Introduction

This profile is used to represent de-identified patient information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance the following data elements have to be removed or de-identified

• Patient Name

• Address that is more specific than a state

  • First 3 digits of Zipcodes can be included if the population of all zipcodes starting with the same 3 digits are > 20000 people and the last 2 digits should be masked with "00", in all other cases, the zipcodes have to be masked to 00000.
• All dates should not have a precision of more than the year. This means month and day cannot be included.
• Demographics including birthdate, deceased indicator
• Patient contact details such as telephone numbers, fax, email, URLs,
• Patient personal identifiers such as SSN, Drivers License,
• Business identifiers such as MRNs, certificate numbers, Account numbers
• Biometrics such as fingerprints, photos

In FHIR Resources, text elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Patient resource text element may contain information such as the full name, Gender and Date of Birth. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Age Computation

The Data Submitter has to compute the age based as of December 31st of the previous year for inclusion in the UDS+ report.

Id Generation

The original patient resource id should not be included in the De-identified patient instance. Instead a new id should be created and provided as part of the FHIR resource. This Data Submitter should be capable of using the generated id to relink the data to the original patient. All resource references to the Patient submitted as part of the UDS+ report should refer to newly generated de-identified id.

The following is new content for 1.1.0

Usage of Data Absent Reason Extension

For the UDS+ reporting, the patient data is de-identified and in the process zip codes may be masked to a value of "00000". In these cases the dataAbsentReason extension must be added to identify that the data is "masked". If the zip code is not known, a value of "00000" must be sent with a dataAbsentReason of "unknown". If the zip code is outside the country, a value of "00000" must be sent with a dataAbsentReason of "unsupported".

Birth Sex Additional Constraints

NullFlavors are not allowed for BirthSex reporting for UDS+ even though they are allowed in US Core.

Race and Ethnicity Additional Constraints

US Core allows Race and Ethnicity to be described as only text or rolled up to the OMB categories, however for UDS+ reporting detailed race and ethnicity have to be captured and reported as part of the profile. If the reported race and ethncity values are not null flavors then detailed values are mandatory.

Sexual Orientation Additional Constraints

Health Centers which have not implemented the methods to capture Sexual Orientation, should use the null flavor coded value of "NASK" specifically.

Gender Identity Additional Constraints

Health Centers which have not implemented the methods to capture Gender Identity, should use the null flavor coded value of "NASK" specifically.

Examples Examples of identifiable data and its corresponding de-identifiable data is present in Reporting Guidance.

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

This structure is derived from Patient

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	De-Identified UDS Plus Patient
id	S	0..1	id	The de-identified patient identifier created by the health center to send data to HRSA.
text		0..0
contained		0..0
Slices for extension				Content/Rules for all slices
uds-plus-race	S	1..1	(Complex)	Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
uds-plus-ethnicty	S	1..1	(Complex)	Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
uds-plus-birthsex	S	1..1	code	Indicates the birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Birth Sex Codes (required): The set of codes to be used for UDS+ reporting.
uds-plus-age-extension	S	1..1	Quantity	Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
uds-plus-gender-identity-extension	S	0..1	CodeableConcept	Gender Identity of the pateient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-gender-identity-extension Binding: Uds Plus Gender Identity Codes (extensible): The set of codes to be used for UDS+ reporting.
uds-plus-agriculture-worker-status	S	0..1	code	Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
uds-plus-housing-status	S	0..1	code	Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
uds-plus-veteran-status	S	0..1	boolean	Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
identifier		0..0
name		0..0
telecom		0..0
birthDate		0..0
deceased[x]	SC	0..1		Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources.
deceasedDateTime			dateTime S
deceasedBoolean			boolean S
address	S	1..1	Address	Included only to support zip code
text		0..0
line		0..0
postalCode	SC	1..1	string	ZipCode must be included in the profile uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000.
Slices for extension				Content/Rules for all slices
dataAbsentReason	S	0..1	(Complex)	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x]	S	1..1	code	Value of extension
maritalStatus		0..0
multipleBirth[x]		0..0
photo		0..0
contact		0..0
communication
language	S	1..1	CodeableConcept	Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
generalPractitioner		0..0
managingOrganization		0..0
link		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language

Constraints

Id	Grade	Path(s)	Details	Requirements
uds-plus-pat-1	error	Patient.deceased[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4
uds-plus-patient-1	error	Patient.address.postalCode	De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. : $this.matches('[0-9]{3}00|00000')

