| PatientPseudonymized (Patient) | C | | Patient | Element idPatient Short descriptionPatienten-Profil im Kontext der Pseudonymisierung. Alternate namesSubjectOfCare Client Resident DefinitionDemographics and other administrative information about an individual or animal receiving care or other health-related services.
Patient Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty() - dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() - dom-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-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty() - dom-6: A resource should have narrative for robust management
text.`div`.exists()
Mappings- rim: Entity. Role, or Act
- rim: Patient[classCode=PAT]
- cda: ClinicalDocument.recordTarget.patientRole
|
| id | S Σ | 1..1 | string | There are no (further) constraints on this element Element idPatient.id Short descriptionLogical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
string |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idPatient.meta Short descriptionMetadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Meta Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idPatient.implicitRules Short descriptionA set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.language Short descriptionLanguage of the resource content DefinitionThe base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
code BindingCommonLanguages (preferred) Binding extensionsConstraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| text | | 0..1 | Narrative | There are no (further) constraints on this element Element idPatient.text Short descriptionText summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Narrative Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| contained | | 0..* | Resource | There are no (further) constraints on this element Element idPatient.contained Short descriptionContained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Resource Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.modifierExtension Short descriptionExtensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| identifier | S Σ | 0..* | Identifier | Element idPatient.identifier Short descriptionAn identifier for this patient DefinitionAn identifier for this patient.
Patients are almost always assigned specific numerical identifiers.
Identifier SlicingUnordered, Open, by $this(Pattern) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- w5: FiveWs.identifier
- v2: PID-3
- rim: id
- cda: .id
|
| kvid10 | S Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idPatient.identifier:kvid10 Short descriptionAn identifier for this patient DefinitionAn identifier for this patient.
Patients are almost always assigned specific numerical identifiers.
Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- w5: FiveWs.identifier
- v2: PID-3
- rim: id
- cda: .id
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idPatient.identifier:kvid10.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.identifier:kvid10.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.identifier:kvid10.use Short descriptionusual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code BindingIdentifies the purpose for this identifier, if known .
IdentifierUse (required) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: N/A
- rim: Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.identifier:kvid10.type Short descriptionDescription of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
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.
CodeableConcept BindingA coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Identifier Type Codes (extensible) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: CX.5
- rim: Role.code or implied by context
|
| system | S Σ | 1..1 | uriPattern | Element idPatient.identifier:kvid10.system Short descriptionThe namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique.
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.
Identifier.system is always case sensitive.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Patternhttp://fhir.de/sid/gkv/kvid-10 Examples
Generalhttp://www.acme.com/identifiers/patient Mappings- v2: CX.4 / EI-2-4
- rim: II.root or Role.id.root
- servd: ./IdentifierType
|
| value | S Σ | 1..1 | string | There are no (further) constraints on this element Element idPatient.identifier:kvid10.value Short descriptionThe value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Examples
General123456 Mappings- 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 idPatient.identifier:kvid10.period Short descriptionTime period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use.
Period Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- 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 idPatient.identifier:kvid10.assigner Short descriptionOrganization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier.
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.
Reference(Organization) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- 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
|
| bloomfilter | S Σ | 0..1 | IdentifierBloomfilter | Element idPatient.identifier:bloomfilter Short descriptionAn identifier intended for computation DefinitionAn identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Patients are almost always assigned specific numerical identifiers.
IdentifierBloomfilter ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- w5: FiveWs.identifier
- v2: PID-3
- rim: id
- cda: .id
- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
- servd: Identifier
|
| active | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element idPatient.active Short descriptionWhether this patient's record is in active use DefinitionWhether this patient record is in active use.
Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.
It is often used to filter patient lists to exclude inactive patients
Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Need to be able to mark a patient record as not to be used because it was created in error.
If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
This resource is generally assumed to be active if no value is provided for the active element
boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- w5: FiveWs.status
- rim: statusCode
- cda: n/a
|
| name | Σ | 0..* | HumanName | There are no (further) constraints on this element Element idPatient.name Short descriptionA name associated with the patient DefinitionA name associated with the individual.
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.
HumanName Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-5, PID-9
- rim: name
- cda: .patient.name
|
| telecom | Σ | 0..* | ContactPoint | There are no (further) constraints on this element Element idPatient.telecom Short descriptionA contact detail for the individual DefinitionA contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
People have (primary) ways to contact them in some way such as phone, email.
