CH EPR FHIR (R4)
4.0.1-ballot-2 - ballot Switzerland flag

CH EPR FHIR (R4), published by eHealth Suisse. This guide is not an authorized publication; it is the continuous build for version 4.0.1-ballot-2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/ehealthsuisse/ch-epr-fhir/ and changes regularly. See the Directory of published versions

Resource Profile: CHmCSDPractitioner - Detailed Descriptions

Active as of 2024-11-19

Definitions for the CH.mCSD.Practitioner resource profile.

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

0. Practitioner
Invariantsch-mcsd-practitioner-ihe-conformance: The Practitioner needs to conform to IHE.mCSD.Practitioner (conformsTo('https://profiles.ihe.net/ITI/mCSD/StructureDefinition/IHE.mCSD.Practitioner'))
2. Practitioner.meta
4. Practitioner.meta.lastUpdated
6. Practitioner.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
8. Practitioner.identifier:LDAP
Slice NameLDAP
ShortLDAP DN (Distinguished Name), if the practitioner is stored in an HPD
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier(LDAP Identifier)
Pattern Value{
  "system" : "urn:ietf:rfc:4514"
}
10. Practitioner.active
12. Practitioner.name
14. Practitioner.name.text
16. Practitioner.name.family
18. Practitioner.name.given
20. Practitioner.name.prefix
22. Practitioner.telecom
24. Practitioner.address
26. Practitioner.gender
28. Practitioner.qualification
Control1..?
30. Practitioner.qualification.code
32. Practitioner.communication
34. Practitioner.communication.coding
36. Practitioner.communication.coding.code

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

0. Practitioner
Definition

The CH Core Practitioner is based upon the core FHIR Practitioner Resource and designed to meet the applicable practitioner demographic data elements in Switzerland. See also https://www.bfs.admin.ch/bfs/de/home/register/personenregister/registerharmonisierung/nomenklaturen.html for further information


A person who is directly or indirectly involved in the provisioning of healthcare.

ShortCH Core Practitioner EPRA person with a formal responsibility in the provisioning of healthcare or related services
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())
ch-pract-1: If a HumanName is provided, at least one HumanName must have a given and family name. (name.where(family.exists() and given.exists()).count()>0 or name.empty())
ch-pract-2: gender unknown is currently not used in Switzerland in eCH and the EPR (gender.empty() or gender!='unknown')
ch-mcsd-practitioner-ihe-conformance: The Practitioner needs to conform to IHE.mCSD.Practitioner (conformsTo('https://profiles.ihe.net/ITI/mCSD/StructureDefinition/IHE.mCSD.Practitioner'))
2. Practitioner.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. Practitioner.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())
6. Practitioner.identifier
Definition

An identifier that applies to this person in this role.

ShortAn identifier for the person as this agent
NoteThis is a business identifier, not a resource identifier (see discussion)
Control10..*
TypeIdentifier
Is Modifierfalse
Summarytrue
Requirements

Often, specific identities are assigned for the agent.

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 Practitioner.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ $this
  • 8. Practitioner.identifier:GLN
    Slice NameGLN
    Definition

    An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.


    An identifier that applies to this person in this role.

    ShortAn identifier intended for computationAn identifier for the person as this agent
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..1*
    This element is affected by the following invariants: ele-1
    TypeIdentifier(GLN Identifier)
    Is Modifierfalse
    Requirements

    Often, specific identities are assigned for the agent.

    Pattern Value{
      "system" : "urn:oid:2.51.1.3"
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Practitioner.identifier:ZSR
    Slice NameZSR
    Definition

    The ZSR/RCC number is issued to self-employed, natural or legal persons (organisations) who can and want to work at the expense of health insurance.


    An identifier that applies to this person in this role.

    ShortZSR (Zahlstellenregister), RCC (Registre des codes-créanciers), RCC (Registro dei codici creditori)An identifier for the person as this agent
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeIdentifier(ZSR Identifier)
    Is Modifierfalse
    Requirements

    Often, specific identities are assigned for the agent.

