Canadian Baseline
1.2.0 - CI Build

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions

## Resource Profile: Practitioner Profile (Provider Registry)

Official URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner-registry | Version: 1.2.0
Draft as of 2024-08-09 | Computable Name: PractitionerProfileRegistry

Proposed constraints and extensions on the Practitioner Resource for use by Provider Registry systems

# CA Baseline Practitioner Profile for Registries

> While the CA Baseline relies on the existing extensible value set for identifier.type (from the base FHIR Spec) - some Canadian Jurisdictions have published the values that are extensions on that value set. Review of the Ontario Provider Registry Identifier.Type ValueSet.identified that the following Ontario specific identifier type codes may be used from the http://ehealthontario.ca/fhir/CodeSystem/ppr-organization-identifier-type code system: LHIN (Local Health Integration Network), MNI (Master Numbering Index), LSS (Lab Services Licensing System, CNUM (Corporate Number), BNUM (Business Number), AC (Accreditation Number).
> The CA Baseline is asking other jurisdictions or implementers to provide feedback if other values are being used for identifier.type not already discussed in this profile

> For Practitioner.qualification, slicing has been maintained to demonstrate that there are some registries supporting hybridized registry/eReferral use cases that utilize a different code system (HealthcareProviderRoleType) from the QualifiedRoleType that was incorporated by many HL7 V3 implementations. This separation based on use case and age of implementation remains a challenge in the Canadian ecosystem, and has persisted in part due to the challenges some registry assets face in consuming the longer character lengths present in the SNOMED CT CA HealthcareProviderRoleType value set. Until practices are more standardized or a resolution is in place regarding the disparate use of these two code systems, implementers are cautioned that the CA Baseline's use of these code systems and value sets still may change.
> The CA Baseline is asking implementers to provide feedback on the value sets and code systems they are expecting to utilize as they transition to FHIR .

> Feedback can be provided through the Simplifier issue log for this profile.

This Practitioner profile sets minimum expectations for the Practitioner resource to record, search and fetch demographics and other administrative information about a person who is directly or indirectly involved in the provisioning of healthcare.

This profile further constrains the general purpose Practitioner profile and is intended to be used by Provider or Healthcare Directory systems.

## Differences from US Core

Note: This profile was generated from HL7 StructureDefinition on 2020-02-19 and constrained during a review of US Core against Canadian sources.

## Mandatory Data Elements

All elements or attributes defined in FHIR have cardinality as part of their definition - a minimum number of required appearances and a maximum number.

Most elements in FHIR specification have a minimum cardinality of 0, which means that they may be missing from a resource when it is exchanged between systems.

Required elements:

- a identifier
- a practitioner name

In addition to that, some optional elements (e.g., Practitioner.qualification) have required components that MUST be present if that optional element is provided.

### Data Absent Reason

In situations where the minimum cardinality of an element or attribute is 1 and information is missing and the Responder knows the precise reason for the absence of data, Responders SHALL send the reason for the missing information using values (such as NullFlavor) from the value set where they exist or using the DataAbsentReason extension.

## Must Support Data Elements

Some elements are labeled as MustSupport meaning that implementations that produce or consume resources SHALL provide "support" for the element in some meaningful way (see Must Support definition).

Following elements are marked as Must Support in the Practitioner profile to aid record matching in databases with many pediatric records.

Must Support elements:

- an identifier
- a practitioner name
- contact detail (e.g. a telephone number or an email address)
- a birth date

## Extensions

### Deceased Extension

This Practitioner profile contains optional deceased extension to indicate if a practitioner is deceased or not.

This extension was previously labeled as a modifier extension (because of its potential impacts on clinical processes if the practitioner is marked deceased), but was removed after further discussion on the nuances of making something a modifierExtension vs regular extension if it was expected to be picked up by registry implementation guides that collect deceased practitioner information but may or may not use it in ways that would align to HL7 FHIR R4 definition and expectations for modifierExtension.

Implementers should recognize that the determination of whether this should be considered a modifierExtension is ongoing. Since Modifier Extensions should have extreme caution in their application and are further nuanced by the use cases in the implementing registry systems, this extension has been shifted back to a regular extension to align to use in existing implementations. Implementers who are considering using this extension in their guidance might consider applying a Must Support flag on the extension, but those treating wanting to re-create it as a modifier extension are required to review the [FHIR Guidance on Modifier Extensions])(https://www.hl7.org/fhir/R4/extensibility.html#modifierExtension) before including this extension in their profile. Implementers should also be aware of the Practitioner.deceased[x] R5 concept and that the CA Baseline is monitoring changes in the element to determine if the approach to this extension requires a shift.

## Usage Note

This Practitioner profile is intended to provide a foundation for a central or distributed Provider or Healthcare Directory. Additional work flow components and elements may be required for a particular implementation.

Usages:

- This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Practitioner |  | 0..* | PractitionerProfile | Practitioner Profile
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:deceased |  | 0..1 | boolean, date | Indicates if the individual is deceased or not. URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..* | IdentifierCABaseline | An identifier for the person as this agent
name | S Σ C | 1..* | HumanName | The name(s) associated with the practitioner Constraints: ca-baseline-practitioner-name
use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
telecom | S Σ | 0..* | ContactPoint | A contact detail for the practitioner (that apply to all roles)
birthDate | S Σ | 0..1 | date | The date on which the practitioner was born
qualification |  | 0..* | BackboneElement | Certification, licenses, or training pertaining to the provision of care
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | CodeableConcept | Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:All Slices |  |  |  | Content/Rules for all slices
system | Σ | 1..1 | uri | Identity of the terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system
coding:Registry | Σ | 0..* | Coding | Code defined by a terminology system
system | Σ | 1..1 | uri | QualifiedRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scpqual
code | Σ | 1..1 | code | Symbol in syntax defined by the system
coding:eReferral | Σ | 0..* | Coding | Code defined by a terminology system
system | Σ | 1..1 | uri | HealthcareProviderRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scptype
code | Σ | 1..1 | code | Symbol in syntax defined by the system
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Practitioner.name.use | Base | required | NameUse | 📍4.0.1 | FHIR Std.
Practitioner.qualification.​code | Base | example | v2 table 0360, Version 2.7 | 📦0360 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-practitioner-name | error | Practitioner.name | Either name.given and/or name.family SHALL be present or a Data Absent Reason Extension SHALL be present | `(family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()`
dom-2 | error | Practitioner | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Practitioner | 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 | error | Practitioner | 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 | error | Practitioner | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Practitioner | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from PractitionerProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Practitioner |  | 0..* | PractitionerProfile | Practitioner Profile
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:deceased |  | 0..1 | boolean, date | Indicates if the individual is deceased or not. URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
identifier | S | 1..* | IdentifierCABaseline | An identifier for the person as this agent
name | S | 1..* | HumanName | The name(s) associated with the practitioner
telecom | S | 0..* | ContactPoint | A contact detail for the practitioner (that apply to all roles)
address |  |  |  |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:preferred |  | 0..1 | boolean | HL7 Preferred Address Flag extension URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred
birthDate | S | 0..1 | date | The date on which the practitioner was born
qualification |  | 0..* | BackboneElement | Certification, licenses, or training pertaining to the provision of care
code |  |  |  |
Slices for coding |  | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:All Slices |  |  |  | Content/Rules for all slices
system |  | 1..1 | uri | Identity of the terminology system
code |  | 1..1 | code | Symbol in syntax defined by the system
coding:Registry |  | 0..* | Coding | Code defined by a terminology system
system |  | 1..1 | uri | QualifiedRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scpqual
coding:eReferral |  | 0..* | Coding | Code defined by a terminology system
system |  | 1..1 | uri | HealthcareProviderRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scptype
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Practitioner |  | 0..* | PractitionerProfile | Practitioner Profile
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:deceased |  | 0..1 | boolean, date | Indicates if the individual is deceased or not. URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..* | IdentifierCABaseline | An identifier for the person as this agent
active | Σ | 0..1 | boolean | Whether this practitioner's record is in active use
name | S Σ C | 1..* | HumanName | The name(s) associated with the practitioner Constraints: ca-baseline-practitioner-name
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text | Σ | 0..1 | string | Text representation of the full name
family | Σ C | 0..1 | string | Family name (often called 'Surname')
given | Σ C | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period | Σ | 0..1 | Period | Time period when name was/is in use
telecom | S Σ | 0..* | ContactPoint | A contact detail for the practitioner (that apply to all roles)
address | Σ | 0..* | Address | Address(es) of the practitioner that are not role specific (typically home address)
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:preferred |  | 0..1 | boolean | HL7 Preferred Address Flag extension URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | Σ | 0..1 | string | Postal code for area Example General: 9132
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code)
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
gender | Σ | 0..1 | code | male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate | S Σ | 0..1 | date | The date on which the practitioner was born
photo |  | 0..* | Attachment | Image of the person
qualification |  | 0..* | BackboneElement | Certification, licenses, or training pertaining to the provision of care
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
identifier |  | 0..* | Identifier | An identifier for this qualification for the practitioner
code |  | 1..1 | CodeableConcept | Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
coding:Registry | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | QualifiedRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scpqual
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
coding:eReferral | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | HealthcareProviderRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scptype
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
period |  | 0..1 | Period | Period during which the qualification is valid
issuer |  | 0..1 | Reference(Organization) | Organization that regulates and issues the qualification
communication |  | 0..* | CodeableConcept | A language the practitioner can use in patient communication Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Practitioner.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Practitioner.name.use | Base | required | NameUse | 📍4.0.1 | FHIR Std.
Practitioner.address.​use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Practitioner.address.​type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Practitioner.gender | Base | required | AdministrativeGender | 📍4.0.1 | FHIR Std.
Practitioner.qualification.​code | Base | example | v2 table 0360, Version 2.7 | 📦0360 | FHIR Std.
Practitioner.communication | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-practitioner-name | error | Practitioner.name | Either name.given and/or name.family SHALL be present or a Data Absent Reason Extension SHALL be present | `(family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()`
dom-2 | error | Practitioner | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Practitioner | 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 | error | Practitioner | 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 | error | Practitioner | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Practitioner | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from PractitionerProfile

