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(CodeableConcept) Extension URL http://nictiz.nl/fhir/StructureDefinition/code-specification Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.address.country.extension:LandISOCodelijst.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://nictiz.nl/fhir/StructureDefinition/code-specification Mappings rim:n/a rim:N/A
valueCodeableConcept		1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.address.country.extension:LandISOCodelijst.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type CodeableConcept Binding LandISOCodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.address.period Short description Time period when address was/is in use Definition Time period when address was/is in use. Requirements Allows addresses to be placed in historical context. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Examples General { "start": "2010-03-23", "end": "2010-07-01" } Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:XAD.12 / XAD.13 + XAD.14 rim:./usablePeriod[type="IVL<TS>"] servd:./StartDate and ./EndDate
maritalStatus		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.maritalStatus Short description MaritalStatus Alternate names BurgerlijkeStaat Definition This field contains a patient's most recent marital (civil) status. A person’s marital status according to the terms and definition in the Dutch civil code. Requirements Most, if not all systems capture it. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding BurgerlijkeStaatCodelijst (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-maritalstatus-v1.2.1-2015EN:NL-CM:7.9.2 hcim-maritalstatus-v3.0-2016EN:NL-CM:7.9.2 hcim-maritalstatus-v3.0-2017EN:NL-CM:7.9.2
multipleBirth[x]		0..1		There are no (further) constraints on this element Element Id Patient.multipleBirth[x] Short description MultipleBirthIndicator Alternate names Meerlingindicator Definition Indicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer). Requirements For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs. Comments Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in tripplets would be valueInteger=2 and the third born would have valueInteger=3 If a bool value was provided for this tripplets examle, then all 3 patient records would have valueBool=true (the ordering is not indicated). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.31 hcim-patient-v3.0-2016EN:NL-CM:0.1.31 hcim-patient-v3.1-2017EN:NL-CM:0.1.31
multipleBirthBoolean			boolean	There are no (further) constraints on this element Data Type boolean
multipleBirthInteger			integer	There are no (further) constraints on this element Data Type integer
photo		0..*	Attachment	There are no (further) constraints on this element Element Id Patient.photo Short description Image of the patient Definition Image of the patient. Requirements Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too. Comments When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Attachment". Data Type Attachment Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` att-1:It 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
contact		0..*	BackboneElement	There are no (further) constraints on this element Element Id Patient.contact Short description ContactPerson Alternate names Contactpersoon Definition Contacts are related persons in some way, but not all related persons are contacts. The HCIM ContactPerson is designed to deal with both related persons and contacts. An HCIM ContactPerson who is a contact, is expected to have an NL-CM:3.1.2 Role primary contact ('Eerste relatie/contactpersoon') or secondary contact ('Tweede relatie/contactpersoon'). See Patient.contact.relationship in slice 'role'. Requirements Need to track people you can contact about the patient. Comments Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-contactperson-v1.2-2015EN:NL-CM:3.1.1 hcim-contactperson-v3.0-2016EN:NL-CM:3.1.1 hcim-contactperson-v3.1-2017EN:NL-CM:3.1.1
relationship		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.contact.relationship Short description The kind of relationship Definition The nature of the relationship between the patient and the contact person. Requirements Used to determine which contact person is the most relevant to approach, depending on circumstances. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Sliced: Unordered, Open, by coding.system(Value) Binding HL7 v2 Value Set 0131 (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
relationship		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.contact.relationship:relationship Short description Relationship Alternate names Relatie Definition The nature of the relationship between the patient and the contact person. Requirements Used to determine which contact person is the most relevant to approach, depending on circumstances. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding RelatieCodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-contactperson-v1.2-2015EN:NL-CM:3.1.3 hcim-contactperson-v3.0-2016EN:NL-CM:3.1.3 hcim-contactperson-v3.1-2017EN:NL-CM:3.1.3
role		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.contact.relationship:role Short description Role Alternate names Rol Definition Expectation is to have at least one of primary contact ('Eerste relatie/contactpersoon') or secondary contact ('Tweede relatie/contactpersoon') 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. Data Type CodeableConcept Binding RolCodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-contactperson-v1.2-2015EN:NL-CM:3.1.2 hcim-contactperson-v3.0-2016EN:NL-CM:3.1.2 hcim-contactperson-v3.1-2017EN:NL-CM:3.1.2
name		0..1	nl-core-humanname	There are no (further) constraints on this element Element Id Patient.contact.name Short description NameInformation Alternate names Naamgegevens Definition A human's name with the ability to identify parts and usage. 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 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. A Dutch HumanName is a proper FHIR HumanName. Systems that do not understand any of the extensions, will be able to render and work with a Dutch name. Dutch names make certain name parts seaprately communicable. These parts are required for use in true Dutch systems when dealing with Dutch names, but may not have value for international systems when information gets sent abroad. To have true compatibility an implementer SHOULD use the core HumanName parts as intended. To have names work for Dutch context, the implementer SHOULD in addition use the extension elements. The extension elements cover birth name (NL: eigennaam / geslachtsnaam) and partner/spouse name. Both may have a prefix (NL: voorvoegsel). When a person marries, he or she may keep their own name, assume the partner name, append the partner name to their own name, or the other way around. For this reason, there are extensions for marking each part for what it is. Example: miss Irma Jongeneel marries mister de Haas and assumes the name Irma Jongeneel-de Haas family = "Jongeneel-de Haas" given = "Irma" humanname-own-name = "Jongeneel" humanname-partner-prefix = "de " humanname-partner-name = "Haas" Data Type nl-core-humanname Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` nl-core-humanname-1:if you specify a prefix for an own name then an own name is also expected `name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty().not()` nl-core-humanname-2:if you specify a voorvoegsel for a partner name then a partner name is also expected `name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-name').empty().not()` Examples General { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode": "NL4" } ], "use": "official", "family": "Jongeneel-de Haas", "_family": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString": "Jongeneel" }, { "url": "http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix", "valueString": "de" }, { "url": "http://hl7.org/fhir/StructureDefinition/humanname-partner-name", "valueString": "Haas" } ] }, "given": [ "Irma", "I." ], "_given": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier", "valueCode": "CL" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier", "valueCode": "IN" } ] } ] } Mappings rim:n/a v2:XPN rim:EN (actually, PN) servd:ProviderName v2:NK1-2 rim:name cda:n/a hcim-nameinformation-v2.0.1-2015EN:NL-CM:0.1.6 hcim-nameinformation-v3.0-2016EN:NL-CM:0.1.6 hcim-nameinformation-v1.0.1-2017EN:NL-CM:20.4.1 BRP:02 Naam hcim-contactperson-v1.2-2015EN:NL-CM:3.1.4 hcim-contactperson-v3.0-2016EN:NL-CM:3.1.4 hcim-contactperson-v3.1-2017EN:NL-CM:3.1.4
telecom		0..*	ContactPoint	There are no (further) constraints on this element Element Id Patient.contact.telecom Short description ContactInformation Alternate names Contactgegevens Definition A contact detail for the person, e.g. a telephone number or an email address. Requirements People have (primary) ways to contact them in some way such as phone, email. Comments Telecommunication data details (phone/email) is physically modeled in the HCIM Patient, which is why the telecommunication mappings appear to be coming from the HCIM Patient instead of the HCIM ContactPerson Data Type ContactPoint Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-contactperson-v1.2-2015EN:NL-CM:3.1.6 hcim-contactperson-v3.0-2016EN:NL-CM:3.1.6 hcim-contactperson-v3.1-2017EN:NL-CM:3.1.6
