Da Vinci Payer Data Exchange
2.1.1 - STU 2.1 United States of America flag

Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions

US Core Patient

Page standards status: Informative

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The US Core 3.1.1 Patient or US Core 6.1.0 Patient resource pdex-32: *SHALL** be used to express a member's demographic information. §cnf-1

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core 3.1.1 Patient or US Core 6.1.0 Patient resource are:

R4 Element Name Cardinality Type
Patient.us-core-race us-core-race 0..1 (Complex)
Patient.us-core-ethnicity us-core-ethnicity 0..1 (Complex)
Patient.us-core-birthsex us-core-birthsex 0..1 code
Patient.identifier identifier 1..* Identifier
Patient.identifier.system system 1..1 uri
Patient.identifier.value value 1..1 string
Patient.name name 1..* HumanName
Patient.name.family family 0..1 string
Patient.name.given given 0..* string
Patient.telecom telecom 0..* ContactPoint
Patient.telecom.system system 1..1 code
Patient.telecom.value value 1..1 string
Patient.telecom.use use 0..1 code
Patient.gender gender 1..1 code
Patient.birthDate birthDate 0..1 date
Patient.address address 0..* Address
Patient.address.line line 0..* string
Patient.address.city city 0..1 string
Patient.address.state state 0..1 string
Patient.address.postalCode postalCode 0..1 string
Patient.address.period period 0..1 Period
Patient.communication communication 0..* BackboneElement
Patient.communication.language language 1..1 CodeableConcept

Table Definition

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the Patient resource from the CPCDS file are:

US Core Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
Patient.meta.lastUpdated   0..1 Patient.meta.lastUpdated [{"163":"Member Demographics Last Updated Date"}]
Patient.us-core-race S 0..1 Patient.us-core-race [{"128":"Race Code"}]
Patient.us-core-ethnicity S 0..1 Patient.us-core-ethnicity [{"129":"Ethnicity"}]
Patient.us-core-birthsex S 0..1 Patient.us-core-birthsex [{"153":"Birth Sex"}]
Patient.identifier S 1..* Patient.identifier [{"MMI=1":"Member id"}, {"191":"Unique Member ID"}, {"PatnAcctNr=109, MedRecNr=110":"Patient account number, Medical record number"}]. Note: Assign Payer System URI for Member Ids in Patient.identifier.system. Set Member Id in Patient.identifier.value
Patient.identifier.system S 1..1   Note: Assign Payer System URI for Member Ids in Patient.identifier.system
Patient.identifier.value S 1..1   Note: Set Member Id in Patient.identifier.value
Patient.name S 1..* Patient.name [{"130":"Patient Name"}] Note: Split Member Name into Patient.name.family, Patient.name.given
Patient.name.family S 0..1   Note: Split Member Name into Patient.name.family, Patient.name.given
Patient.name.given S 0..*   Note: Split Member Name into Patient.name.family, Patient.name.given
Patient.telecom S 0..*   Note: Provide contact information from member record, if available
Patient.telecom.system S 1..1   Note: phone | fax | email | pager | url | sms | other - if avaiable
Patient.telecom.value S 1..1   Note: provide contact information from member record, if available
Patient.telecom.use S 0..1   Note: provide home | work | temp | old | mobile if known
Patient.gender S 1..1 Patient.gender [{"71":"Gender code"}]
Patient.birthDate S 0..1 Patient.birthDate [{"70":"Date of birth"}]
Patient.deceasedBoolean     Patient.deceasedBoolean [{"150":"Deceased"}]
Patient.deceasedDateTime     Patient.deceasedDateTime [{"124":"Date of death"}]
Patient.address S 0..*   Note: Provide address elements, if available
Patient.address.line S 0..* Patient.address.line [{"158":"Street Address"}]
Patient.address.city S 0..1   Note: Provide city, if available
Patient.address.district   0..1 Patient.address.district [{"125":"County"}]
Patient.address.state S 0..1 Patient.address.state [{"126":"State"}]
Patient.address.postalCode S 0..1 Patient.address.postalCode [{"131":"Zip"}]
Patient.address.country   0..1 Patient.address.country [{"127":"Country"}]
Patient.address.period S 0..1   Note: Provide validity period for address, if available
Patient.communication S 0..*   . Note: Provide preferred communication language via language code below, if available
Patient.communication.language S 1..1   Note: Provide preferred communication language, if available

Table Definition

The Member Number will be entered in the identifier field. The code MB SHALL be used to identify the member identifier. §pdex-33 See the example below:

{
      "use" : "member",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ],
        "text" : "Health Plan Member Number"
      },
      "system" : "http://plan.healthplan.com",
      "value" : "987654321"
    }

Example Patient Resource

An example mapping of a Patient resource is shown here:

{
  "resourceType" : "Patient",
  "id" : "example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "

			

				Generated Narrative with Details
			

			

				id: example

			

				identifier: Medical Record Number = 1032702 (USUAL)

			

				identifier: Health Plan Member Number = 987654321 (USUAL)

			

				active: true

			

				name: Arthur B. Dent 

			

				telecom: ph: 555-555-5555(HOME), amy.shaw@example.com

			

				gender: 

			

				birthsex: Male

			

				birthDate: Jan 22, 1953

			

				address: 6518 Meadowridge Rd, Elkridge, MD 21075 US 

			

				race: White, American Indian or Alaska Native, Asian, Shoshone, Filipino

			

				ethnicity: Hispanic or Latino, Dominican, Mexican

		
"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2106-3",
            "display" : "White"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1002-5",
            "display" : "American Indian or Alaska Native"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2028-9",
            "display" : "Asian"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1586-7",
            "display" : "Shoshone"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2036-2",
            "display" : "Filipino"
          }
        },
        {
          "url" : "text",
          "valueString" : "Mixed"
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2135-2",
            "display" : "Hispanic or Latino"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2184-0",
            "display" : "Dominican"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2148-5",
            "display" : "Mexican"
          }
        },
        {
          "url" : "text",
          "valueString" : "Hispanic or Latino"
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
      "valueCode" : "M"
    }
  ],
  "identifier" : [
    {
      "use" : "member",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ],
        "text" : "Health Plan Member Number"
      },
      "system" : "http://plan.healthplan.com",
      "value" : "987654321"
    },
    {
      "use" : "usual",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/v2/0203",
            "code" : "MR",
            "display" : "Medical Record Number"
          }
        ],
        "text" : "Medical Record Number"
      },
      "system" : "http://hospital.smarthealthit.org",
      "value" : "1032702"
    }
  ],
  "active" : true,
  "name" : [
    {
      "family" : "Dent",
      "given" : [
        "Arthur",
        "B."
      ]
    }
  ],
  "telecom" : [
    {
      "system" : "phone",
      "value" : "555-555-5555",
      "use" : "home"
    },
    {
      "system" : "email",
      "value" : "arthur.dent@example.com"
    }
  ],
  "gender" : "male",
  "birthDate" : "1953-01-22",
  "address" : [
    {
      "line" : [
        "6518 Meadowridge Rd"
      ],
      "city" : "Elkridge",
      "state" : "MD",
      "postalCode" : "21075",
      "country" : "US"
    }
  ]
}

Refer to the US Core Additional examples of the US Core 3.1.1 or US Core 6.1.0 Implementation Guide for further examples of completed Patient Profiles.

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