Summary

Mandatory: 2 elements(4 nested mandatory elements)
Must-Support: 4 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

- Identifier DataType Profile (CA Baseline) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-identifier)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
- http://hl7.org/fhir/StructureDefinition/iso21090-preferred

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Practitioner.qualification.code.coding

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Practitioner |  | 0..* | PractitionerProfile | Practitioner Profile
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:deceased |  | 0..1 | boolean, date | Indicates if the individual is deceased or not. URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..* | IdentifierCABaseline | An identifier for the person as this agent
name | S Σ C | 1..* | HumanName | The name(s) associated with the practitioner Constraints: ca-baseline-practitioner-name
use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
telecom | S Σ | 0..* | ContactPoint | A contact detail for the practitioner (that apply to all roles)
birthDate | S Σ | 0..1 | date | The date on which the practitioner was born
qualification |  | 0..* | BackboneElement | Certification, licenses, or training pertaining to the provision of care
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | CodeableConcept | Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:All Slices |  |  |  | Content/Rules for all slices
system | Σ | 1..1 | uri | Identity of the terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system
coding:Registry | Σ | 0..* | Coding | Code defined by a terminology system
system | Σ | 1..1 | uri | QualifiedRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scpqual
code | Σ | 1..1 | code | Symbol in syntax defined by the system
coding:eReferral | Σ | 0..* | Coding | Code defined by a terminology system
system | Σ | 1..1 | uri | HealthcareProviderRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scptype
code | Σ | 1..1 | code | Symbol in syntax defined by the system
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Practitioner.name.use | Base | required | NameUse | 📍4.0.1 | FHIR Std.
Practitioner.qualification.​code | Base | example | v2 table 0360, Version 2.7 | 📦0360 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-practitioner-name | error | Practitioner.name | Either name.given and/or name.family SHALL be present or a Data Absent Reason Extension SHALL be present | `(family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()`
dom-2 | error | Practitioner | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Practitioner | 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 | error | Practitioner | 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 | error | Practitioner | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Practitioner | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from PractitionerProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Practitioner |  | 0..* | PractitionerProfile | Practitioner Profile
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:deceased |  | 0..1 | boolean, date | Indicates if the individual is deceased or not. URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
identifier | S | 1..* | IdentifierCABaseline | An identifier for the person as this agent
name | S | 1..* | HumanName | The name(s) associated with the practitioner
telecom | S | 0..* | ContactPoint | A contact detail for the practitioner (that apply to all roles)
address |  |  |  |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:preferred |  | 0..1 | boolean | HL7 Preferred Address Flag extension URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred
birthDate | S | 0..1 | date | The date on which the practitioner was born
qualification |  | 0..* | BackboneElement | Certification, licenses, or training pertaining to the provision of care
code |  |  |  |
Slices for coding |  | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:All Slices |  |  |  | Content/Rules for all slices
system |  | 1..1 | uri | Identity of the terminology system
code |  | 1..1 | code | Symbol in syntax defined by the system
coding:Registry |  | 0..* | Coding | Code defined by a terminology system
system |  | 1..1 | uri | QualifiedRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scpqual
coding:eReferral |  | 0..* | Coding | Code defined by a terminology system
system |  | 1..1 | uri | HealthcareProviderRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scptype
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Practitioner |  | 0..* | PractitionerProfile | Practitioner Profile
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:deceased |  | 0..1 | boolean, date | Indicates if the individual is deceased or not. URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..* | IdentifierCABaseline | An identifier for the person as this agent
active | Σ | 0..1 | boolean | Whether this practitioner's record is in active use
name | S Σ C | 1..* | HumanName | The name(s) associated with the practitioner Constraints: ca-baseline-practitioner-name
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text | Σ | 0..1 | string | Text representation of the full name
family | Σ C | 0..1 | string | Family name (often called 'Surname')
given | Σ C | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period | Σ | 0..1 | Period | Time period when name was/is in use
telecom | S Σ | 0..* | ContactPoint | A contact detail for the practitioner (that apply to all roles)
address | Σ | 0..* | Address | Address(es) of the practitioner that are not role specific (typically home address)
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:preferred |  | 0..1 | boolean | HL7 Preferred Address Flag extension URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | Σ | 0..1 | string | Postal code for area Example General: 9132
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code)
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
gender | Σ | 0..1 | code | male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate | S Σ | 0..1 | date | The date on which the practitioner was born
photo |  | 0..* | Attachment | Image of the person
qualification |  | 0..* | BackboneElement | Certification, licenses, or training pertaining to the provision of care
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
identifier |  | 0..* | Identifier | An identifier for this qualification for the practitioner
code |  | 1..1 | CodeableConcept | Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
coding:Registry | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | QualifiedRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scpqual
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
coding:eReferral | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | HealthcareProviderRoleType Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/scptype
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
period |  | 0..1 | Period | Period during which the qualification is valid
issuer |  | 0..1 | Reference(Organization) | Organization that regulates and issues the qualification
communication |  | 0..* | CodeableConcept | A language the practitioner can use in patient communication Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Practitioner.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Practitioner.name.use | Base | required | NameUse | 📍4.0.1 | FHIR Std.
Practitioner.address.​use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Practitioner.address.​type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Practitioner.gender | Base | required | AdministrativeGender | 📍4.0.1 | FHIR Std.
Practitioner.qualification.​code | Base | example | v2 table 0360, Version 2.7 | 📦0360 | FHIR Std.
Practitioner.communication | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-practitioner-name | error | Practitioner.name | Either name.given and/or name.family SHALL be present or a Data Absent Reason Extension SHALL be present | `(family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()`
dom-2 | error | Practitioner | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Practitioner | 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 | error | Practitioner | 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 | error | Practitioner | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Practitioner | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from PractitionerProfile