system	Σ	1..1	codeBinding	There are no (further) constraints on this element Element Id Patient.contact.telecom.system Short description phone \| fax \| email \| pager \| url \| sms \| other Definition Telecommunications form for contact point - what communications system is required to make use of the contact. Comments Note that FHIR strings may not exceed 1MB in size Data Type code Binding contact-point-system (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:XTN.3 rim:./scheme servd:./ContactPointType hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.5
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Patient.contact.telecom.value Short description TelephoneNumber / E-mailAddress Alternate names Telefoonnummer, EmailAdres Definition The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). Requirements Need to support legacy numbers that are not in a tightly controlled format. Comments Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:XTN.1 (or XTN.12) rim:./url servd:./Value hcim-patient-v2.0.1-2015EN:NL-CM:0.1.23 hcim-patient-v3.0-2016EN:NL-CM:0.1.23 hcim-patient-v3.1-2017EN:NL-CM:0.1.23 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.20 hcim-patient-v3.0-2016EN:NL-CM:0.1.20 hcim-patient-v3.1-2017EN:NL-CM:0.1.20
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.contact.telecom.use Short description NumberType / E-mailAddressType Alternate names NummerSoort, EmailSoort Definition Identifies the purpose for the contact point. Requirements Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one. Applications can assume that a contact is current unless it explicitly says that it is temporary or old. Data Type code Binding contact-point-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:XTN.2 - but often indicated by field rim:unique(./use) servd:./ContactPointPurpose hcim-patient-v2.0.1-2015EN:NL-CM:0.1.22 hcim-patient-v3.0-2016EN:NL-CM:0.1.22 hcim-patient-v3.1-2017EN:NL-CM:0.1.22 hcim-patient-v2.0.1-2015EN:NL-CM:0.1.19 hcim-patient-v3.0-2016EN:NL-CM:0.1.19 hcim-patient-v3.1-2017EN:NL-CM:0.1.19 hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.5 hcim-contactinformation-v1.0-2017EN:NL-CM:20.6.8
rank	Σ	0..1	positiveInt	There are no (further) constraints on this element Element Id Patient.contact.telecom.rank Short description Specify preferred order of use (1 = highest) Definition Specifies a preferred order in which to use a set of contacts. Contacts are ranked with lower values coming before higher values. Comments Note that rank does not necessarily follow the order in which the contacts are represented in the instance. Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:n/a
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.contact.telecom.period Short description Time period when the contact point was/is in use Definition Time period when the contact point was/is in use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() 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:N/A rim:./usablePeriod[type="IVL<TS>"] servd:./StartDate and ./EndDate
address		0..1	nl-core-address	There are no (further) constraints on this element Element Id Patient.contact.address Short description AddressInformation Alternate names AdresInformatie, Adresgegevens Definition There is a variety of postal address formats defined around the world. This format defines a superset that is the basis for all addresses around the world and adds all relevant components to express Dutch addresses. A Dutch Address is a proper FHIR Address. Systems that do not understand any of the extensions, will be able to render and work with a Dutch address. Dutch addresses make certain address parts separately communicable. These parts are required for use in true Dutch systems when dealing with Dutch addresses, but may not have value for international systems when information gets sent abroad. To have true compatibility an implementer SHOULD use the core Address parts as intended. To have addresses work for Dutch context, the implementer SHOULD in addition use the extension elements. The HCIM defines certain address types in the AdresSoortCodelijst. These do not all have a one to one mapping in the FHIR Address datatype. The following explains how to deal with that. HCIM Postal Address maps to Address.type 'postal'; HCIM Primary Home Address maps to Address.extension:official 'true' + Address.use 'home' + Address.use.extension 'HP'; HCIM Visit Address (Woon-/verblijfadres) maps to Address.use 'home' + Address.type 'physical' + Address.use.extension 'PHYS'; HCIM Temporary Address maps to Address.use 'temp'; HCIM Work Place Address maps to Address.use 'work'; HCIM Vacation Home Address maps to Address.type 'temp' + Address.use.extension 'HV'. If Address.type is "both" then this is to be understood as a dual purpose address (postal and physical). Systems that support importing it like this are encouraged to do so, otherwise they may need to import this as two separate addresses. Requirements Need to keep track where the contact person can be contacted per postal mail or visited. Comments Note: address is for postal addresses, not physical locations. Data Type nl-core-address Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` nl-streetname-if-official-and-other-line-parts:Address.streetName in an official address SHALL have a value if one of houseNumber\|buildingNumberSuffix\|additionalLocator has a value (extension.where(url = 'http://fhir.nl/fhir/StructureDefinition/nl-core-address-official').where(value = true)).empty() or (line.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty().not() and (line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty().not())) Examples Example of a vacation home address { "extension": [ { "url": "http://fhir.nl/fhir/StructureDefinition/nl-core-address-official", "valueBoolean": false } ], "use": "temp", "_use": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-AD-use", "valueCode": "HV" } ] }, "line": [ "Binnenkant 12A Hoog" ], "_line": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString": "Binnenkant" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString": "12" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix", "valueString": "A" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID", "valueString": "Hoog" } ] } ], "city": "Amsterdam", "state": "NH", "postalCode": "1000AA", "country": "NLD" } Example of a primary home address { "extension": [ { "url": "http://fhir.nl/fhir/StructureDefinition/nl-core-address-official", "valueBoolean": true } ], "use": "home", "line": [ "Binnenkant to 10" ], "_line": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString": "Binnenkant" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator", "valueString": "to" }, { "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString": "10" } ] } ], "city": "Amsterdam", "state": "NH", "postalCode": "1001AA", "country": "NLD" } Mappings rim:n/a v2:XAD rim:AD servd:Address v2:NK1-4 rim:addr cda:n/a hcim-address-v2.0.1-2015EN:NL-CM:0.1.4 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.4 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.1 hcim-contactperson-v1.2-2015EN:NL-CM:3.1.5 hcim-contactperson-v3.0-2016EN:NL-CM:3.1.5 hcim-contactperson-v3.1-2017EN:NL-CM:3.1.5
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
official		0..1	Extension(boolean)	There are no (further) constraints on this element Element Id Patient.contact.address.extension:official Short description Mark an address as an 'officially registered' address. Alternate names extensions, user content, Markeer een adres als een 'officieel geregistreerd adres. Definition Mark an address as an 'officially registered' address. In Dutch context that means it is registered in the Basisregistratie persoonsgegevens (BRP) Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(boolean) Extension URL http://fhir.nl/fhir/StructureDefinition/nl-core-address-official Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-address-v2.0.1-2015EN:NL-CM:0.1.11 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.8
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.extension:official.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://fhir.nl/fhir/StructureDefinition/nl-core-address-official Mappings rim:n/a rim:N/A
valueBoolean		1..1	boolean	There are no (further) constraints on this element Element Id Patient.contact.address.extension:official.value[x]:valueBoolean Short description true if part of an official registry. false if it is not Alternate names true als deze deel is van een officieel register. false indien dat niet het geval is Definition When the value is true, this address is marked to be part of an official registry (Dutch realm: BRP). When the value is false, this address is explicitly marked as not part of an official registry. Comments A stream of bytes, base64 encoded Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A rim:AD/@use[.='OR']
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.contact.address.use Short description home \| work \| temp \| old - purpose of this address Definition Purpose of this address Requirements Allows an appropriate address to be chosen from a list of many. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one. Applications can assume that an address is current unless it explicitly says that it is temporary or old. Data Type code Binding address-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General home Mappings rim:n/a v2:XAD.7 rim:unique(./use) servd:./AddressPurpose hcim-address-v2.0.1-2015EN:NL-CM:0.1.11 hcim-address-v3.0-2016EN:NL-CM:0.1.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.8