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	De-Identified UDS Plus Patient
id	SΣ	0..1	id	The de-identified patient identifier created by the health center to send data to HRSA.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		4..*	Extension	Extension Slice: Unordered, Open by value:url
uds-plus-race	S	1..1	(Complex)	Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
uds-plus-ethnicty	S	1..1	(Complex)	Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
uds-plus-birthsex	S	1..1	code	Indicates the birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Birth Sex Codes (required): The set of codes to be used for UDS+ reporting.
uds-plus-age-extension	S	1..1	Quantity	Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
uds-plus-gender-identity-extension	S	0..1	CodeableConcept	Gender Identity of the pateient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-gender-identity-extension Binding: Uds Plus Gender Identity Codes (extensible): The set of codes to be used for UDS+ reporting.
uds-plus-agriculture-worker-status	S	0..1	code	Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
uds-plus-housing-status	S	0..1	code	Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
uds-plus-veteran-status	S	0..1	boolean	Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
deceased[x]	?!SΣC	0..1		Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources.
deceasedDateTime			dateTime
deceasedBoolean			boolean
address	SΣ	1..1	Address	Included only to support zip code
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
postalCode	SΣC	1..1	string	ZipCode must be included in the profile uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. Example General: 9132
Slices for extension				Content/Rules for all slices
dataAbsentReason	S	0..1	(Complex)	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]	S	1..1	code	Value of extension Binding: DataAbsentReason (required)
communication		0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x]	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-pat-1	error	Patient.deceased[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4
uds-plus-patient-1	error	Patient.address.postalCode	De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. : $this.matches('[0-9]{3}00|00000')

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	De-Identified UDS Plus Patient
id	SΣ	0..1	id	The de-identified patient identifier created by the health center to send data to HRSA.
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		4..*	Extension	Extension Slice: Unordered, Open by value:url
uds-plus-race	S	1..1	(Complex)	Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
uds-plus-ethnicty	S	1..1	(Complex)	Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
uds-plus-birthsex	S	1..1	code	Indicates the birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Birth Sex Codes (required): The set of codes to be used for UDS+ reporting.
uds-plus-age-extension	S	1..1	Quantity	Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
uds-plus-gender-identity-extension	S	0..1	CodeableConcept	Gender Identity of the pateient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-gender-identity-extension Binding: Uds Plus Gender Identity Codes (extensible): The set of codes to be used for UDS+ reporting.
uds-plus-agriculture-worker-status	S	0..1	code	Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
uds-plus-housing-status	S	0..1	code	Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
uds-plus-veteran-status	S	0..1	boolean	Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
deceased[x]	?!SΣC	0..1		Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources.
deceasedDateTime			dateTime S
deceasedBoolean			boolean S
address	SΣ	1..1	Address	Included only to support zip code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
city	Σ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	Σ	0..1	string	Sub-unit of country (abbreviations ok)
postalCode	SΣC	1..1	string	ZipCode must be included in the profile uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. Example General: 9132
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
dataAbsentReason	S	0..1	(Complex)	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]	S	1..1	code	Value of extension Binding: DataAbsentReason (required)
value		0..1	string	Primitive value for string Max Length: 1048576
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication		0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
preferred		0..1	boolean	Language preference indicator
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Patient.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Patient.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Patient.address.type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x]	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Patient.contact.relationship	extensible	PatientContactRelationship http://hl7.org/fhir/ValueSet/patient-contactrelationship from the FHIR Standard
Patient.contact.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-pat-1	error	Patient.deceased[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4
uds-plus-patient-1	error	Patient.address.postalCode	De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. : $this.matches('[0-9]{3}00|00000')

Differential View

This structure is derived from Patient

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	De-Identified UDS Plus Patient
id	S	0..1	id	The de-identified patient identifier created by the health center to send data to HRSA.
text		0..0
contained		0..0
Slices for extension				Content/Rules for all slices
uds-plus-race	S	1..1	(Complex)	Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
uds-plus-ethnicty	S	1..1	(Complex)	Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
uds-plus-birthsex	S	1..1	code	Indicates the birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Birth Sex Codes (required): The set of codes to be used for UDS+ reporting.
uds-plus-age-extension	S	1..1	Quantity	Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
uds-plus-gender-identity-extension	S	0..1	CodeableConcept	Gender Identity of the pateient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-gender-identity-extension Binding: Uds Plus Gender Identity Codes (extensible): The set of codes to be used for UDS+ reporting.
uds-plus-agriculture-worker-status	S	0..1	code	Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
uds-plus-housing-status	S	0..1	code	Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
uds-plus-veteran-status	S	0..1	boolean	Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
identifier		0..0
name		0..0
telecom		0..0
birthDate		0..0
deceased[x]	SC	0..1		Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources.
deceasedDateTime			dateTime S
deceasedBoolean			boolean S
address	S	1..1	Address	Included only to support zip code
text		0..0
line		0..0
postalCode	SC	1..1	string	ZipCode must be included in the profile uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000.
Slices for extension				Content/Rules for all slices
dataAbsentReason	S	0..1	(Complex)	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x]	S	1..1	code	Value of extension
maritalStatus		0..0
multipleBirth[x]		0..0
photo		0..0
contact		0..0
communication
language	S	1..1	CodeableConcept	Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
generalPractitioner		0..0
managingOrganization		0..0
link		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language