Summary

Mandatory: 2 elements(4 nested mandatory elements)
Must-Support: 4 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

- Identifier DataType Profile (CA Baseline) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-identifier)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-deceased
- http://hl7.org/fhir/StructureDefinition/iso21090-preferred

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Practitioner.qualification.code.coding

Other representations of profile: CSV, Excel, Schematron

### Notes:

## Identifiers

Multiple types of provider identifiers may be used in Practitioner.identifier element in the Canadian context:

- Provincial health plan provider/ Billing number
- Licence Number
- Medical Doctor Number

Implementers may use other identifiers to capture in a more specific way such as internal provider number, jurisdictions providing credentials. The full list of possible identifier types is in Canadian URI Registry

In some cases, the same license number can be used as the provider identifier and provider's qualification identifier.

## Telecom

A provider may have multiple ways to be contacted with different uses or applicable periods. This Practitioner profile allows multiple contact points (e.g. a telephone number or an email address) by which the individual may be contacted.

To indicate the preferred way to contact use Practitioner.telecom.rank attribute (i.e., the ContactPoint.rank component) that specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

## Address

The Practitioner profile is provided for use in a Canadian context where some constraint on content is desirable to guarantee the quality of the Canadian address whilst still supporting other type of address (e.g., other countries or UNstructured addresses).

### Canadian postal code

If an address in the Practitioner resource instance represents Canadian address, it SHOULD follow Canadian postal code format.

The Canadian Postal Code SHOULD be a six-character uniformly structured uppercase alphanumeric code in the form of "ANA NAN", where "A" represents an alphabetic character and "N" represents a numeric character, with one space between the first three and the last three characters.

A hyphen SHOULD NOT be used (example of UNacceptable format: T0L-1K0).

### Preferred

The Practitioner.address MAY have a Preferred extension. This is the FHIR standard defined extension used as a flag denoting whether parent address item is preferred.

### Qualifications & Credentials

In Canadian context qualifications and credentials are not synonymous. This difference is defined by slices applied to Practitioner.qualification.code.coding element.

Qualification defines a code for the degree or educational rank that the credential specifies and may also apply to an expertise type. This profile recommends to use Canadian QualifiedRoleType value set as the coded representation of the provider's qualification.

Credential defines a role type that is used to categorize an entity that delivers health care in an expected and professional manner to an entity in need of health care services. It uses Canadian HealthcareProviderRoleType value set as the coded representation of the provider's credentials.

The binding strength for the Practitioner.qualification.code element is Preferred meaning that implementers are encouraged to draw codes from the specified code system for interoperability purposes but are not required to do so to be considered conformant.

Example:

    "code": {
      "coding": [
        {
          "system": "https://fhir.infoway-inforoute.ca/CodeSystem/scpqual",
          "code": "BSC",
          "display": "Bachelor of Science Degree"
        }
      ],
      "text": "Bachelor of Science Degree"
    }