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.use.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
AD_use		0..1	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.use.extension:AD_use Short description Further define the address use with the exact HCIM code. Alternate names extensions, user content, Precieze definiëring van adressoort op basis van exacte zib-code Definition Further define the address use with the exact HCIM code. Mostly relevant to distinguish between different types of temporasry addresses. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-AD-use Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:AD.use
type	Σ	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.contact.address.type Short description postal \| physical \| both Definition Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both. Comments Note that FHIR strings may not exceed 1MB in size Data Type code Binding address-type (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General both Mappings rim:n/a v2:XAD.18 rim:unique(./use) vcard:address type parameter hcim-address-v2.0.1-2015EN:NL-CM:0.1.11 hcim-address-v3.0-2016EN:NL-CM:0.1.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.8
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.text Short description Text representation of the address Definition A full text representation of the address. Requirements A renderable, unencoded form. Comments Can provide both a text representation and parts. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 137 Nowhere Street, Erewhon 9132 Mappings rim:n/a v2:XAD.1 + XAD.2 + XAD.3 + XAD.4 + XAD.5 + XAD.6 rim:./formatted vcard:address label parameter
line	Σ	0..*	string	There are no (further) constraints on this element Element Id Patient.contact.address.line Short description Street name, number, direction & P.O. Box etc. Definition This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information. Requirements home \| work \| temp \| old - purpose of this address. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 137 Nowhere Street Mappings rim:n/a v2:XAD.1 + XAD.2 (note: XAD.1 and XAD.2 have different meanings for a company address than for a person address) rim:AD.part[parttype = AL] vcard:street servd:./StreetAddress (newline delimitted)
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
streetName		0..1	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:streetName Short description streetName Alternate names extensions, user content Definition Street name. If the address is a P.O. Box then the Dutch word "Postbus" shall be communicated. If the address is an answer number (mailing address where the receiver pays postage) then the Dutch word "Antwoordnummer" shall be communicated. Requirements Basisregistratie Persoonsgegevens 11.10 Straatnaam Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=STR] hcim-address-v2.0.1-2015EN:NL-CM:0.1.12 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.12 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.2 BRP:11.10 Straatnaam
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:streetName.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:streetName.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
houseNumber		0..1	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:houseNumber Short description houseNumber Alternate names extensions, user content Definition The element houseNumber shall contain the house number. The house number may contains non-numeric parts that further determine the address, e.g. "23a", but only if the source system cannot discretely communicate those. House letter shall, if possible, be communicated through the element buildingNumberSuffix. Information such as "to" (house boats that do not have their own house number, but are across (tegenover) a house with a house number or "3 hoog achter" are not part of this attribute. This type of information is conveyed elsewhere in the Address datatype. Requirements Basisregistratie Persoonsgegevens 11.20 Huisnummer Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=BNR] hcim-address-v2.0.1-2015EN:NL-CM:0.1.13 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.13 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.12 BRP:11.20 Huisnummer
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:houseNumber.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:houseNumber.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
buildingNumbersuffix		0..*	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:buildingNumbersuffix Short description buildingNumberSuffix Alternate names extensions, user content Definition HouseNumberLetter A letter following the house number as assigned by the municipal authorities. HouseNumberAddition The letters or signs needed to locate the mailbox, in addition to the house number and letter. Requirements Basisregistratie Persoonsgegevens 11.30 Huisletter 11.40 Huisnummertoevoeging 12.10 Locatieomschrijving Comments Export If a house letter as well as a house number addition is known: house letter first, followed by a space and finally the house letter suffix. If only a house letter is known send just that. No trailing space is required. If only a house letter suffix is known, communicate that with a leading space. Import If the value of buildingNumberSuffix contains no space, then the whole value is considered to be the house letter If the value of buildingNumberSuffix contains a space, then everything before the first space is considered to be the house letter, and the everything trailing the first space is considered to be the house number suffix Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=BNS] hcim-address-v2.0.1-2015EN:NL-CM:0.1.40 hcim-address-v2.0.1-2015EN:NL-CM:0.1.41 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.40 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.41 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.11 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.10 BRP:11.30 Huisletter BRP:11.40 Huisnummertoevoeging
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:buildingNumbersuffix.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:buildingNumbersuffix.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
unitID		0..1	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:unitID Short description unitID Alternate names extensions, user content Definition Extra information such as the building name, building number, entrance, route number. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=UNID] hcim-address-v2.0.1-2015EN:NL-CM:0.1.28 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.28 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.7
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:unitID.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:unitID.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
additionalLocator		0..1	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:additionalLocator Short description additionalLocator Alternate names extensions, user content Definition HouseNumberIndication - The indication used for addresses that do not consist of the usual street name and house number. Requirements Basisregistratie Persoonsgegevens 11.50 Aanduiding bij huisnummer Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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:ADXP[partType=ADL] hcim-address-v2.0.1-2015EN:NL-CM:0.1.42 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.42 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.9 BRP:11.50 Aanduiding bij huisnummer
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:additionalLocator.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator Mappings rim:n/a rim:N/A
valueString		0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.line.extension:additionalLocator.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
city	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.city Short description Name of city, town etc. Alternate names Municpality, Municipality, woonplaats Definition The name of the city, town, village or other community or delivery center. Requirements Basisregistratie Persoonsgegevens 11.70 Woonplaatsnaam Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General Erewhon Example city Den Haag Mappings rim:n/a v2:XAD.3 rim:AD.part[parttype = CTY] vcard:locality servd:./Jurisdiction hcim-address-v2.0.1-2015EN:NL-CM:0.1.14 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.14 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.3 BRP:11.70 Woonplaatsnaam
district	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.district Short description District name (aka county) Alternate names County, Gemeente Definition The name of the administrative area (county). Requirements Basisregistratie Persoonsgegevens 09.10 Gemeente van inschrijving Comments District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead. In a Dutch address this element is used for the population of a "gemeente" Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General Madison Example district Wateringen Mappings rim:n/a v2:XAD.9 rim:AD.part[parttype = CNT \| CPA] hcim-address-v2.0.1-2015EN:NL-CM:0.1.16 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.16 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.4 BRP:09.10 Gemeente van inschrijving
state	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.state Short description Sub-unit of country (abbreviations ok). Alternate names Province, Territory, Provincie Definition Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (i.e. US 2 letter state codes). For Dutch addresses this element should contain the "provincie" code Requirements Some (Dutch) cities have the same name in multiple provinces. Dutch examples include Bergen (Noord-Holland / Limburg) and Geesteren (Gelderland / Overijssel). Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples Example province ZH Mappings rim:n/a v2:XAD.4 rim:AD.part[parttype = STA] vcard:region servd:./Region
postalCode	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.postalCode Short description Postal code for area Alternate names Zip, Postcode Definition A postal code designating a region defined by the postal service. Comments Dutch postal codes have pattern '\d{4}[A-Z]{2}' so they do not have spaces. Systems can easily render postal codes with a space if necessary. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` nl-postal-code-pattern:Dutch postal code pattern 'nnnnAA' `(country in 'nl' \| 'nld' \| 'nederland').not() or matches('^\\d{4}[A-Z]{2}$')` Examples General 9132 Example postcode 9132AG Mappings rim:n/a v2:XAD.5 rim:AD.part[parttype = ZIP] vcard:code servd:./PostalIdentificationCode hcim-address-v2.0.1-2015EN:NL-CM:0.1.15 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.15 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.6 BRP:11.60 Postcode
country	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.address.country Short description Country (can be ISO 3166 3 letter code) Alternate names land Definition A country (code) for the address. Comments The FHIR datatype does not properly support coding the country using a CodeableConcept or Coding datatype. If the sender supports coded countries, it SHALL send the coded value using the code-specification extension under Address.country. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples Example country NLD Mappings rim:n/a v2:XAD.6 rim:AD.part[parttype = CNT] vcard:country servd:./Country hcim-address-v2.0.1-2015EN:NL-CM:0.1.17 hcim-addressinformation-v3.0-2016EN:NL-CM:0.1.17 hcim-addressinformation-v1.0-2017EN:NL-CM:20.5.5
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.contact.address.country.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value), value.coding.system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
LandGBACodelijst		0..1	Extension(CodeableConcept)	There are no (further) constraints on this element Element Id Patient.contact.address.country.extension:LandGBACodelijst Short description LandGBACode Alternate names extensions, user content, Bevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet. Definition Defines a more specific coded value for a code or string. Especially useful for FHIR's required ValueSets. These extensions are primarily used on codes bound to a required value set, where you would like to use a more specific code than the codes in the bounded value set. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(CodeableConcept) Extension URL http://nictiz.nl/fhir/StructureDefinition/code-specification Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.country.extension:LandGBACodelijst.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://nictiz.nl/fhir/StructureDefinition/code-specification Mappings rim:n/a rim:N/A
valueCodeableConcept		1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.contact.address.country.extension:LandGBACodelijst.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type CodeableConcept Binding LandGBACodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
LandISOCodelijst		0..1	Extension(CodeableConcept)	There are no (further) constraints on this element Element Id Patient.contact.address.country.extension:LandISOCodelijst Short description LandISOCode Alternate names extensions, user content, Bevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet. Definition Defines a more specific coded value for a code or string. Especially useful for FHIR's required ValueSets. These extensions are primarily used on codes bound to a required value set, where you would like to use a more specific code than the codes in the bounded value set. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(CodeableConcept) Extension URL http://nictiz.nl/fhir/StructureDefinition/code-specification Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.contact.address.country.extension:LandISOCodelijst.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://nictiz.nl/fhir/StructureDefinition/code-specification Mappings rim:n/a rim:N/A
valueCodeableConcept		1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.contact.address.country.extension:LandISOCodelijst.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type CodeableConcept Binding LandISOCodelijst (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.contact.address.period Short description Time period when address was/is in use Definition Time period when address was/is in use. Requirements Allows addresses to be placed in historical context. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Examples General { "start": "2010-03-23", "end": "2010-07-01" } Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:XAD.12 / XAD.13 + XAD.14 rim:./usablePeriod[type="IVL<TS>"] servd:./StartDate and ./EndDate
gender		0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.contact.gender Short description male \| female \| other \| unknown Definition Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes. Requirements Needed to address the person correctly. Comments Note that FHIR strings may not exceed 1MB in size Data Type code Binding administrative-gender (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:NK1-15 rim:player[classCode=PSN\|ANM and determinerCode=INSTANCE]/administrativeGender cda:n/a
organization		0..1	KoppeltaalReference(KoppeltaalOrganization)	Element Id Patient.contact.organization Short description A reference from one resource to another Definition A reference from one resource to another. 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. Data Type KoppeltaalReference(KoppeltaalOrganization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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
reference	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.organization.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 rim:.identifier
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
reference-identifier-resource-type		1..1	Extension	Element Id Patient.contact.organization.identifier.extension:reference-identifier-resource-type Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://ggz.koppeltaal.nl/fhir/StructureDefinition/reference-identifier-resource-type Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding identifier-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding identifier-type (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Patient.contact.organization.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.contact.organization.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
period		0..1	Period	There are no (further) constraints on this element Element Id Patient.contact.period Short description The period during which this contact person or organization is valid to be contacted relating to this patient Definition The period during which this contact person or organization is valid to be contacted relating to this patient. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() 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
animal	Σ ?!	0..0	BackboneElement	There are no (further) constraints on this element Element Id Patient.animal Short description This patient is known to be an animal (non-human) Definition This patient is known to be an animal. Requirements Many clinical systems are extended to care for animal patients as well as human. Comments The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal). Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:player[classCode=ANM] cda:n/a
communication		0..*	BackboneElement	There are no (further) constraints on this element Element Id Patient.communication Short description A list of Languages which may be used to communicate with the patient about his or her health Alternate names Taalvaardigheid Definition Languages which may be used to communicate with the patient about his or her health. Requirements If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest. Comments If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:LanguageCommunication cda:patient.languageCommunication hcim-languageproficiency-v3.1-2017EN:NL-CM:7.12.1
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.communication.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
languageProficiency		0..*	Extension(Complex)	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency Short description Proficiency level of the communication Alternate names extensions, user content Definition Proficiency level of the communication. Comments A mocked offical HL7 core extension from the R4 FHIR specification is used as extension. This extension is used to capture the three ZIB concepts: LanguageControlListening, LanguageControlSpeaking, LanguageControlReading. Data Type Extension(Complex) Extension URL http://nictiz.nl/fhir/StructureDefinition/patient-proficiency Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-languageproficiency-v3.1-2017EN:NL-CM:7.12.6 hcim-languageproficiency-v3.1-2017EN:NL-CM:7.12.7 hcim-languageproficiency-v3.1-2017EN:NL-CM:7.12.8