    Pattern Value{
      "system" : "urn:oid:2.16.756.5.30.1.123.100.2.1.1"
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. Practitioner.identifier:LDAP
    Slice NameLDAP
    Definition

    An identifier that applies to this person in this role.

    ShortLDAP DN (Distinguished Name), if the practitioner is stored in an HPDAn identifier for the person as this agent
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..1*
    TypeIdentifier(LDAP Identifier)
    Is Modifierfalse
    Summarytrue
    Requirements

    Often, specific identities are assigned for the agent.

    Pattern Value{
      "system" : "urn:ietf:rfc:4514"
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. Practitioner.active
    Definition

    Whether this practitioner's record is in active use.

    ShortWhether this practitioner's record is in active use
    Comments

    If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.

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

    Need to be able to mark a practitioner record as not to be used because 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()))
    16. Practitioner.name
    Definition

    A human's name with the ability to identify parts and usage.


    The name(s) associated with the practitioner.

    ShortName of a human - parts and usageThe name(s) associated with the practitioner
    Comments

    Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.


    The selection of the use property should ensure that there is a single usual name specified, and others use the nickname (alias), old, or other values as appropriate.

    In general, select the value to be used in the ResourceReference.display based on this:

    1. There is more than 1 name
    2. Use = usual
    3. Period is current to the date of the usage
    4. Use = official
    5. Other order as decided by internal business rules.
    Control10..*
    This element is affected by the following invariants: ele-1
    TypeHumanName(Human Name)
    Is Modifierfalse
    Requirements

    The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ch-core-hm-1: if officalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is official (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').empty() or (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').exists() and use='official'))
    ch-core-hm-2: if orginalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is maiden (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').empty() or ((family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').exists() and use='maiden')))
    ch-core-hm-3: ch-ext-ech-11-name can only be put on a family name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count()=family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count())
    ch-core-hm-4: ch-ext-ech-11-firstname can only be put on a given name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count()=given.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count())
    18. Practitioner.name.use
    Definition

    Identifies the purpose for this name.

    Shortusual | official | temp | nickname | anonymous | old | maiden
    Comments

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

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

    The use of a human name.

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

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

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

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

    ShortText representation of the full name
    Comments

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

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

    A renderable, unencoded form.

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

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

    ShortFamily name (often called 'Surname')
    Comments

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

    Control0..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Alternate Namessurname
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. Practitioner.name.family.extension:ech11name
    Slice Nameech11name
    Definition

    Extension for eCH-0011 - namedatatype

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Name) (Extension Type: code)
    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())
    26. Practitioner.name.given
    Definition

    Given name.

    ShortGiven names (not always 'first'). Includes middle names
    Comments

    If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

    Control0..*
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Alternate Namesfirst name, middle name
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. Practitioner.name.given.extension:ech11firstname
    Slice Nameech11firstname
    Definition

    eCH-0011: Extension to define first name type

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(First Name) (Extension Type: code)
    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())
    30. Practitioner.name.prefix
    Definition

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

    ShortFor a salutation use a prefix without the iso21090-EN-qualifier extension. For academical titles and legal status use the http://hl7.org/fhir/ExtensionDefinition/iso21090-EN-qualifier with the codes AC, LS.Parts that come before the name
    Control0..*
    Typestring
    Is Modifierfalse
    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()))
    32. Practitioner.name.prefix.extension:salutationandtitle
    Slice Namesalutationandtitle
    Definition

    A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type.

    ShortFor academical titles and legal status use the http://hl7.org/fhir/ExtensionDefinition/iso21090-EN-qualifier with the codes AC, LS.
    Comments

    Used to indicate additional information about the name part and how it should be used.

    Control0..*
    TypeExtension(EN Qualifier) (Extension Type: code)
    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())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    34. Practitioner.telecom
    Definition

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

    ShortA contact detail for the practitioner (that apply to all roles)
    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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

    Control0..*
    TypeContactPoint
    Is Modifierfalse
    Summarytrue
    Requirements

    Need to know how to reach a practitioner independent to any roles the practitioner may have.

    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 Practitioner.telecom. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ system
    • 36. Practitioner.telecom:email
      Slice Nameemail
      Definition

      Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.


