Identifer is not allowed in this IG due to risk of accidental, unnecessary exposure of sensitive identifiers to verifiers. For use in the United States.

Demographics and other administrative information about an individual receiving a vaccination or infectious disease-related laboratory test.

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.

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.

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).

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.

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.

Identifer is not allowed in this IG due to risk of accidental, unnecessary exposure of sensitive identifiers to verifiers. For use in the United States.

Patients are almost always assigned specific numerical identifiers.

Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

It is often used to filter patient lists to exclude inactive patients

Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

Need to be able to mark a patient record as not to be used because it was created in error.

Official name (i.e., legal name) of the patient, corresponding to official in this value set. Issuers SHALL provide a single name element UNLESS they believe providing multiple name elements is critical for verification of the credential. If providing only a single name element, Issuers SHALL NOT populate name.use, and Verifiers SHALL assume that the provided name is official.

Cardinality for this element is set to 1..* rather than 1..1 as in rare cases there may be a valid rational for including multiple name elements (e.g., for a recent name change that is not yet reflected on a photo ID but will be soon). The Data Minimization version of this profile reflects the rarity of this by setting name to 1..1.

Name parts are typically split between name.family and name.given. For example Marie Salomea Skłodowska Curie would be represented as name.family=“Curie”, and name.given=[“Marie”, “Salomea”, “Skłodowska”].

If it is not clear how to split the parts of a person's name into name.family and name.given, or if a person has a single word for their name, implementers MAY use name.text instead (e.g., name.text=“Marie Salomea Skłodowska Curie”).

Issuers SHOULD make every effort to have the contents of name match what appears on the patient's government-issued photo ID.

Other implementers SHALL support display/processing of name.family/name.given AND name.text.

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

Identifies the purpose for this name.

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

The use of a human name.

Allows the appropriate name for a particular context of use to be selected from among a set of names.

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

Given name.

This element is used to represent all parts of a patient's name that are not their family name. For example, Marie Salomea Skłodowska Curie would have three values for name.given: ["Marie", "Salomea", "Skłodowska"].

Implementers SHOULD include all given name parts that appear on the patient's government-issued photo ID.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

SHOULD be included if it appears on a government-issued ID.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

SHOULD be included if it appears on a government-issued ID.

Administrative gender.

Issuers SHALL NOT include gender unless required by law in the jurisdiction where the SMART Health Card is issued.

Verifiers SHALL NOT use gender in their workflows unless required by law in both the jurisdiction where the SMART Health Card was issued and the jurisdiction governing the Verifier.

SMART Health Cards cannot be used as a form of identification. From the SMART Health Card specification:

"SMART Health Cards are designed for use alongside existing forms of identification (e.g., a driver's license in person, or an online ID verification service). A SMART Health Card is a non-forgeable digital artifact analogous to a paper record on official letterhead. Concretely, the problem SMART Health Cards solve is one of provenance: a digitally signed SMART Health Card is a credential that guarantees that a specific issuer generated the record. The duty of verifying that the person presenting a Health Card is the subject of the data within the Health Card (or is authorized to act on behalf of this data subject) falls to the person or system receiving and validating a Health Card."

To facilitate verifying that the person presenting a Health Card is the subject of the data within the Health Card (or is authorized to act on behalf of this data subject), the patient's name and date of birth are included the SMART Health Card. Gender is typically not included because name and date of birth are sufficient for verification workflows, and there may be legitimate reasons why gender in a SMART Health Card does not match that in an existing form of identification (e.g., a change in administrative gender, or differences in how gender is represented). Note that it may not be possible to get a re-issued SMART Health Card if a patient's administrative gender changes.

Additionally, patients may not wish to share their administrative gender with Verifiers. Since this information is typically not necessary for the Verifiers' use case, it should be omitted as is consistent with the privacy by design approach used throughout this IG.

The gender of a person used for administrative purposes.

Needed for identification of the individual, in combination with (at least) name and birth date.

The date of birth for the individual.

If exact date of birth is partially or completely unknown, Issuers SHALL populate this element with the date of birth information listed on the patient's government-issued identification. This MAY include a partial date of birth like 1999 or 1999-01, or "filler" for unknown portions. (E.g., if a patient was born in 1950 but does not know the month or day, their government-issued identification may fill the month and day with -01-01. In this case, it is acceptable to populate this element with 1950-01-01 even if it is known the patient was not actually born on January 1.) If date of birth is completely unknown and no government-issued identification is available, Issuers MAY omit this element.

Age of the individual drives many clinical processes.

Indicates if the individual is deceased or not.

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.

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.

Image of the patient.

Attachments are not allowed due to data size constraints.

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

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

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.

Need to track people you can contact about the patient.

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

There is no assumption that linked patient records have mutual links.

There are multiple use cases:

• Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
• Distribution of patient information across multiple servers.

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).

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.

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.

The other patient resource that the link refers to.

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

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

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

Demographics and other administrative information about an individual receiving a vaccination or infectious disease-related laboratory test.

For data minimization reasons, this element SHOULD NOT be populated when generating a resource conforming to this profile for inclusion in one of the Bundles profiled in this IG.

Not including id may result in FHIR validation errors of resources. These errors can be ignored for the purposes of assessing conformance to this IG.

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.

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.

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.

The base language in which the resource is written.

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).

A human language.

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.

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.

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.

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.

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.

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.

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).

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.

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.

Identifer is not allowed in this IG due to risk of accidental, unnecessary exposure of sensitive identifiers to verifiers. For use in the United States.

Patients are almost always assigned specific numerical identifiers.

Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

It is often used to filter patient lists to exclude inactive patients

Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

Need to be able to mark a patient record as not to be used because it was created in error.

Official name (i.e., legal name) of the patient, corresponding to official in this value set. Issuers SHALL provide a single name element UNLESS they believe providing multiple name elements is critical for verification of the credential. If providing only a single name element, Issuers SHALL NOT populate name.use, and Verifiers SHALL assume that the provided name is official.

Cardinality for this element is set to 1..* rather than 1..1 as in rare cases there may be a valid rational for including multiple name elements (e.g., for a recent name change that is not yet reflected on a photo ID but will be soon). The Data Minimization version of this profile reflects the rarity of this by setting name to 1..1.

Name parts are typically split between name.family and name.given. For example Marie Salomea Skłodowska Curie would be represented as name.family=“Curie”, and name.given=[“Marie”, “Salomea”, “Skłodowska”].

If it is not clear how to split the parts of a person's name into name.family and name.given, or if a person has a single word for their name, implementers MAY use name.text instead (e.g., name.text=“Marie Salomea Skłodowska Curie”).

Issuers SHOULD make every effort to have the contents of name match what appears on the patient's government-issued photo ID.

Other implementers SHALL support display/processing of name.family/name.given AND name.text.

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

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

May be used to represent additional information that is not part of the basic definition of the element. 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.

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.

• value @ url

Identifies the purpose for this name.

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

The use of a human name.

Allows the appropriate name for a particular context of use to be selected from among a set of names.

Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

A renderable, unencoded form.

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

Given name.

This element is used to represent all parts of a patient's name that are not their family name. For example, Marie Salomea Skłodowska Curie would have three values for name.given: ["Marie", "Salomea", "Skłodowska"].

Implementers SHOULD include all given name parts that appear on the patient's government-issued photo ID.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

SHOULD be included if it appears on a government-issued ID.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

SHOULD be included if it appears on a government-issued ID.

Indicates the period of time when this name was valid for the named person.

Allows names to be placed in historical context.

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

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 might 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).

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

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

May be used to represent additional information that is not part of the basic definition of the element. 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.

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.

• value @ url

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

Telecommunications form for contact point.

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

For patient privacy reasons, this element SHALL NOT be populated unless the Issuer believes the credential cannot be verified in its absence.

Need to support legacy numbers that are not in a tightly controlled format.

Identifies the purpose for the contact point.

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

Use of contact point.

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

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.

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

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

Administrative gender.

Issuers SHALL NOT include gender unless required by law in the jurisdiction where the SMART Health Card is issued.

Verifiers SHALL NOT use gender in their workflows unless required by law in both the jurisdiction where the SMART Health Card was issued and the jurisdiction governing the Verifier.

SMART Health Cards cannot be used as a form of identification. From the SMART Health Card specification:

"SMART Health Cards are designed for use alongside existing forms of identification (e.g., a driver's license in person, or an online ID verification service). A SMART Health Card is a non-forgeable digital artifact analogous to a paper record on official letterhead. Concretely, the problem SMART Health Cards solve is one of provenance: a digitally signed SMART Health Card is a credential that guarantees that a specific issuer generated the record. The duty of verifying that the person presenting a Health Card is the subject of the data within the Health Card (or is authorized to act on behalf of this data subject) falls to the person or system receiving and validating a Health Card."

To facilitate verifying that the person presenting a Health Card is the subject of the data within the Health Card (or is authorized to act on behalf of this data subject), the patient's name and date of birth are included the SMART Health Card. Gender is typically not included because name and date of birth are sufficient for verification workflows, and there may be legitimate reasons why gender in a SMART Health Card does not match that in an existing form of identification (e.g., a change in administrative gender, or differences in how gender is represented). Note that it may not be possible to get a re-issued SMART Health Card if a patient's administrative gender changes.

Additionally, patients may not wish to share their administrative gender with Verifiers. Since this information is typically not necessary for the Verifiers' use case, it should be omitted as is consistent with the privacy by design approach used throughout this IG.

The gender of a person used for administrative purposes.

Needed for identification of the individual, in combination with (at least) name and birth date.

The date of birth for the individual.

If exact date of birth is partially or completely unknown, Issuers SHALL populate this element with the date of birth information listed on the patient's government-issued identification. This MAY include a partial date of birth like 1999 or 1999-01, or "filler" for unknown portions. (E.g., if a patient was born in 1950 but does not know the month or day, their government-issued identification may fill the month and day with -01-01. In this case, it is acceptable to populate this element with 1950-01-01 even if it is known the patient was not actually born on January 1.) If date of birth is completely unknown and no government-issued identification is available, Issuers MAY omit this element.

Age of the individual drives many clinical processes.

Indicates if the individual is deceased or not.

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.

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.

An address for the individual.

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

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

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

May be used to represent additional information that is not part of the basic definition of the element. 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.

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.

• value @ url

The purpose of this address.

Applications can assume that an address is current unless it explicitly says that it is temporary or old.

The use of an address.

Allows an appropriate address to be chosen from a list of many.

Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

The type of an address (physical / postal).

Full physical address SHALL not be included because of patient privacy concerns.

There are scenarios where a Holder of a credential may wish to present their credential without revealing their full physical address.

A renderable, unencoded form.

Full physical address SHALL not be included because of patient privacy concerns.

There are scenarios where a Holder of a credential may wish to present their credential without revealing their full physical address.

The name of the city, town, suburb, village or other community or delivery center.

For patient privacy reasons, this element SHALL NOT be populated unless the Issuer believes the credential cannot be verified in its absence.

The name of the administrative area (county).

For patient privacy reasons, this element SHALL NOT be populated unless the Issuer believes the credential cannot be verified in its absence.

Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

For patient privacy reasons, this element SHALL NOT be populated unless the Issuer believes the credential cannot be verified in its absence.

A postal code designating a region defined by the postal service.

For patient privacy reasons, this element SHALL NOT be populated unless the Issuer believes the credential cannot be verified in its absence.

Country - a nation as commonly understood or generally accepted.

ISO 3166 3 letter codes can be used in place of a human readable country name.

Time period when address was/is in use.

Allows addresses to be placed in historical context.

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

The domestic partnership status of a person.

Most, if not all systems capture it.

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

Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

Image of the patient.

Attachments are not allowed due to data size constraints.

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

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

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.

Need to track people you can contact about the patient.

A language which may be used to communicate with the patient about his or her health.

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.

If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

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

May be used to represent additional information that is not part of the basic definition of the element. 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.

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.

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).

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.

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.

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.

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.

A human language.

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

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

This language is specifically identified for communicating healthcare information.

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.

Patient's nominated care provider.

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability 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. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

Organization that is the custodian of the patient record.

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).

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

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

There is no assumption that linked patient records have mutual links.

There are multiple use cases:

• Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
• Distribution of patient information across multiple servers.

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

May be used to represent additional information that is not part of the basic definition of the element. 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.

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.

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).

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.

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.

The other patient resource that the link refers to.

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

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

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