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
level		0..1	Extension	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.extension:level Short description The proficiency level of the communication Alternate names extensions, user content Definition How well the patient can communicate this communication (good, poor, etc.). Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.extension:level.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value level Mappings rim:n/a rim:N/A
valueCoding		0..1	CodingBinding	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.extension:level.value[x]:valueCoding Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type Coding Binding LanguageAbilityProficiency (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
type		0..*	Extension	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.extension:type Short description The proficiency type of the communication Alternate names extensions, user content Definition What type of communication for the proficiency (spoken, written, etc.). Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.extension:type.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value type Mappings rim:n/a rim:N/A
valueCoding		0..1	CodingBinding	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.extension:type.value[x]:valueCoding Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type Coding Binding LanguageAbilityMode (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://nictiz.nl/fhir/StructureDefinition/patient-proficiency Mappings rim:n/a rim:N/A
value[x]		0..0		There are no (further) constraints on this element Element Id Patient.communication.extension:languageProficiency.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
comment		0..*	Extension(string)	There are no (further) constraints on this element Element Id Patient.communication.extension:comment Short description Comment Alternate names extensions, user content, Toelichting Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(string) Extension URL http://nictiz.nl/fhir/StructureDefinition/Comment Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-languageproficiency-v3.1-2017EN:NL-CM:7.12.5
language		1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.communication.language Short description CommunicationLanguage Alternate names CommunicatieTaal Definition The language of communication. The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English. Requirements Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect. Comments The FHIR valueset http://hl7.org/fhir/valueset-languages.html is used instead of the ZIB valueset CommunicationLanguageCodelist. The FHIR valueset uses the codesystem urn:ietf:bcp:47 which includes the ISO-639-2 alpha codesystem used by the ZIB valueset. Data Type CodeableConcept Binding languages (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 hcim-languageproficiency-v3.1-2017EN:NL-CM:7.12.3
preferred		0..1	boolean	There are no (further) constraints on this element Element Id Patient.communication.preferred Short description Language preference indicator Definition Indicates whether or not the patient prefers this language (over other languages he masters up a certain level). 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. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:PID-15 rim:preferenceInd cda:.preferenceInd
generalPractitioner		0..1	KoppeltaalReference(KoppeltaalOrganization \| KoppeltaalPractitioner)	Element Id Patient.generalPractitioner Short description A reference from one resource to another Alternate names careProvider, Huisarts Definition A reference from one resource to another. 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. Data Type KoppeltaalReference(KoppeltaalOrganization \| KoppeltaalPractitioner) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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 hcim-healthcareprovider-v1.2-2015EN:NL-CM:17.2.1 hcim-healthcareprovider-v3.0-2016EN:NL-CM:17.2.1 hcim-healthcareprovider-v3.1-2017EN:NL-CM:17.2.1 hcim-healthprofessional-v1.2.1-2015EN:NL-CM:17.1.1 hcim-healthprofessional-v3.0-2016EN:NL-CM:17.1.1 hcim-healthprofessional-v3.1-2017EN:NL-CM:17.1.1
reference	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.generalPractitioner.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 rim:.identifier
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
reference-identifier-resource-type		1..1	Extension	Element Id Patient.generalPractitioner.identifier.extension:reference-identifier-resource-type Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://ggz.koppeltaal.nl/fhir/StructureDefinition/reference-identifier-resource-type Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding identifier-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding identifier-type (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Patient.generalPractitioner.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.generalPractitioner.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
managingOrganization	Σ	0..1	KoppeltaalReference(KoppeltaalOrganization)	Element Id Patient.managingOrganization Short description A reference from one resource to another Definition A reference from one resource to another. Requirements Need to know who recognizes this patient record, manages and updates it. 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. Data Type KoppeltaalReference(KoppeltaalOrganization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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
reference	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.managingOrganization.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 rim:.identifier
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
reference-identifier-resource-type		1..1	Extension	Element Id Patient.managingOrganization.identifier.extension:reference-identifier-resource-type Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://ggz.koppeltaal.nl/fhir/StructureDefinition/reference-identifier-resource-type Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding identifier-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding identifier-type (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Patient.managingOrganization.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.managingOrganization.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
link	Σ ?!	0..*	BackboneElement	There are no (further) constraints on this element Element Id Patient.link Short description Link to another patient resource that concerns the same actual person Definition Link to another patient resource that concerns the same actual patient. Requirements There are multiple usecases: 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. This element is labelled as a modifier because it may not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:outboundLink cda:n/a
other	Σ	0..1	KoppeltaalReference(KoppeltaalRelatedPerson \| KoppeltaalPatient)	Element Id Patient.link.other Short description A reference from one resource to another Definition A reference from one resource to another. 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. Data Type KoppeltaalReference(KoppeltaalRelatedPerson \| KoppeltaalPatient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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
reference	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.link.other.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id Patient.link.other.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 rim:.identifier
extension		0..*	Extension	There are no (further) constraints on this element Element Id Patient.link.other.identifier.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
reference-identifier-resource-type		1..1	Extension	Element Id Patient.link.other.identifier.extension:reference-identifier-resource-type Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://ggz.koppeltaal.nl/fhir/StructureDefinition/reference-identifier-resource-type Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Patient.link.other.identifier.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding identifier-use (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Patient.link.other.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding identifier-type (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Patient.link.other.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.link.other.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Patient.link.other.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Patient.link.other.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Patient.link.other.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	1..1	codeBinding	There are no (further) constraints on this element Element Id Patient.link.type Short description replaced-by \| replaces \| refer \| seealso - type of link Definition The type of link between this patient resource and another patient resource. Comments Note that FHIR strings may not exceed 1MB in size Data Type code Binding link-type (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:typeCode cda:n/a

HelseVest

HelseVest is a Norwegian health authority, responsible for the western region of Norway.

HelseVest Perioperative

The HelseVest Perioperative project aims to provide integrations covering the perioperative domain. Below is an example of a complex extension that was built for this project. This extension is used in the HelseVestProcedure profile for the registration of timestamps during a procedure (e.g. time of first cut or start of surgery). To make the extension as generic and reusable as possible, instead of building an extension for each type of timestamp, the type is specified in the extension itself by adding the following "child" extensions:

TimeType: the type of timestamp, e.g. time of start aneasthesia
StartDateTime: the actual timestamp
Comment: an optional text field for additional comments

Extension	0..*	Extension	There are no (further) constraints on this element Element Id Extension Short description Optional Extensions Element Definition Optional Extension Element - found in all resources. Data Type Extension Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
extension	0..*	Extension	Element Id Extension.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
TimeType	0..1	Extension	There are no (further) constraints on this element Element Id Extension.extension:TimeType Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url	1..1	uriFixed Value	Element Id Extension.extension:TimeType.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value TimeType Mappings rim:n/a rim:N/A
valueCoding	0..1	Coding	Element Id Extension.extension:TimeType.value[x]:valueCoding Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type Coding Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
StartDateTime	0..1	Extension	There are no (further) constraints on this element Element Id Extension.extension:StartDateTime Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url	1..1	uriFixed Value	Element Id Extension.extension:StartDateTime.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value StartDateTime Mappings rim:n/a rim:N/A
valueDateTime	0..1	dateTime	Element Id Extension.extension:StartDateTime.value[x]:valueDateTime Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
Comment	0..1	Extension	There are no (further) constraints on this element Element Id Extension.extension:Comment Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
url	1..1	uriFixed Value	Element Id Extension.extension:Comment.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value Comment Mappings rim:n/a rim:N/A
valueString	0..1	string	Element Id Extension.extension:Comment.value[x]:valueString Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
url	1..1	uriFixed Value	Element Id Extension.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. 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. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://hl7.org/fhir/StructureDefinition/procedure-timestamp Mappings rim:n/a rim:N/A
value[x]	0..0		There are no (further) constraints on this element Element Id Extension.value[x] Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Comments A stream of bytes, base64 encoded Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A

Below you can see the HelseVestProcedure profile that uses this extension.