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

      ShortCH Core ContactPoint eCH-0046 EmailA contact detail for the practitioner (that apply to all roles)
      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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeContactPoint(CH Core ContactPoint eCH-0046 Email)
      Is Modifierfalse
      Requirements

      Need to know how to reach a practitioner independent to any roles the practitioner may have.

      Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. Practitioner.telecom:phone
      Slice Namephone
      Definition

      Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.


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

      ShortCH Core ContactPoint eCH-0046 PhoneA contact detail for the practitioner (that apply to all roles)
      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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeContactPoint(CH Core ContactPoint eCH-0046 Phone)
      Is Modifierfalse
      Requirements

      Need to know how to reach a practitioner independent to any roles the practitioner may have.

      Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. Practitioner.telecom:internet
      Slice Nameinternet
      Definition

      Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.


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

      ShortCH Core ContactPoint eCH-0046 InternetA contact detail for the practitioner (that apply to all roles)
      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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeContactPoint(CH Core ContactPoint eCH-0046 Internet)
      Is Modifierfalse
      Requirements

      Need to know how to reach a practitioner independent to any roles the practitioner may have.

      Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. Practitioner.address
      Definition

      An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.


      Address(es) of the practitioner that are not role specific (typically home address). Work addresses are not typically entered in this property as they are usually role dependent.

      ShortAn address expressed using postal conventions (as opposed to GPS or other location definition formats)Address(es) of the practitioner that are not role specific (typically home address)
      Comments

      Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).


      The PractitionerRole does not have an address value on it, as it is expected that the location property be used for this purpose (which has an address).

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeAddress(CH Core Address)
      Is Modifierfalse
      Requirements

      The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ch-addr-2: For a Swiss address, a canton abbreviation from the value set 'eCH-0007 Canton Abbreviation' must be used. (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').empty() or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH') = false) or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH').exists() and (state.empty() or state.memberOf('http://fhir.ch/ig/ch-core/ValueSet/ech-7-cantonabbreviation'))))
      44. Practitioner.gender
      Definition

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

      Shortmale | female | othermale | female | other | unknown
      Control0..1
      BindingThe codes SHALL be taken from AdministrativeGenderhttp://hl7.org/fhir/ValueSet/administrative-gender|4.0.1
      (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 to address the person correctly.

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

      The official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.

      ShortCertification, licenses, or training pertaining to the provision of care
      Control10..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. Practitioner.qualification.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())
      50. Practitioner.qualification.code
      Definition

      Coded representation of the qualification.

      ShortCoded representation of the qualification
      Control1..1
      BindingFor example codes, see v2 table 0360, Version 2.7http://terminology.hl7.org/ValueSet/v2-2.7-0360
      (example to http://terminology.hl7.org/ValueSet/v2-2.7-0360)

      Specific qualification the practitioner has to provide a service.

      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      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. Practitioner
      Definition

      The CH Core Practitioner is based upon the core FHIR Practitioner Resource and designed to meet the applicable practitioner demographic data elements in Switzerland. See also https://www.bfs.admin.ch/bfs/de/home/register/personenregister/registerharmonisierung/nomenklaturen.html for further information

      ShortCH Core Practitioner EPR
      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())
      ch-pract-1: If a HumanName is provided, at least one HumanName must have a given and family name. (name.where(family.exists() and given.exists()).count()>0 or name.empty())
      ch-pract-2: gender unknown is currently not used in Switzerland in eCH and the EPR (gender.empty() or gender!='unknown')
      ch-mcsd-practitioner-ihe-conformance: The Practitioner needs to conform to IHE.mCSD.Practitioner (conformsTo('https://profiles.ihe.net/ITI/mCSD/StructureDefinition/IHE.mCSD.Practitioner'))
      2. Practitioner.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. Practitioner.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. Practitioner.meta.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
      8. Practitioner.meta.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 Practitioner.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 10. Practitioner.meta.versionId
        Definition

        The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

        ShortVersion specific identifier
        Comments

        The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

        Control0..1
        Typeid
        Is Modifierfalse
        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()))
        12. Practitioner.meta.lastUpdated
        Definition

        When the resource last changed - e.g. when the version changed.

