eHealth Infrastructure (v2020.4)

StructureDefinition: ehealth-patient - Detailed Descriptions

Definitions for the ehealth-patient Profile.

1. Patient
Definition

Demographics and other administrative information about an individual or animal receiving care or other health-related services

Control0..*
Alternate NamesSubjectOfCare Client Resident
InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty())
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 (: contained.where(('#'+id in %resource.descendants().reference).not()).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())
2. Patient.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

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

3. Patient.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
4. Patient.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

5. Patient.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Max Binding: All Languages
Typecode
Comments

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

6. Patient.text
Definition

A human-readable narrative that contains a summary of the resource, and may 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.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

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

7. Patient.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

8. Patient.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Patient.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. Patient.extension:itcompetencelevel
SliceNameitcompetencelevel
Definition

Optional Extension Element - found in all resources

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(ITCompetenceLevel) (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing)
InvariantsDefined on this element
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())
10. Patient.extension:interpreterRequired
SliceNameinterpreterRequired
Definition

This Patient requires an interpreter to communicate healthcare information to the practitioner.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(Interpreter required) (Extension Type: boolean)
Comments

The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.

InvariantsDefined on this element
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())
11. Patient.extension:generalHealthCondition
SliceNamegeneralHealthCondition
Definition

An Extension

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(GeneralHealthCondition) (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing)
InvariantsDefined on this element
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())
12. Patient.extension:nameAndAddressProtection
SliceNamenameAndAddressProtection
Definition

An Extension

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(NameAndAddressProtection) (Extension Type: Period)
InvariantsDefined on this element
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())
13. Patient.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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

14. Patient.identifier
Definition

An identifier for this patient.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..*
TypeIdentifier
Must Supporttrue
Requirements

Patients are almost always assigned specific numerical identifiers.

SlicingThis element introduces a set of slices on Patient.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
15. Patient.identifier:dk-civil-registration-number
SliceNamedk-civil-registration-number
Definition

A technical identifier - identifies some entity uniquely and unambiguously. This identifier holds the social security number defined in a danish context

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1 This element is affected by the following invariants: ele-1
TypeIdentifier(DK CRN Identifier)
Requirements

Patients are almost always assigned specific numerical identifiers.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
16. Patient.active
Definition

Whether this patient record is in active use.

Control0..1
Typeboolean
Is Modifiertrue
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.

Default Valuetrue
17. Patient.name
Definition

A name associated with the individual.

Control0..*
TypeHumanName
Requirements

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

Comments

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.

18. Patient.telecom
Definition

A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

Control0..*
TypeContactPoint
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).

SlicingThis element introduces a set of slices on Patient.telecom. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ value
19. Patient.telecom:NemSMS
SliceNameNemSMS
Definition

A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

Control0..*
TypeContactPoint
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).

20. Patient.telecom:NemSMS.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
21. Patient.telecom:NemSMS.extension
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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on Patient.telecom.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
22. Patient.telecom:NemSMS.system
Definition

Telecommunications form for contact point - what communications system is required to make use of the contact.

Control1..1 This element is affected by the following invariants: cpt-2
BindingTelecommunications form for contact point
The codes SHALL be taken from ContactPointSystem
Typecode
Fixed Valueother
23. Patient.telecom:NemSMS.value
Definition

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

Control1..1
Typestring
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.

Fixed ValueNemSMS
24. Patient.telecom:NemSMS.use
Definition

Identifies the purpose for the contact point.

Control0..0
BindingUse of contact point
The codes SHALL be taken from ContactPointUse
Typecode
Is Modifiertrue
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.

25. Patient.telecom:NemSMS.rank
Definition

Specifies a preferred order in which to use a set of contacts. Contacts are ranked with lower values coming before higher values.

Control0..0
TypepositiveInt
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

26. Patient.telecom:NemSMS.period
Definition

Time period when the contact point was/is in use.

Control0..1
TypePeriod
27. Patient.telecom:eBoks
SliceNameeBoks
Definition

A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

Control0..*
TypeContactPoint
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).

28. Patient.telecom:eBoks.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
29. Patient.telecom:eBoks.extension
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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on Patient.telecom.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
30. Patient.telecom:eBoks.system
Definition

Telecommunications form for contact point - what communications system is required to make use of the contact.

Control1..1 This element is affected by the following invariants: cpt-2
BindingTelecommunications form for contact point
The codes SHALL be taken from ContactPointSystem
Typecode
Fixed Valueother
31. Patient.telecom:eBoks.value
Definition

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

Control1..1
Typestring
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.

Fixed ValueeBoks
32. Patient.telecom:eBoks.use
Definition

Identifies the purpose for the contact point.

Control0..0
BindingUse of contact point
The codes SHALL be taken from ContactPointUse
Typecode
Is Modifiertrue
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.

33. Patient.telecom:eBoks.rank
Definition

Specifies a preferred order in which to use a set of contacts. Contacts are ranked with lower values coming before higher values.

Control0..0
TypepositiveInt
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

34. Patient.telecom:eBoks.period
Definition

Time period when the contact point was/is in use.

Control0..1
TypePeriod
35. Patient.gender
Definition

Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

Control1..1
BindingThe gender of a person used for administrative purposes.
The codes SHALL be taken from AdministrativeGender
Typecode
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.

36. Patient.birthDate
Definition

The date of birth for the individual.

Control0..1
Typedate
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).

LOINC Code21112-8
37. Patient.deceased[x]
Definition

Indicates if the individual is deceased or not.

Control0..1
TypeChoice of: boolean, dateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifiertrue
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.

38. Patient.address
Definition

Addresses for the individual.

Control1..*
TypeAddress
Requirements

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

Comments

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

SlicingThis element introduces a set of slices on Patient.address. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ use
39. Patient.address:officialHomeAddress
SliceNameofficialHomeAddress
Definition

An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.

Control1..1 This element is affected by the following invariants: ele-1
TypeAddress(DanishAddress)
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
40. Patient.maritalStatus
Definition

This field contains a patient's most recent marital (civil) status.

Control0..1
BindingThe domestic partnership status of a person.
The codes SHALL be taken from Marital Status Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Most, if not all systems capture it.

41. Patient.multipleBirth[x]
Definition

Indicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer).

Control0..1
TypeChoice of: boolean, integer
[x] NoteSee Choice of Data Types for further information about how to use [x]
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).

42. Patient.photo
Definition

Image of the patient.

Control0..*
TypeAttachment
Requirements

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

43. Patient.contact
Definition

A contact party (e.g. guardian, partner, friend) for the patient.

Control0..*
TypeBackboneElement
Requirements

Need to track people you can contact about the patient.

Comments

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

InvariantsDefined on this element
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())
44. Patient.contact.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
45. Patient.contact.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Patient.contact.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
46. Patient.contact.extension:contactNote
SliceNamecontactNote
Definition

An Extension

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(PatientContactNote) (Extension Type: string)
InvariantsDefined on this element
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())
47. Patient.contact.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

48. Patient.contact.relationship
Definition

The nature of the relationship between the patient and the contact person.

Control0..*
BindingThe nature of the relationship between a patient and a contact person for that patient.
The codes SHALL be taken from v2 Contact Role; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

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

49. Patient.contact.name
Definition

A name associated with the contact person.

Control0..1
TypeHumanName
Requirements

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

50. Patient.contact.telecom
Definition

A contact detail for the person, e.g. a telephone number or an email address.

Control0..*
TypeContactPoint
Requirements

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

Comments

Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

51. Patient.contact.address
Definition

An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.

Control0..1 This element is affected by the following invariants: ele-1
TypeAddress(DanishAddress)
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
52. Patient.contact.gender
Definition

Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.

Control0..1
BindingThe gender of a person used for administrative purposes.
The codes SHALL be taken from AdministrativeGender
Typecode
Requirements

Needed to address the person correctly.

53. Patient.contact.organization
Definition

Organization on behalf of which the contact is acting or for which the contact is working.

Control0..1 This element is affected by the following invariants: pat-1
TypeReference(Organization)
Requirements

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

54. Patient.contact.period
Definition

The period during which this contact person or organization is valid to be contacted relating to this patient.

Control0..1
TypePeriod
55. Patient.animal
Definition

This patient is known to be an animal.

Control0..0
TypeBackboneElement
Is Modifiertrue
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).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
56. Patient.animal.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
57. Patient.animal.extension
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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

58. Patient.animal.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

59. Patient.animal.species
Definition

Identifies the high level taxonomic categorization of the kind of animal.

Control1..1
BindingThe species of an animal.
For example codes, see AnimalSpecies
TypeCodeableConcept
Requirements

Need to know what kind of animal.

Comments

If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).

60. Patient.animal.breed
Definition

Identifies the detailed categorization of the kind of animal.

Control0..1
BindingThe breed of an animal.
For example codes, see AnimalBreeds
TypeCodeableConcept
Requirements

May need to know the specific kind within the species.

Comments

Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.

61. Patient.animal.genderStatus
Definition

Indicates the current state of the animal's reproductive organs.

Control0..1
BindingThe state of the animal's reproductive organs.
For example codes, see GenderStatus
TypeCodeableConcept
Requirements

Gender status can affect housing and animal behavior.

62. Patient.communication
Definition

Languages which may be used to communicate with the patient about his or her health

Control0..*
TypeBackboneElement
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
63. Patient.communication.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
64. Patient.communication.extension
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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

65. Patient.communication.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

66. Patient.communication.language
Definition

The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English

Control1..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Max Binding: All Languages
TypeCodeableConcept
Requirements

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

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

67. Patient.communication.language.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
68. Patient.communication.language.extension
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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on Patient.communication.language.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
69. Patient.communication.language.coding
Definition

A reference to a code defined by a terminology system

Control0..*
TypeCoding
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.

70. Patient.communication.language.coding.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
71. Patient.communication.language.coding.extension
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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on Patient.communication.language.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
72. Patient.communication.language.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control0..1
Typeuri
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.

Fixed Valueurn:ietf:bcp:47
73. Patient.communication.language.coding.version
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.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
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.

74. Patient.communication.language.coding.code
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).

Control0..1
Typecode
Requirements

Need to refer to a particular code in the system.

75. Patient.communication.language.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

76. Patient.communication.language.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
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.

77. Patient.communication.language.text
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.

Control0..1
Typestring
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.

78. Patient.communication.preferred
Definition

Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

Control0..1
Typeboolean
Requirements

People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

Comments

This language is specifically identified for communicating healthcare information.

79. Patient.generalPractitioner
Definition

Patient's nominated care provider.

Control0..*
TypeReference(Organization | Practitioner)
Alternate NamescareProvider
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity 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.

80. Patient.managingOrganization
Definition

Organization that is the custodian of the patient record.

Control0..1
TypeReference(Organization)
Requirements

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

Comments

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

81. Patient.link
Definition

Link to another patient resource that concerns the same actual patient.

Control0..*
TypeBackboneElement
Is Modifiertrue
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'.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
82. Patient.link.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
83. Patient.link.extension
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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

84. Patient.link.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

85. Patient.link.other
Definition

The other patient resource that the link refers to.

Control1..1
TypeReference(Patient | RelatedPerson)
Comments

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

86. Patient.link.type
Definition

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

Control1..1
BindingThe type of link between this patient resource and another patient resource.
The codes SHALL be taken from LinkType
Typecode