Procedure		0..*	Procedure	There are no (further) constraints on this element Element Id Procedure Short description An action that is being or was performed on a patient Definition An action that is or was performed on a patient. This can be a physical intervention like an operation, or less invasive like counseling or hypnotherapy. Data Type Procedure Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1:If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.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 `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` pro-1:Reason not done is only permitted if notDone indicator is true `notDoneReason.empty() or notDone = true` Mappings rim:Entity. Role, or Act rim:Procedure[moodCode=EVN] w5:clinical.general
extension		0..*	Extension	Element Id Procedure.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
timestamp		0..*	Extension	Element Id Procedure.extension:timestamp Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Extension URL http://hl7.org/fhir/StructureDefinition/procedure-timestamp Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element Id Procedure.identifier Short description External Identifiers for this procedure Definition This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation). Requirements Need to allow connection to a wider workflow. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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 v2:Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4 rim:.id w5:id
definition	Σ	0..*	Reference(PlanDefinition \| ActivityDefinition \| HealthcareService)	There are no (further) constraints on this element Element Id Procedure.definition Short description Instantiates protocol or definition Definition A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this procedure. 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. Data Type Reference(PlanDefinition \| ActivityDefinition \| HealthcareService) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.outboundRelationship[typeCode=DEFN].target
basedOn	Σ	0..*	Reference(HelseVestProcedureRequest)	Element Id Procedure.basedOn Short description A request for this procedure Alternate names fulfills Definition A reference to a resource that contains details of the request for this procedure. 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. Data Type Reference(HelseVestProcedureRequest) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT, moodCode=RQO].code helsevest:Behandlingsnummer orbit:General.TreatmentIdentifier.TreatmentNumber dips:MEDTJENESTEID orplan:OperationID
partOf	Σ	0..*	Reference(Procedure \| Observation \| MedicationAdministration)	There are no (further) constraints on this element Element Id Procedure.partOf Short description Part of referenced event Alternate names container Definition A larger event of which this particular procedure is a component or step. Comments The MedicationAdministration has a partOf reference to Procedure, but this is not a circular reference. For a surgical procedure, the anesthesia related medicationAdministration is part of the procedure. For an IV medication administration, the procedure to insert the IV port is part of the medication administration. Data Type Reference(Procedure \| Observation \| MedicationAdministration) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Procedure.status Short description preparation \| in-progress \| suspended \| aborted \| completed \| entered-in-error \| unknown Definition A code specifying the state of the procedure. Generally this will be in-progress or completed state. Comments The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data Type code Binding event-status (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:statusCode w5:status
notDone	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element Id Procedure.notDone Short description True if procedure was not performed as scheduled Definition Set this to true if the record is saying that the procedure was NOT performed. Comments If true, it means the procedure did not occur as described. Typically it would be accompanied by attributes describing the type of activity. It might also be accompanied by body site information or time information (i.e. no procedure was done to the left arm or no procedure was done in this 2-year period). Specifying additional information such as performer, outcome, etc. is generally inappropriate. For example, it's not that useful to say "There was no appendectomy done at 12:03pm June 6th by Dr. Smith with a successful outcome" as it implies that there could have been an appendectomy done at any other time, by any other clinician or with any other outcome. This element is labeled as a modifier because it indicates that a procedure didn't happen. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Default value false Mappings rim:n/a rim:.actionNegationInd
notDoneReason	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.notDoneReason Short description Reason procedure was not performed Definition A code indicating why the procedure was not performed. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding procedure-not-performed-reason (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.reason.Observation.value
category	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.category Short description Classification of the procedure Definition A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure"). Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding procedure-category (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code w5:class
code	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.code Short description Identification of the procedure Alternate names type Definition The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy"). Requirements 0..1 to account for primarily narrative only resources. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding procedure-code (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:OBR-44/OBR-45 rim:.code w5:what
subject	Σ	1..1	Reference(http://hl7.no/fhir/StructureDefinition/LabPatientNorway)	Element Id Procedure.subject Short description Who the procedure was performed on Alternate names patient Definition The person, animal or group on which the procedure was performed. 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. Data Type Reference(http://hl7.no/fhir/StructureDefinition/LabPatientNorway) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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 rim:.participation[typeCode=SBJ].role w5:who.focus helsevest:PasientID orbit:Patient.CivilRegistrationNumber dips:FOEDSELSNR orplan:PatientID
context	Σ	0..1	Reference(Encounter \| EpisodeOfCare)	There are no (further) constraints on this element Element Id Procedure.context Short description Encounter or episode associated with the procedure Alternate names encounter Definition The encounter during which the procedure was performed. 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. Data Type Reference(Encounter \| EpisodeOfCare) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:PV1-19 rim:.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN] w5:context
performed[x]	Σ	0..1		There are no (further) constraints on this element Element Id Procedure.performed[x] Short description Date/Period the procedure was performed Definition The date(time)/period over which the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:OBR-7 rim:.effectiveTime w5:when.done
performedDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
performedPeriod			Period	There are no (further) constraints on this element Data Type Period
performer	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id Procedure.performer Short description The people who performed the procedure Definition Limited to 'real' people rather than equipment. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:.participation[typeCode=PRF]
role	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.performer.role Short description The role the actor was in Definition For example: surgeon, anaethetist, endoscopist. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding performer-role (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:Some combination of STF-18 / PRA-3 / PRT-4 / ROL-3 / ORC-12 / OBR-16 / PV1-7 / PV1-8 / PV1-9 / PV1-17 / OBX-25 rim:.functionCode
actor	Σ	1..1	Reference(Practitioner \| Organization \| Patient \| RelatedPerson \| Device)	There are no (further) constraints on this element Element Id Procedure.performer.actor Short description The reference to the practitioner Definition The practitioner who was involved in the procedure. Requirements A reference to Device supports use cases, such as pacemakers. 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. Data Type Reference(Practitioner \| Organization \| Patient \| RelatedPerson \| Device) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:ORC-19/PRT-5 rim:.role w5:who.actor
onBehalfOf		0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Procedure.performer.onBehalfOf Short description Organization the device or practitioner was acting for Definition The organization the device or practitioner was acting on behalf of. Requirements Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action. 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. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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
location	Σ	0..1	Reference(Location)	There are no (further) constraints on this element Element Id Procedure.location Short description Where the procedure happened Definition The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant. Requirements Ties a procedure to where the records are likely kept. 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. Data Type Reference(Location) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.participation[typeCode=LOC].role[classCode=SDLOC] w5:where
reasonCode	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.reasonCode Short description Coded reason procedure performed Definition The coded reason why the procedure was performed. This may be coded entity of some type, or may simply be present as text. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding procedure-reason (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.reasonCode w5:why
reasonReference	Σ	0..*	Reference(Condition \| Observation)	There are no (further) constraints on this element Element Id Procedure.reasonReference Short description Condition that is the reason the procedure performed Definition The condition that is the reason why the procedure was performed. Comments e.g. endoscopy for dilatation and biopsy, combination diagnosis and therapeutic. Data Type Reference(Condition \| Observation) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.reasonCode w5:why
bodySite	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.bodySite Short description Target body sites Definition Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding body-site (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:OBX-20 rim:.targetSiteCode
outcome	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.outcome Short description The result of procedure Definition The outcome of the procedure - did it resolve reasons for the procedure being performed? Comments If outcome contains narrative text only, it can be captured using the CodeableConcept.text. Data Type CodeableConcept Binding procedure-outcome (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.outboundRelationship[typeCode=OUT].target.text
report		0..*	Reference(DiagnosticReport)	There are no (further) constraints on this element Element Id Procedure.report Short description Any report resulting from the procedure Definition This could be a histology result, pathology report, surgical report, etc.. Comments There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports. Data Type Reference(DiagnosticReport) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN]
complication		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.complication Short description Complication following the procedure Definition Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues. Comments If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text. Data Type CodeableConcept Binding condition-code (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
complicationDetail		0..*	Reference(Condition)	There are no (further) constraints on this element Element Id Procedure.complicationDetail Short description A condition that is a result of the procedure Definition Any complications that occurred during the procedure, or in the immediate post-performance period. Requirements This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure. 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. Data Type Reference(Condition) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
followUp		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.followUp Short description Instructions for follow up Definition If the procedure required specific follow up - e.g. removal of sutures. The followup may be represented as a simple note, or could potentially be more complex in which case the CarePlan resource can be used. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding procedure-followup (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.outboundRelationship[typeCode=COMP].target[classCode=ACT, moodCode=INT].code
note		0..*	Annotation	There are no (further) constraints on this element Element Id Procedure.note Short description Additional information about the procedure Definition Any other notes about the procedure. E.g. the operative notes. Comments For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Data Type Annotation Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act v2:NTE rim:.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
focalDevice		0..*	BackboneElement	There are no (further) constraints on this element Element Id Procedure.focalDevice Short description Device changed in procedure Definition A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:.participation[typeCode=DEV].role[classCode=MANU]
action		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Procedure.focalDevice.action Short description Kind of change to device Definition The kind of change that happened to the device during the procedure. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding device-action (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="procedure device action"].value=:procedure device action codes
manipulated		1..1	Reference(Device)	There are no (further) constraints on this element Element Id Procedure.focalDevice.manipulated Short description Device that was changed Definition The device that was manipulated (changed) during the procedure. 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. Data Type Reference(Device) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.participation[typeCode=DEV].role[classCode=SDLOC]
usedReference		0..*	Reference(Device \| Medication \| Substance)	There are no (further) constraints on this element Element Id Procedure.usedReference Short description Items used during procedure Definition Identifies medications, devices and any other substance used as part of the procedure. Requirements Used for tracking contamination, etc. Comments For devices actually implanted or removed, use Procedure.device. Data Type Reference(Device \| Medication \| Substance) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (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 %resource.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:.participation[typeCode=DEV].role[classCode=MANU] or .participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)
usedCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Procedure.usedCode Short description Coded items used during the procedure Definition Identifies coded items that were used as part of the procedure. Comments For devices actually implanted or removed, use Procedure.device. Data Type CodeableConcept Binding device-kind (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:participation[typeCode=Dev].role[classCode=MANU]