        ShortWhen the resource version last changed
        Comments

        This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

        Control0..1
        Typeinstant
        Is Modifierfalse
        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()))
        14. Practitioner.meta.source
        Definition

        A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

        ShortIdentifies where the resource comes from
        Comments

        In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

        This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

        Control0..1
        Typeuri
        Is Modifierfalse
        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()))
        16. Practitioner.meta.profile
        Definition

        A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

        ShortProfiles this resource claims to conform to
        Comments

        It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

        Control0..*
        Typecanonical(StructureDefinition)
        Is Modifierfalse
        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()))
        18. Practitioner.meta.security
        Definition

        Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

        ShortSecurity Labels applied to this resource
        Comments

        The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

        Control0..*
        BindingUnless not suitable, these codes SHALL be taken from All Security Labels
        (extensible to http://hl7.org/fhir/ValueSet/security-labels)

        Security Labels from the Healthcare Privacy and Security Classification System.

        TypeCoding
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Practitioner.meta.tag
        Definition

        Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

        ShortTags applied to this resource
        Comments

        The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

        Control0..*
        BindingFor example codes, see CommonTags
        (example to http://hl7.org/fhir/ValueSet/common-tags)

        Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

        TypeCoding
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Practitioner.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()))
        24. Practitioner.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()))
        26. Practitioner.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()))
        28. Practitioner.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
        30. Practitioner.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        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())
        32. Practitioner.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())
        34. Practitioner.identifier
        Definition

        An identifier that applies to this person in this role.

        ShortAn identifier for the person as this agent
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control1..*
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Requirements

        Often, specific identities are assigned for the agent.

        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 Practitioner.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ $this
        • 36. Practitioner.identifier:GLN
          Slice NameGLN
          Definition

          An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.

          ShortAn identifier intended for computation
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control1..1
          This element is affected by the following invariants: ele-1
          TypeIdentifier(GLN Identifier)
          Is Modifierfalse
          Requirements

          Often, specific identities are assigned for the agent.

          Pattern Value{
            "system" : "urn:oid:2.51.1.3"
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. Practitioner.identifier:ZSR
          Slice NameZSR
          Definition

          The ZSR/RCC number is issued to self-employed, natural or legal persons (organisations) who can and want to work at the expense of health insurance.

          ShortZSR (Zahlstellenregister), RCC (Registre des codes-créanciers), RCC (Registro dei codici creditori)
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          This element is affected by the following invariants: ele-1
          TypeIdentifier(ZSR Identifier)
          Is Modifierfalse
          Requirements

          Often, specific identities are assigned for the agent.

          Pattern Value{
            "system" : "urn:oid:2.16.756.5.30.1.123.100.2.1.1"
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. Practitioner.identifier:LDAP
          Slice NameLDAP
          Definition

          An identifier that applies to this person in this role.

          ShortLDAP DN (Distinguished Name), if the practitioner is stored in an HPD
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..1
          TypeIdentifier(LDAP Identifier)
          Is Modifierfalse
          Summarytrue
          Requirements

          Often, specific identities are assigned for the agent.

          Pattern Value{
            "system" : "urn:ietf:rfc:4514"
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          42. Practitioner.active
          Definition

          Whether this practitioner's record is in active use.

          ShortWhether this practitioner's record is in active use
          Comments

          If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.

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

          Need to be able to mark a practitioner record as not to be used because 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()))
          44. Practitioner.name
          Definition

          A human's name with the ability to identify parts and usage.

          ShortName of a human - parts and usage
          Comments

          Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

          Control1..*
          This element is affected by the following invariants: ele-1
          TypeHumanName(Human Name)
          Is Modifierfalse
          Requirements

          The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ch-core-hm-1: if officalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is official (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').empty() or (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').exists() and use='official'))
          ch-core-hm-2: if orginalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is maiden (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').empty() or ((family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').exists() and use='maiden')))
          ch-core-hm-3: ch-ext-ech-11-name can only be put on a family name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count()=family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count())
          ch-core-hm-4: ch-ext-ech-11-firstname can only be put on a given name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count()=given.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count())
          46. Practitioner.name.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
          48. Practitioner.name.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 Practitioner.name.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 50. Practitioner.name.use
            Definition

            Identifies the purpose for this name.