Constraints

Id	Grade	Path(s)	Details	Requirements
uds-plus-pat-1	error	Patient.deceased[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4
uds-plus-patient-1	error	Patient.address.postalCode	De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. : $this.matches('[0-9]{3}00|00000')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	De-Identified UDS Plus Patient
id	SΣ	0..1	id	The de-identified patient identifier created by the health center to send data to HRSA.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		4..*	Extension	Extension Slice: Unordered, Open by value:url
uds-plus-race	S	1..1	(Complex)	Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
uds-plus-ethnicty	S	1..1	(Complex)	Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
uds-plus-birthsex	S	1..1	code	Indicates the birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Birth Sex Codes (required): The set of codes to be used for UDS+ reporting.
uds-plus-age-extension	S	1..1	Quantity	Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
uds-plus-gender-identity-extension	S	0..1	CodeableConcept	Gender Identity of the pateient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-gender-identity-extension Binding: Uds Plus Gender Identity Codes (extensible): The set of codes to be used for UDS+ reporting.
uds-plus-agriculture-worker-status	S	0..1	code	Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
uds-plus-housing-status	S	0..1	code	Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
uds-plus-veteran-status	S	0..1	boolean	Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
deceased[x]	?!SΣC	0..1		Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources.
deceasedDateTime			dateTime
deceasedBoolean			boolean
address	SΣ	1..1	Address	Included only to support zip code
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
postalCode	SΣC	1..1	string	ZipCode must be included in the profile uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. Example General: 9132
Slices for extension				Content/Rules for all slices
dataAbsentReason	S	0..1	(Complex)	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]	S	1..1	code	Value of extension Binding: DataAbsentReason (required)
communication		0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x]	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-pat-1	error	Patient.deceased[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4
uds-plus-patient-1	error	Patient.address.postalCode	De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. : $this.matches('[0-9]{3}00|00000')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	Patient	De-Identified UDS Plus Patient
id	SΣ	0..1	id	The de-identified patient identifier created by the health center to send data to HRSA.
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		4..*	Extension	Extension Slice: Unordered, Open by value:url
uds-plus-race	S	1..1	(Complex)	Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
uds-plus-ethnicty	S	1..1	(Complex)	Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
uds-plus-birthsex	S	1..1	code	Indicates the birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Birth Sex Codes (required): The set of codes to be used for UDS+ reporting.
uds-plus-age-extension	S	1..1	Quantity	Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
uds-plus-gender-identity-extension	S	0..1	CodeableConcept	Gender Identity of the pateient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-gender-identity-extension Binding: Uds Plus Gender Identity Codes (extensible): The set of codes to be used for UDS+ reporting.
uds-plus-agriculture-worker-status	S	0..1	code	Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
uds-plus-housing-status	S	0..1	code	Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
uds-plus-veteran-status	S	0..1	boolean	Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
deceased[x]	?!SΣC	0..1		Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources.
deceasedDateTime			dateTime S
deceasedBoolean			boolean S
address	SΣ	1..1	Address	Included only to support zip code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
city	Σ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	Σ	0..1	string	Sub-unit of country (abbreviations ok)
postalCode	SΣC	1..1	string	ZipCode must be included in the profile uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. Example General: 9132
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
dataAbsentReason	S	0..1	(Complex)	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]	S	1..1	code	Value of extension Binding: DataAbsentReason (required)
value		0..1	string	Primitive value for string Max Length: 1048576
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication		0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
preferred		0..1	boolean	Language preference indicator
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Patient.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Patient.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 from the FHIR Standard
Patient.address.type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x]	required	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Patient.contact.relationship	extensible	PatientContactRelationship http://hl7.org/fhir/ValueSet/patient-contactrelationship from the FHIR Standard
Patient.contact.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-pat-1	error	Patient.deceased[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4
uds-plus-patient-1	error	Patient.address.postalCode	De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. : $this.matches('[0-9]{3}00|00000')

This structure is derived from Patient

Summary

Mandatory: 6 elements(2 nested mandatory elements)
Must-Support: 15 elements
Prohibited: 15 elements

Extensions

This structure refers to these extensions:

• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-gender-identity-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
• http://hl7.org/fhir/StructureDefinition/data-absent-reason

Maturity: 2