HelseVest Prescription

The Helsevest Prescription project aims to provide integrations for medication prescription. The example below shows the MedicationStatement profile that was built for this project. It contains two extensions at the base profile level and a couple of extensions on the underlying elements. The prescriptionStatus extension on the status is an example of a Modifier extension as it changes the meaning of the element. Receiving systems should prioritise prescriptionStatus over status if it is present. When the prescriptionStatus is set to 'on-hold', MedicationStatement.status should be set to 'intended'.

Name	Flags	Card.	Type	Description & Constraints
MedicationStatement	I			KULE Prescribing profile. kuleprescribing-5: Reason not taken must be filled if wasNotTaken is true
authoredOn	S	1..1	Extension	URL: http://nictiz.nl/fhir/StructureDefinition/mp9-authored-on
drugUseType	S	..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-drug-use-type Binding: Legemiddelbruk (required)
identifier				Slice: Unordered, Open, by system
identifier (prescriptionInstance)	S	1..1		Prescription identifier
use				Fixed Value: official
system				Fixed Value: urn:oid:2.16.578.1.34.5.5
identifier (LIB)		..1
use				Fixed Value: secondary
system				Fixed Value: urn:oid:OID-FOR-LIBS-HERE.
identifier (eResept)		..1
use				Fixed Value: secondary
system				Fixed Value: urn:oid:OID-FOR-ERESEPT-HERE.
informationSource	S		Reference(Patient \| PractitionerNorway \| RelatedPerson)
status	S
prescriptionStatus	S	..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-prescription-status
valueCode				Binding: (unbound) (required)
wasNotTaken	S
reasonNotTaken	S
reasonForUse[x]	S			Binding: Bruksområde til etikett (required)
effectivePeriod	S		Period
start		1..
end
medicationReference	S		Reference(KULE Medication)
dosage	I			kuleprescribing-1: Dosage must include a freetext if no structured dosage is used kuleprescribing-3: Either detailed timing information or coded dosage information can be specified, but not both kuleprescribing-4: daysNotAdministeredAmount must always be used in combination with daysAdministeredAmount
calculationBasis	S	1..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-calculation-basis
valueCode				Binding: (unbound) (required)
daysAdministeredAmount	S	..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-days-administered-amount
daysNotAdministeredAmount	S	..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-days-not-administered-amount
shortDosage	S	..1	Extension	Dosage timing information expressed as a code URL: http://hl7.no/fhir/StructureDefinition/kule-short-dosage Binding: Coded dosage timing (required)
text	S
timing
administerAtSpecificTime	S	1..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-timing-exact
extension	S		Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-timing-interval Binding: Benevning tidsenhet (required)
repeat	I			kuleprescribing-2: Either specificTime or timePeriod can be specified, but not both
specificTime	S	..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-time-of-day
timePeriod	S	..1	Extension	URL: http://hl7.no/fhir/StructureDefinition/kule-timeperiod
dayOfWeek	S		Extension	URL: http://nictiz.nl/fhir/StructureDefinition/mp9-day-of-week Binding: http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.5.4--2015-04-01T00:00:00 (required)
asNeeded[x]		..0
site[x]	S
route	S
coding				Binding: Administrasjonsvei (required)
text		..0
quantityQuantity (SimpleQuantity)	S		SimpleQuantity	Binding: Enhet for dosering (required)
rate[x]	S			Slice: Unordered, Open, by @type
rate[x] (ratio)	S		Ratio
numerator				Binding: Måleenhet for legemidlers styrke (required)
denominator				Binding: Benevning tidsenhet (required)
rate[x] (range)	S		Range
low (SimpleQuantity)				Binding: Måleenhet for legemidlers styrke (required)
high (SimpleQuantity)				Binding: Måleenhet for legemidlers styrke (required)
Documentation for this format

Exercise

In this exercise you will continue with the Patient profile that you created in the Start Profiling module. If you did not follow this module, please create a new profile on Patient and complete the required fields in the Properties tab. Start by reading the case description. Here below are a couple of links that you may find useful during this exercise:

Download Forge (if you did not already do so)
FHIR extensions
Simplifier

Case description

Place of birth is mandatory
Optional opt-in for one or more clinical studies

Steps to follow

1. Simple extension

Visit Simplifier.net and the FHIR specification and search for a relevant extension for place of birth.
Found one? Download the XML and open it in Forge.
Or build your own extension in Forge...
Add the extension to your profile and make it mandatory.

2. Complex extension

Build a new extension in Forge for opt-in status.
Add three elements: clinical trial number (String), period of involvement (Period) and reason for enrollment (CodeableConcept).
For CodeableConcept you may use a fictive naming system.
Add the extension to your profile.

Feedback

We are always looking for ways to improve our products. The Profiling Academy was built using our own IG-editor in Simplifier. If you have any feedback on this module or on our Profiling Academy in general, please leave a comment in the Issue Tracker of the project.

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