            Shortusual | official | temp | nickname | anonymous | old | maiden
            Comments

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

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

            The use of a human name.

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

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

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

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

            ShortText representation of the full name
            Comments

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

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

            A renderable, unencoded form.

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

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

            ShortFamily name (often called 'Surname')
            Comments

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

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Alternate Namessurname
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. Practitioner.name.family.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
            58. Practitioner.name.family.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 Practitioner.name.family.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 60. Practitioner.name.family.extension:ech11name
              Slice Nameech11name
              Definition

              Extension for eCH-0011 - namedatatype

              ShortExtension
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Name) (Extension Type: code)
              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. Practitioner.name.family.value
              Definition

              The actual value

              ShortPrimitive value for string
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Max Length:1048576
              64. Practitioner.name.given
              Definition

              Given name.

              ShortGiven names (not always 'first'). Includes middle names
              Comments

              If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

              Control0..*
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Alternate Namesfirst name, middle name
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. Practitioner.name.given.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
              68. Practitioner.name.given.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 Practitioner.name.given.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 70. Practitioner.name.given.extension:ech11firstname
                Slice Nameech11firstname
                Definition

                eCH-0011: Extension to define first name type

                ShortExtension
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(First Name) (Extension Type: code)
                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())
                72. Practitioner.name.given.value
                Definition

                The actual value

                ShortPrimitive value for string
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                Max Length:1048576
                74. Practitioner.name.prefix
                Definition

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

                ShortFor a salutation use a prefix without the iso21090-EN-qualifier extension. For academical titles and legal status use the http://hl7.org/fhir/ExtensionDefinition/iso21090-EN-qualifier with the codes AC, LS.
                Control0..*
                Typestring
                Is Modifierfalse
                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()))
                76. Practitioner.name.prefix.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
                78. Practitioner.name.prefix.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 Practitioner.name.prefix.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 80. Practitioner.name.prefix.extension:salutationandtitle
                  Slice Namesalutationandtitle
                  Definition

                  A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type.

                  ShortFor academical titles and legal status use the http://hl7.org/fhir/ExtensionDefinition/iso21090-EN-qualifier with the codes AC, LS.
                  Comments

                  Used to indicate additional information about the name part and how it should be used.

                  Control0..*
                  TypeExtension(EN Qualifier) (Extension Type: code)
                  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())
                  82. Practitioner.name.prefix.value
                  Definition

                  The actual value

                  ShortPrimitive value for string
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  Max Length:1048576
                  84. Practitioner.name.suffix
                  Definition

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

                  ShortParts that come after the name
                  Control0..*
                  Typestring
                  Is Modifierfalse
                  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()))
                  86. Practitioner.name.period
                  Definition

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

                  ShortTime period when name was/is in use
                  Control0..1
                  TypePeriod
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Allows names to be placed in historical context.

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

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

                  ShortA contact detail for the practitioner (that apply to all roles)
                  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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

                  Control0..*
                  TypeContactPoint
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Need to know how to reach a practitioner independent to any roles the practitioner may have.

                  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 Practitioner.telecom. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ system
                  • 90. Practitioner.telecom:email
                    Slice Nameemail
                    Definition

                    Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.

                    ShortCH Core ContactPoint eCH-0046 Email
                    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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeContactPoint(CH Core ContactPoint eCH-0046 Email)
                    Is Modifierfalse
                    Requirements

                    Need to know how to reach a practitioner independent to any roles the practitioner may have.

                    Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    92. Practitioner.telecom:phone
                    Slice Namephone
                    Definition

                    Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.

                    ShortCH Core ContactPoint eCH-0046 Phone
                    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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeContactPoint(CH Core ContactPoint eCH-0046 Phone)
                    Is Modifierfalse
                    Requirements

                    Need to know how to reach a practitioner independent to any roles the practitioner may have.

