QI-Core Implementation Guide
4.1.0 - release

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## Resource Profile: QICoreFamilyMemberHistory - Detailed Descriptions

Definitions for the qicore-familymemberhistory resource profile.

1. FamilyMemberHistory
Definition | Significant health conditions for a person related to the patient relevant in the context of care for the patient.
Control | 0..*
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.`div`.exists()) fhs-1: Can have age[x] or born[x], but not both (: age.empty() or born.empty()) fhs-2: Can only have estimatedAge if age[x] is present (: age.exists() or estimatedAge.empty())
2. FamilyMemberHistory.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | string
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. FamilyMemberHistory.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Control | 0..1
Type | Meta
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. FamilyMemberHistory.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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Control | 0..1
Type | uri
Is Modifier | true
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. FamilyMemberHistory.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages A human language.
Type | code
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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. FamilyMemberHistory.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Control | 0..1
Type | Narrative
Alternate Names | narrative, 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 information is added later.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. FamilyMemberHistory.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.
Control | 0..*
Type | Resource
Alternate Names | inline 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
8. FamilyMemberHistory.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
9. FamilyMemberHistory.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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. FamilyMemberHistory.identifier
Definition | Business identifiers assigned to this family member history by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Requirements | Allows identification of the family member history as it is known by various participating systems and in a way that remains consistent across servers.
Comments | This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
11. FamilyMemberHistory.instantiatesCanonical
Definition | The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.
Control | 0..*
Type | canonical(PlanDefinition | Questionnaire | ActivityDefinition | Measure | OperationDefinition)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
12. FamilyMemberHistory.instantiatesUri
Definition | The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.
Control | 0..*
Type | uri
Comments | This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. FamilyMemberHistory.status
Definition | A code specifying the status of the record of the family history of a specific family member.
Control | 1..1
Binding | The codes SHALL be taken from FamilyHistoryStatus A code that identifies the status of the family history record.
Type | code
Is Modifier | true
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. FamilyMemberHistory.dataAbsentReason
Definition | Describes why the family member's history is not available.
Control | 0..1
Binding | For example codes, see FamilyHistoryAbsentReason Codes describing the reason why a family member's history is not available.
Type | CodeableConcept
Requirements | This is a separate element to allow it to have a distinct binding from reasonCode.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. FamilyMemberHistory.patient
Definition | The person who this history concerns.
Control | 1..1
Type | Reference(QICorePatient)
Must Support | true
Alternate Names | Proband
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. FamilyMemberHistory.date
Definition | The date (and possibly time) when the family member history was recorded or last updated.
Control | 0..1
Type | dateTime
Must Support | true
Requirements | Allows determination of how current the summary is.
Comments | This should be captured even if the same as the date on the List aggregating the full family history.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. FamilyMemberHistory.name
Definition | This will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair".
Control | 0..1
Type | string
Requirements | Allows greater ease in ensuring the same person is being talked about.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. FamilyMemberHistory.relationship
Definition | The type of relationship this person has to the patient (father, mother, brother etc.).
Control | 1..1
Binding | For example codes, see FamilyMember The nature of the relationship between the patient and the related person being described in the family member history.
Type | CodeableConcept
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. FamilyMemberHistory.sex
Definition | The birth sex of the family member.
Control | 0..1
Binding | The codes SHALL be taken from AdministrativeGender; other codes may be used where these codes are not suitable Codes describing the sex assigned at birth as documented on the birth registration.
Type | CodeableConcept
Requirements | Not all relationship codes imply sex and the relative's sex can be relevant for risk assessments.
Comments | This element should ideally reflect whether the individual is genetically male or female. However, as reported information based on the knowledge of the patient or reporting friend/relative, there may be situations where the reported sex might not be totally accurate. E.g. 'Aunt Sue' might be XY rather than XX. Questions soliciting this information should be phrased to encourage capture of genetic sex where known. However, systems performing analysis should also allow for the possibility of imprecision with this element.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. FamilyMemberHistory.born[x]
