Usage Note: This will usually be a GUID assigned by the sending application.

The pronouns to use when referring to an individual in verbal or written communication

Usage Note: This is a pre-adoption of an HL7 extension, http://hl7.org/fhir/StructureDefinition/individual-pronouns in R5

Conformance Rule: This will generally be an OID of the form [Vendor OID].[Application Instance node].1.Suggested format: A branch “.1” is appended to create a unique namespace for the Patient ID.

Conformance Rule: This is the OID representing the jurisdictional identifier.

If identifier.system is urn:ietf:rfc:3986, then the identifier.value must be a full URI (e.g. start with a scheme).

Conformance Rule: This is the patient's jurisdictional health number

If the value is a full URI, then the system must be urn:ietf:rfc:3986.

Usage Note: This may be referred to as the Preferred name in some EMRs - this would map to "usual". Usage Note: "Official" use should always be present. "Usual" should be used for preferred when this name is populated as a separate field in the EMR.

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

Usage Note: This data is most often captured as a single data element in the EMR. This can also be considered as the Recorded Sex or Gender, that is introduced as an extension in R5. (http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender) which will map into this data element. This extension is not used at this point in time. The gender field in the EMRs tend to represent sex at birth, or admin sex or chromosomal sex. Typically this comes from a birth certificate, OHIP/JHN passport, etc - known government identification

Usage Note: When gender has a value of "other" or unknown", systems may be capable of specifying the "Sex for Clinical Use" which an HL7 extension introduced for R5 (http://hl7.org/fhir/StructureDefinition/patient-sexForClinicalUse). This field may be recorded as part of the lab, observation or any other resource where this context is appropriate.

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.

Usage Note: At least an estimated year should be provided as a guess if the real DOB is unknown.

Usage Note: There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

Usage Note: Either the identifier or reference may be used.

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.