A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
ContactPoint Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-13, PID-14, PID-40
- rim: telecom
- cda: .telecom
|
| gender | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.gender Short descriptionmale | female | other | unknown DefinitionAdministrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Needed for identification of the individual, in combination with (at least) name and birth date.
The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
code BindingThe gender of a person used for administrative purposes.
AdministrativeGender (required) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-8
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
- cda: .patient.administrativeGenderCode
|
| birthDate | Σ | 0..1 | date | There are no (further) constraints on this element Element idPatient.birthDate Short descriptionThe date of birth for the individual DefinitionThe date of birth for the individual.
Age of the individual drives many clinical processes.
At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).
date Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-7
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime
- cda: .patient.birthTime
- loinc: 21112-8
|
| deceased[x] | Σ ?! | 0..1 | | There are no (further) constraints on this element Element idPatient.deceased[x] Short descriptionIndicates if the individual is deceased or not DefinitionIndicates if the individual is deceased or not.
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.
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.
- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- 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
|
| deceasedBoolean | | | boolean | There are no (further) constraints on this element Data typeboolean |
| deceasedDateTime | | | dateTime | There are no (further) constraints on this element Data typedateTime |
| address | Σ | 0..* | Address | There are no (further) constraints on this element Element idPatient.address Short descriptionAn address for the individual DefinitionAn address for the individual.
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Patient may have multiple addresses with different uses or applicable periods.
Address Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-11
- rim: addr
- cda: .addr
|
| maritalStatus | | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.maritalStatus Short descriptionMarital (civil) status of a patient DefinitionThis field contains a patient's most recent marital (civil) status.
Most, if not all systems capture it.
CodeableConcept BindingThe domestic partnership status of a person.
Marital Status Codes (extensible) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-16
- rim: player[classCode=PSN]/maritalStatusCode
- cda: .patient.maritalStatusCode
|
| multipleBirth[x] | | 0..1 | | There are no (further) constraints on this element Element idPatient.multipleBirth[x] Short descriptionWhether patient is part of a multiple birth DefinitionIndicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- 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
|
| multipleBirthBoolean | | | boolean | There are no (further) constraints on this element Data typeboolean |
| multipleBirthInteger | | | integer | There are no (further) constraints on this element Data typeinteger |
| photo | | 0..* | Attachment | There are no (further) constraints on this element Element idPatient.photo Short descriptionImage of the patient DefinitionRequirementsMany EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Guidelines:
- Use id photos, not clinical photos.
- Limit dimensions to thumbnail.
- Keep byte count low to ease resource updates.
Attachment Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: OBX-5 - needs a profile
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc
- cda: n/a
|
| contact | C | 0..* | BackboneElement | There are no (further) constraints on this element Element idPatient.contact Short descriptionA contact party (e.g. guardian, partner, friend) for the patient DefinitionA contact party (e.g. guardian, partner, friend) for the patient.
Need to track people you can contact about the patient.
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.
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - pat-1: SHALL at least contain a contact's details or a reference to an organization
name.exists() or telecom.exists() or address.exists() or organization.exists()
Mappings- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
- cda: n/a
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idPatient.contact.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.contact.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.contact.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| relationship | | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.contact.relationship Short descriptionThe kind of relationship DefinitionThe nature of the relationship between the patient and the contact person.
Used to determine which contact person is the most relevant to approach, depending on circumstances.
CodeableConcept BindingThe nature of the relationship between a patient and a contact person for that patient.
PatientContactRelationship (extensible) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: NK1-7, NK1-3
- rim: code
- cda: n/a
|
| name | | 0..1 | HumanName | There are no (further) constraints on this element Element idPatient.contact.name Short descriptionA name associated with the contact person DefinitionA name associated with the contact person.
Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
HumanName Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: NK1-2
- rim: name
- cda: n/a
|
| telecom | | 0..* | ContactPoint | There are no (further) constraints on this element Element idPatient.contact.telecom Short descriptionA contact detail for the person DefinitionA contact detail for the person, e.g. a telephone number or an email address.
People have (primary) ways to contact them in some way such as phone, email.
Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
ContactPoint Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: NK1-5, NK1-6, NK1-40
- rim: telecom
- cda: n/a
|
| address | | 0..1 | Address | There are no (further) constraints on this element Element idPatient.contact.address Short descriptionAddress for the contact person DefinitionAddress for the contact person.
Need to keep track where the contact person can be contacted per postal mail or visited.
Address Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: NK1-4
- rim: addr
- cda: n/a
|
| gender | | 0..1 | codeBinding | There are no (further) constraints on this element Element idPatient.contact.gender Short descriptionmale | female | other | unknown DefinitionAdministrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Needed to address the person correctly.
code BindingThe gender of a person used for administrative purposes.
AdministrativeGender (required) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: NK1-15
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
- cda: n/a
|
| organization | C | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idPatient.contact.organization Short descriptionOrganization that is associated with the contact DefinitionOrganization on behalf of which the contact is acting or for which the contact is working.
For guardians or business related contacts, the organization is relevant.
Reference(Organization) ConditionsThe cardinality or value of this element may be affected by these constraints: pat-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: NK1-13, NK1-30, NK1-31, NK1-32, NK1-41
- rim: scoper
- cda: n/a
|
| period | | 0..1 | Period | There are no (further) constraints on this element Element idPatient.contact.period Short descriptionThe period during which this contact person or organization is valid to be contacted relating to this patient DefinitionThe period during which this contact person or organization is valid to be contacted relating to this patient.
Period Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: effectiveTime
- cda: n/a
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| communication | | 0..* | BackboneElement | There are no (further) constraints on this element Element idPatient.communication Short descriptionA language which may be used to communicate with the patient about his or her health DefinitionA language which may be used to communicate with the patient about his or her health.
If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
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.
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: LanguageCommunication
- cda: patient.languageCommunication
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idPatient.communication.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.communication.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.communication.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| language | | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idPatient.communication.language Short descriptionThe language which can be used to communicate with the patient about his or her health DefinitionThe ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
CodeableConcept BindingCommonLanguages (preferred) Binding extensionsConstraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-15, LAN-2
- rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code
- cda: .languageCode
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| preferred | | 0..1 | boolean | There are no (further) constraints on this element Element idPatient.communication.preferred Short descriptionLanguage preference indicator DefinitionIndicates whether or not the patient prefers this language (over other languages he masters up a certain level).
People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
This language is specifically identified for communicating healthcare information.
boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-15
- rim: preferenceInd
- cda: .preferenceInd
|
| generalPractitioner | | 0..* | Reference(Organization | Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idPatient.generalPractitioner Short descriptionPatient's nominated primary care provider Alternate namescareProvider DefinitionPatient's nominated care provider.
This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.
Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.
Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
Reference(Organization | Practitioner | PractitionerRole) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PD1-4
- rim: subjectOf.CareEvent.performer.AssignedEntity
- cda: n/a
|
| managingOrganization | Σ | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idPatient.managingOrganization Short descriptionOrganization that is the custodian of the patient record DefinitionOrganization that is the custodian of the patient record.
Need to know who recognizes this patient record, manages and updates it.
There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
Reference(Organization) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: scoper
- cda: .providerOrganization
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| link | Σ ?! | 0..* | BackboneElement | There are no (further) constraints on this element Element idPatient.link Short descriptionLink to another patient resource that concerns the same actual person DefinitionLink to another patient resource that concerns the same actual patient.
There are multiple use cases:
- Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
- Distribution of patient information across multiple servers.
There is no assumption that linked patient records have mutual links.
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: outboundLink
- cda: n/a
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idPatient.link.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.link.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idPatient.link.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| other | Σ | 1..1 | Reference(Patient | RelatedPerson) | There are no (further) constraints on this element Element idPatient.link.other Short descriptionThe other patient or related person resource that the link refers to DefinitionThe other patient resource that the link refers to.
Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
Reference(Patient | RelatedPerson) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: PID-3, MRG-1
- rim: id
- cda: n/a
|
| type | Σ | 1..1 | codeBinding | There are no (further) constraints on this element Element idPatient.link.type Short descriptionreplaced-by | replaces | refer | seealso DefinitionThe type of link between this patient resource and another patient resource.
code BindingThe type of link between this patient resource and another patient resource.
LinkType (required) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |