Vital Records Common Library (VRCL) STU2-ballot
2.0.0 - trial-use United States of America flag

Vital Records Common Library (VRCL) STU2-ballot, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/vr-common-library/ and changes regularly. See the Directory of published versions

Resource Profile: RelatedPersonParentVitalRecords - Detailed Descriptions

Active as of 2024-03-21

Definitions for the RelatedPerson-parent-vr resource profile.

Guidance on how to interpret the contents of this table can be found here

0. RelatedPerson
2. RelatedPerson.extension
SlicingThis element introduces a set of slices on RelatedPerson.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. RelatedPerson.extension:birthPlace
    Slice NamebirthPlace
    Control0..1
    TypeExtension(RelatedPerson Birth Place Vital Records) (Extension Type: Address)
    6. RelatedPerson.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    SlicingThis element introduces a set of slices on RelatedPerson.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • pattern @ type
    • 8. RelatedPerson.identifier:SSN
      Slice NameSSN
      ShortSSN if available and appropriate to send
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1
      10. RelatedPerson.identifier:SSN.type
      Control1..?
      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
          "code" : "SS"
        }]
      }
      12. RelatedPerson.patient
      TypeReference(Patient - Vital Records)
      14. RelatedPerson.relationship
      Control1..?
      16. RelatedPerson.name
      Control1..?
      18. RelatedPerson.birthDate
      Must Supporttrue
      20. RelatedPerson.birthDate.extension
      SlicingThis element introduces a set of slices on RelatedPerson.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 22. RelatedPerson.birthDate.extension:partialDate
        Slice NamepartialDate
        Definition

        Indicates reason for missing data on either the birthDate or the birthTime.

        ShortProvides values of a partial date
        Control0..*
        TypeExtension(Partial Date Vital Records) (Complex Extension)
        Must Supporttrue
        24. RelatedPerson.birthDate.extension:bypassEditFlag
        Slice NamebypassEditFlag
        Control0..1
        TypeExtension(BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
        26. RelatedPerson.birthDate.extension:bypassEditFlag.value[x]
        ShortTo reflect the relevant edit possibilities for date of birth.
        BindingThe codes SHALL be taken from Date of Birth Edit Flags (NCHS) Vital Records
        (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-date-of-birth-edit-flags-vr)

        Date of Birth Edit Flags (NCHS)

        [x] NoteSee Choice of Data Types for further information about how to use [x]

        Guidance on how to interpret the contents of this table can be found here

        0. RelatedPerson
        Definition

        -


        Information about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.

        ShortA person that is related to a patient, but who is not a direct target of care
        Comments

        -

        Control0..*
        Is Modifierfalse
        Summaryfalse
        Invariantsdom-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())
        us-core-14: Either a name or a relationship SHALL be provided (or both) (name.exists() or relationship.exists())
        2. RelatedPerson.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.

        ShortA set of rules under which this content was created
        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.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        4. RelatedPerson.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional content defined by implementations
        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-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())
        SlicingThis element introduces a set of slices on RelatedPerson.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 6. RelatedPerson.extension:birthPlace
          Slice NamebirthPlace
          Definition

          The registered place of birth for the related person. A system may use the address.text if it doesn't store the birthPlace address in discrete elements. This extension is the same as the patient birthPlace extension, but with relatedPerson context.

          ShortRelatedPerson Birth Place Vital Records
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(RelatedPerson Birth Place Vital Records) (Extension Type: Address)
          Is Modifierfalse
          Invariantsele-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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          8. RelatedPerson.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).

          ShortExtensions that cannot be ignored
          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summaryfalse
          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 Namesextensions, user content
          Invariantsele-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. RelatedPerson.identifier
          Definition

          Identifier for a person within a particular scope.

          ShortA human identifier for this person
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Requirements

          People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on RelatedPerson.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • pattern @ type
          • 12. RelatedPerson.identifier:SSN
            Slice NameSSN
            Definition

            Identifier for a person within a particular scope.

            ShortSSN if available and appropriate to sendA human identifier for this person
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1*
            TypeIdentifier
            Is Modifierfalse
            Summarytrue
            Requirements

            People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            14. RelatedPerson.identifier:SSN.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control0..1
            BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            16. RelatedPerson.identifier:SSN.type
            Definition

            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

            ShortDescription of identifier
            Comments

            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

            Control10..1
            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows users to make use of identifiers when the identifier system is not known.

            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "SS"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            18. RelatedPerson.active
            Definition

            Whether this related person record is in active use.

            ShortWhether this related person's record is in active use
            Comments

            This element is labeled as a modifier because it may be used to mark that the resource was created in error.

            Control10..1
            Typeboolean
            Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be able to mark a related person record as not to be used, such as if it was created in error.

            Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            20. RelatedPerson.patient
            Definition

            The patient this person is related to.

            ShortThe patient this person is related to
            Control1..1
            TypeReference(Patient - Vital Records, Patient)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            We need to know which patient this RelatedPerson is related to.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. RelatedPerson.relationship
            Definition

            The nature of the relationship between a patient and the related person.

            ShortThe nature of the relationship
            Control10..*
            This element is affected by the following invariants: us-core-14
            BindingThe codes SHOULD be taken from PatientRelationshipTypehttp://hl7.org/fhir/ValueSet/relatedperson-relationshiptype
            (preferred to http://hl7.org/fhir/ValueSet/relatedperson-relationshiptype)

            The nature of the relationship between a patient and the related person.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            We need to know the relationship with the patient since it influences the interpretation of the information attributed to this person.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. RelatedPerson.name
            Definition

            A name associated with the person.

            ShortA name associated with the person
            Control10..*
            This element is affected by the following invariants: us-core-14
            TypeHumanName
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. RelatedPerson.telecom
            Definition

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

            ShortA contact detail for the person
            Comments

            Person 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.

            Control0..*
            TypeContactPoint
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. RelatedPerson.birthDate
            Definition

            The date on which the related person was born.

            ShortThe date on which the related person was born
            Control0..1
            Typedate
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. RelatedPerson.birthDate.extension
            Definition

            An Extension


            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.

            ShortExtensionAdditional content defined by implementations
            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.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-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())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on RelatedPerson.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 32. RelatedPerson.birthDate.extension:partialDate
              Slice NamepartialDate
              Definition

              Indicates reason for missing data on either the birthDate or the birthTime.

              ShortProvides values of a partial date
              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(Partial Date Vital Records) (Complex Extension)
              Is Modifierfalse
              Must Supporttrue
              Invariantsele-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())
              34. RelatedPerson.birthDate.extension:bypassEditFlag
              Slice NamebypassEditFlag
              Definition

              Extension to hold a codeable concept from one of several valuesets.

              ShortBypassEditFlag Vital Records
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Invariantsele-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())
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              36. RelatedPerson.birthDate.extension:bypassEditFlag.extension
              Definition

              An Extension


              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.

              ShortExtensionAdditional content defined by implementations
              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.

              Control0..0*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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())
              SlicingThis element introduces a set of slices on RelatedPerson.birthDate.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 38. RelatedPerson.birthDate.extension:bypassEditFlag.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                Fixed Valuehttp://hl7.org/fhir/us/vr-common-library/StructureDefinition/BypassEditFlag
                40. RelatedPerson.birthDate.extension:bypassEditFlag.value[x]
                Definition

                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                ShortTo reflect the relevant edit possibilities for date of birth.Value of extension
                Control10..1
                BindingThe codes SHALL be taken from For codes, see Date of Birth Edit Flags (NCHS) Vital Records
                (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-date-of-birth-edit-flags-vr)

                Date of Birth Edit Flags (NCHS)

                TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                42. RelatedPerson.address
                Definition

                Address where the related person can be contacted or visited.

                ShortAddress where the related person can be contacted or visited
                Control0..*
                TypeAddress
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Need to keep track where the related person can be contacted per postal mail or visited.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                Guidance on how to interpret the contents of this table can be found here

                0. RelatedPerson
                Definition

                -

                ShortA person that is related to a patient, but who is not a direct target of care
                Comments

                -

                Control0..*
                Is Modifierfalse
                Summaryfalse
                Invariantsdom-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())
                us-core-14: Either a name or a relationship SHALL be provided (or both) (name.exists() or relationship.exists())
                2. RelatedPerson.id
                Definition

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

                ShortLogical id of this artifact
                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.

                Control0..1
                Typeid
                Is Modifierfalse
                Summarytrue
                4. RelatedPerson.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.

                ShortMetadata about the resource
                Control0..1
                TypeMeta
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                6. RelatedPerson.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.

                ShortA set of rules under which this content was created
                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.

                Control0..1
                Typeuri
                Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                8. RelatedPerson.language
                Definition

                The base language in which the resource is written.

                ShortLanguage of the resource content
                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).

                Control0..1
                BindingThe codes SHOULD be taken from CommonLanguages
                (preferred to http://hl7.org/fhir/ValueSet/languages)

                A human language.

                Additional BindingsPurpose
                AllLanguagesMax Binding
                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                10. RelatedPerson.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.

                ShortText summary of the resource, for human interpretation
                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.

                Control0..1
                TypeNarrative
                Is Modifierfalse
                Summaryfalse
                Alternate Namesnarrative, html, xhtml, display
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                12. RelatedPerson.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.

                ShortContained, inline 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.

                Control0..*
                TypeResource
                Is Modifierfalse
                Summaryfalse
                Alternate Namesinline resources, anonymous resources, contained resources
                14. RelatedPerson.extension
                Definition

                An Extension

                ShortExtension
                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-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())
                SlicingThis element introduces a set of slices on RelatedPerson.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 16. RelatedPerson.extension:birthPlace
                  Slice NamebirthPlace
                  Definition

                  The registered place of birth for the related person. A system may use the address.text if it doesn't store the birthPlace address in discrete elements. This extension is the same as the patient birthPlace extension, but with relatedPerson context.

                  ShortRelatedPerson Birth Place Vital Records
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(RelatedPerson Birth Place Vital Records) (Extension Type: Address)
                  Is Modifierfalse
                  Invariantsele-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())
                  18. RelatedPerson.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).

                  ShortExtensions that cannot be ignored
                  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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  Summaryfalse
                  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 Namesextensions, user content
                  Invariantsele-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())
                  20. RelatedPerson.identifier
                  Definition

                  Identifier for a person within a particular scope.

                  ShortA human identifier for this person
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..*
                  TypeIdentifier
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on RelatedPerson.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • pattern @ type
                  • 22. RelatedPerson.identifier:SSN
                    Slice NameSSN
                    Definition

                    Identifier for a person within a particular scope.

                    ShortSSN if available and appropriate to send
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..1
                    TypeIdentifier
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    24. RelatedPerson.identifier:SSN.id
                    Definition

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

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    26. RelatedPerson.identifier:SSN.extension
                    Definition

                    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.

                    ShortAdditional content defined by implementations
                    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.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-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())
                    SlicingThis element introduces a set of slices on RelatedPerson.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 28. RelatedPerson.identifier:SSN.use
                      Definition

                      The purpose of this identifier.

                      Shortusual | official | temp | secondary | old (If known)
                      Comments

                      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                      Control0..1
                      BindingThe codes SHALL be taken from IdentifierUse
                      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                      Identifies the purpose for this identifier, if known .

                      Typecode
                      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      30. RelatedPerson.identifier:SSN.type
                      Definition

                      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                      ShortDescription of identifier
                      Comments

                      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                      Control1..1
                      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Allows users to make use of identifiers when the identifier system is not known.

                      Pattern Value{
                        "coding" : [{
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "SS"
                        }]
                      }
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      32. RelatedPerson.identifier:SSN.system
                      Definition

                      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                      ShortThe namespace for the identifier value
                      Comments

                      Identifier.system is always case sensitive.

                      Control0..1
                      Typeuri
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      34. RelatedPerson.identifier:SSN.value
                      Definition

                      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                      ShortThe value that is unique
                      Comments

                      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Example<br/><b>General</b>:123456
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      36. RelatedPerson.identifier:SSN.period
                      Definition

                      Time period during which identifier is/was valid for use.

                      ShortTime period when id is/was valid for use
                      Control0..1
                      TypePeriod
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      38. RelatedPerson.identifier:SSN.assigner
                      Definition

                      Organization that issued/manages the identifier.

                      ShortOrganization that issued id (may be just text)
                      Comments

                      The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                      Control0..1
                      TypeReference(Organization)
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      40. RelatedPerson.active
                      Definition

                      Whether this related person record is in active use.

                      ShortWhether this related person's record is in active use
                      Comments

                      This element is labeled as a modifier because it may be used to mark that the resource was created in error.

                      Control1..1
                      Typeboolean
                      Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Need to be able to mark a related person record as not to be used, such as if it was created in error.

                      Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      42. RelatedPerson.patient
                      Definition

                      The patient this person is related to.

                      ShortThe patient this person is related to
                      Control1..1
                      TypeReference(Patient - Vital Records)
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      We need to know which patient this RelatedPerson is related to.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      44. RelatedPerson.relationship
                      Definition

                      The nature of the relationship between a patient and the related person.

                      ShortThe nature of the relationship
                      Control1..*
                      This element is affected by the following invariants: us-core-14
                      BindingThe codes SHOULD be taken from PatientRelationshipType
                      (preferred to http://hl7.org/fhir/ValueSet/relatedperson-relationshiptype)

                      The nature of the relationship between a patient and the related person.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      We need to know the relationship with the patient since it influences the interpretation of the information attributed to this person.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      46. RelatedPerson.name
                      Definition

                      A name associated with the person.

                      ShortA name associated with the person
                      Control1..*
                      This element is affected by the following invariants: us-core-14
                      TypeHumanName
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      48. RelatedPerson.telecom
                      Definition

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

                      ShortA contact detail for the person
                      Comments

                      Person 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.