Definition | The actual or approximate date of birth of the relative.
Control | 0..1 This element is affected by the following invariants: fhs-1
Type | Choice of: Period, date, string
[x] Note | See Choice of Data Types for further information about how to use [x]
Requirements | Allows calculation of the relative's age.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. FamilyMemberHistory.age[x]
Definition | The age of the relative at the time the family member history is recorded.
Control | 0..1 This element is affected by the following invariants: fhs-1
Type | Choice of: Age, Range, string
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Requirements | While age can be calculated from date of birth, sometimes recording age directly is more natural for clinicians.
Comments | use estimatedAge to indicate whether the age is actual or not.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. FamilyMemberHistory.estimatedAge
Definition | If true, indicates that the age value specified is an estimated value.
Control | 0..1 This element is affected by the following invariants: fhs-2
Type | boolean
Requirements | Clinicians often prefer to specify an estimaged age rather than an age range.
Comments | This element is labeled as a modifier because the fact that age is estimated can/should change the results of any algorithm that calculates based on the specified age.
Meaning if Missing | It is unknown whether the age is an estimate or not
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. FamilyMemberHistory.deceased[x]
Definition | Deceased flag or the actual or approximate age of the relative at the time of death for the family member history record.
Control | 0..1
Type | Choice of: boolean, Age, Range, date, string
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. FamilyMemberHistory.reasonCode
Definition | Describes why the family member history occurred in coded or textual form.
Control | 0..*
Binding | For example codes, see SNOMEDCTClinicalFindings Codes indicating why the family member history was done.
Type | CodeableConcept
Comments | Textual reasons can be captured using reasonCode.text.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. FamilyMemberHistory.reasonReference
Definition | Indicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event.
Control | 0..*
Type | Reference(Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. FamilyMemberHistory.note
Definition | This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible.
Control | 0..*
Type | Annotation
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. FamilyMemberHistory.condition
Definition | The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition.
Control | 0..*
Type | BackboneElement
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
28. FamilyMemberHistory.condition.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
29. FamilyMemberHistory.condition.extension
Definition | An Extension
Control | 0..*
Type | Extension
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Slicing | This element introduces a set of slices on FamilyMemberHistory.condition.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
30. FamilyMemberHistory.condition.extension:condition-abatement
SliceName | condition-abatement
Definition | The approximate date, age, or flag indicating that the condition of the family member resolved. The abatement should only be specified if the condition is stated in the positive sense, i.e., the didNotHave flag is false.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(abatement) (Extension Type: Choice of: date, Age, boolean)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
31. FamilyMemberHistory.condition.extension:condition-severity
SliceName | condition-severity
Definition | A qualification of the seriousness or impact on health of the family member condition.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(severity) (Extension Type: CodeableConcept)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
32. FamilyMemberHistory.condition.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
33. FamilyMemberHistory.condition.code
Definition | The actual condition specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system.
Control | 1..1
Binding | For example codes, see Condition/Problem/DiagnosisCodes Identification of the Condition or diagnosis.
Type | CodeableConcept
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. FamilyMemberHistory.condition.outcome
Definition | Indicates what happened following the condition. If the condition resulted in death, deceased date is captured on the relation.
Control | 0..1
Binding | For example codes, see ConditionOutcomeCodes The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.
Type | CodeableConcept
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. FamilyMemberHistory.condition.contributedToDeath
Definition | This condition contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown.
Control | 0..1
Type | boolean
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. FamilyMemberHistory.condition.onset[x]
Definition | Either the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence.
Control | 0..1
Type | Choice of: Age, Range, Period, string
[x] Note | See Choice of Data Types for further information about how to use [x]
Requirements | Age of onset of a condition in relatives is predictive of risk for the patient.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
37. FamilyMemberHistory.condition.note
Definition | An area where general notes can be placed about this specific condition.
Control | 0..*
Type | Annotation
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))