                    Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    94. Practitioner.telecom:internet
                    Slice Nameinternet
                    Definition

                    Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.

                    ShortCH Core ContactPoint eCH-0046 Internet
                    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 to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeContactPoint(CH Core ContactPoint eCH-0046 Internet)
                    Is Modifierfalse
                    Requirements

                    Need to know how to reach a practitioner independent to any roles the practitioner may have.

                    Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    96. Practitioner.address
                    Definition

                    An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.

                    ShortAn address expressed using postal conventions (as opposed to GPS or other location definition formats)
                    Comments

                    Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeAddress(CH Core Address)
                    Is Modifierfalse
                    Requirements

                    The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ch-addr-2: For a Swiss address, a canton abbreviation from the value set 'eCH-0007 Canton Abbreviation' must be used. (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').empty() or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH') = false) or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH').exists() and (state.empty() or state.memberOf('http://fhir.ch/ig/ch-core/ValueSet/ech-7-cantonabbreviation'))))
                    98. Practitioner.gender
                    Definition

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

                    Shortmale | female | other
                    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 to address the person correctly.

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

                    The date of birth for the practitioner.

                    ShortThe date on which the practitioner was born
                    Control0..1
                    Typedate
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Needed for identification.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    102. Practitioner.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 patients and personnel. Fits with newer social media usage too.

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

                    The official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.

                    ShortCertification, licenses, or training pertaining to the provision of care
                    Control1..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    106. Practitioner.qualification.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
                    108. Practitioner.qualification.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())
                    110. Practitioner.qualification.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())
                    112. Practitioner.qualification.identifier
                    Definition

                    An identifier that applies to this person's qualification in this role.

                    ShortAn identifier for this qualification for the practitioner
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..*
                    TypeIdentifier
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Often, specific identities are assigned for the qualification.

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

                    Coded representation of the qualification.

                    ShortCoded representation of the qualification
                    Control1..1
                    BindingFor example codes, see v2 table 0360, Version 2.7
                    (example to http://terminology.hl7.org/ValueSet/v2-2.7-0360)

                    Specific qualification the practitioner has to provide a service.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    116. Practitioner.qualification.period
                    Definition

                    Period during which the qualification is valid.

                    ShortPeriod during which the qualification is valid
                    Control0..1
                    TypePeriod
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Qualifications are often for a limited period of time, and can be revoked.

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

                    Organization that regulates and issues the qualification.

                    ShortOrganization that regulates and issues the qualification
                    Control0..1
                    TypeReference(Organization)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    120. Practitioner.communication
                    Definition

                    A language the practitioner can use in patient communication.

                    ShortA language the practitioner can use in patient communication
                    Comments

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

                    Control0..*
                    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

                    Knowing which language a practitioner speaks can help in facilitating communication with patients.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    122. Practitioner.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
                    124. Practitioner.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())
                    SlicingThis element introduces a set of slices on Practitioner.communication.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 126. Practitioner.communication.coding
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                      Control0..*
                      TypeCoding
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      128. Practitioner.communication.coding.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
                      130. Practitioner.communication.coding.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 Practitioner.communication.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 132. Practitioner.communication.coding.system
                        Definition

                        The identification of the code system that defines the meaning of the symbol in the code.

                        ShortIdentity of the terminology system
                        Comments

                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

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

                        Need to be unambiguous about the source of the definition of the symbol.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        134. Practitioner.communication.coding.version
                        Definition

                        The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                        ShortVersion of the system - if relevant
                        Comments

                        Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                        NoteThis is a business version Id, not a resource version Id (see discussion)
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        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()))
                        136. Practitioner.communication.coding.code
                        Definition

                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                        ShortSymbol in syntax defined by the system
                        Control0..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        138. Practitioner.communication.coding.display
                        Definition

                        A representation of the meaning of the code in the system, following the rules of the system.

                        ShortRepresentation defined by the system
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        140. Practitioner.communication.coding.userSelected
                        Definition

                        Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                        ShortIf this coding was chosen directly by the user
                        Comments

                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

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

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

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

                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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