                      Control0..*
                      TypeContactPoint
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      50. RelatedPerson.gender
                      Definition

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

                      Shortmale | female | other | unknown
                      Control0..1
                      BindingThe codes SHALL be taken from AdministrativeGender
                      (required to http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1)

                      The gender of a person used for administrative purposes.

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      52. RelatedPerson.birthDate
                      Definition

                      The date on which the related person was born.

                      ShortThe date on which the related person was born
                      Control0..1
                      Typedate
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      54. RelatedPerson.birthDate.id
                      Definition

                      unique id for the element within a resource (for internal references)

                      Shortxml:id (or equivalent in JSON)
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      56. RelatedPerson.birthDate.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-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())
                      SlicingThis element introduces a set of slices on RelatedPerson.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 58. RelatedPerson.birthDate.extension:partialDate
                        Slice NamepartialDate
                        Definition

                        Indicates reason for missing data on either the birthDate or the birthTime.

                        ShortProvides values of a partial date
                        Control0..*
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Partial Date Vital Records) (Complex Extension)
                        Is Modifierfalse
                        Must Supporttrue
                        Invariantsele-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())
                        60. RelatedPerson.birthDate.extension:bypassEditFlag
                        Slice NamebypassEditFlag
                        Definition

                        Extension to hold a codeable concept from one of several valuesets.

                        ShortBypassEditFlag Vital Records
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(BypassEditFlag Vital Records) (Extension Type: CodeableConcept)
                        Is Modifierfalse
                        Invariantsele-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())
                        62. RelatedPerson.birthDate.extension:bypassEditFlag.id
                        Definition

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

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        64. RelatedPerson.birthDate.extension:bypassEditFlag.extension
                        Definition

                        An Extension

                        ShortExtension
                        Control0..0
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-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())
                        SlicingThis element introduces a set of slices on RelatedPerson.birthDate.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 66. RelatedPerson.birthDate.extension:bypassEditFlag.url
                          Definition

                          Source of the definition for the extension code - a logical name or a URL.

                          Shortidentifies the meaning of the extension
                          Comments

                          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                          Control1..1
                          Typeuri
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          Fixed Valuehttp://hl7.org/fhir/us/vr-common-library/StructureDefinition/BypassEditFlag
                          68. RelatedPerson.birthDate.extension:bypassEditFlag.value[x]
                          Definition

                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                          ShortTo reflect the relevant edit possibilities for date of birth.
                          Control1..1
                          BindingThe codes SHALL be taken from Date of Birth Edit Flags (NCHS) Vital Records
                          (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-date-of-birth-edit-flags-vr)

                          Date of Birth Edit Flags (NCHS)

                          TypeCodeableConcept
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          70. RelatedPerson.birthDate.value
                          Definition

                          The actual value

                          ShortPrimitive value for date
                          Control0..1
                          Typedate
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          72. RelatedPerson.address
                          Definition

                          Address where the related person can be contacted or visited.

                          ShortAddress where the related person can be contacted or visited
                          Control0..*
                          TypeAddress
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          Need to keep track where the related person can be contacted per postal mail or visited.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          74. RelatedPerson.photo
                          Definition

                          Image of the person.

                          ShortImage of the person
                          Control0..*
                          TypeAttachment
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          76. RelatedPerson.period
                          Definition

                          The period of time during which this relationship is or was active. If there are no dates defined, then the interval is unknown.

                          ShortPeriod of time that this relationship is considered valid
                          Control0..1
                          TypePeriod
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          78. RelatedPerson.communication
                          Definition

                          A language which may be used to communicate with about the patient's health.

                          ShortA language which may be used to communicate with about the patient's health
                          Comments

                          If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple RelatedPerson.Communication associations. If the RelatedPerson does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          80. RelatedPerson.communication.id
                          Definition

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

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          82. RelatedPerson.communication.extension
                          Definition

                          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.

                          ShortAdditional content defined by implementations
                          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.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-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())
                          84. RelatedPerson.communication.modifierExtension
                          Definition

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

                          ShortExtensions that cannot be ignored even if unrecognized
                          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.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          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 Namesextensions, user content, modifiers
                          Invariantsele-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())
                          86. RelatedPerson.communication.language
                          Definition

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

                          ShortThe language which can be used to communicate with the patient about his or her health
                          Comments

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

                          Control1..1
                          BindingThe codes SHOULD be taken from CommonLanguages
                          (preferred to http://hl7.org/fhir/ValueSet/languages)

                          A human language.

                          Additional BindingsPurpose
                          AllLanguagesMax Binding
                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          88. RelatedPerson.communication.preferred
                          Definition

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

                          ShortLanguage preference indicator
                          Comments

                          This language is specifically identified for communicating healthcare information.

                          Control0..1
                          Typeboolean
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Requirements

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

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))