CH EPR FHIR (R4)
4.0.1-ci-build - ci-build 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-ci-build 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: CHPDQmPatient - Detailed Descriptions

Active as of 2024-11-05

Definitions for the ch-pdqm-patient resource profile.

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

0. Patient
2. Patient.extension:religion
Slice Namereligion
Control0..0
4. Patient.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..?
Must Supporttrue
6. Patient.identifier:EPR-SPID
Slice NameEPR-SPID
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
Must Supporttrue
8. Patient.identifier:LocalPid
Slice NameLocalPid
NoteThis is a business identifier, not a resource identifier (see discussion)
Must Supporttrue
10. Patient.name
Control1..?
Must Supporttrue
SlicingThis element introduces a set of slices on Patient.name. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • profile @ $this
  • 12. Patient.name:HumanName
    Slice NameHumanName
    ShortA name associated with the patient
    Control1..*
    TypeHumanName(CH EPR FHIR HumanName)
    Must Supporttrue
    14. Patient.name:BirthName
    Slice NameBirthName
    ShortThe birthname of the patient
    Comments

    The birthname is added with the ISO 21090 qualifier https://www.hl7.org/fhir/extension-iso21090-en-qualifier.html BR

    Control0..1
    TypeHumanName(CH EPR FHIR BirthName)
    Must Supporttrue
    16. Patient.contact
    Control0..0
    18. Patient.contact:contact
    Slice Namecontact
    Control0..0
    20. Patient.contact:nameOfParent
    Slice NamenameOfParent
    Control0..0
    22. Patient.managingOrganization
    ShortProvider organization of the patient
    TypeReference(CH PDQm Provider Organization)
    Must Supporttrue

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

    0. Patient
    Definition

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


    Demographics and other administrative information about an individual or animal receiving care or other health-related services.

    ShortCH Core PatientInformation about an individual or animal receiving health care services
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Alternate NamesSubjectOfCare Client Resident
    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-pat-1: At least one HumanName with given and family name must be provided. (name.where(family.exists() and given.exists()).count()>0 or name.empty())
    ch-pat-2: gender unknown is currently not used in Switzerland in eCH and the EPR (gender.empty() or gender!='unknown')
    2. Patient.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. Patient.extension:placeOfBirth
    Slice NameplaceOfBirth
    Definition

    The registered place of birth of the patient.

    ShortPlace of birth of patient
    Control0..1
    TypeExtension(Place of Birth according to eCH-0011) (Extension Type: Address(Address for Place of Birth))
    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())
    6. Patient.extension:placeOfOrigin
    Slice NameplaceOfOrigin
    Definition

    The registered place of origin of the patient.

    ShortPlace of origin(s) of patient
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Place of Origin according to eCH-0011) (Extension Type: Address)
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. Patient.extension:citizenship
    Slice Namecitizenship
    Definition

    The content of the country code element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, if the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.

    ShortCitizenship(s) of patient
    Control0..*
    TypeExtension(Patient Citizenship) (Complex Extension)
    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())
    ch-pat-3: ISO Country Alpha-2 or ISO Country Alpha-3 code (((extension.where(url='code').value.coding.code.length()=2) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2')) or ((extension.where(url='code').value.coding.code.length() = 3) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
    10. Patient.extension:religion
    Slice Namereligion
    Definition

    The patient's professed religious affiliations.

    ShortThe patient's professed religious affiliations
    Control0..0
    TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    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())
    12. Patient.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())
    14. Patient.identifier
    Definition

    An identifier for this patient.

    ShortAn identifier for this patient
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..*
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Patients are almost always assigned specific numerical identifiers.

    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 Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ $this
    • 16. Patient.identifier:EPR-SPID
      Slice NameEPR-SPID
      Definition

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


      An identifier for this patient.

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

      Patients are almost always assigned specific numerical identifiers.

      Pattern Value{
        "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3"
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. Patient.identifier:AHVN13
      Slice NameAHVN13
      Definition

      The AHVN13 / NAVS13 - (abbreviation for new thirteen-digit Social Security number) - is an administrative identifier for natural persons in Switzerland. It is issued, announced and administered by the Central Compensation Office. It is available to all organisations and communities for which there is a legal basis.


      An identifier for this patient.

      ShortAHVN13 / NAVS13 of the patient (13 digits starting with 756, no separation points)An identifier for this patient
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeIdentifier(AHVN13 / NAVS13 Identifier)
      Is Modifierfalse
      Requirements

      Patients are almost always assigned specific numerical identifiers.

      Pattern Value{
        "system" : "urn:oid:2.16.756.5.32"
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Patient.identifier:LocalPid
      Slice NameLocalPid
      Definition

      An identifier for this patient.

      ShortLocal patient identifier(s)An identifier for this patient
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Patients are almost always assigned specific numerical identifiers.

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

      The purpose of this identifier.

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

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

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

      Identifies the purpose for this identifier, if known .

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

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

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

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

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

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

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

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

      ShortThe value that is unique
      Comments

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

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Example<br/><b>General</b>:123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Patient.identifier:insuranceCardNumber
      Slice NameinsuranceCardNumber
      Definition

      Cardnumber Swiss insurance card v1


      An identifier for this patient.

      ShortInsurance card number of the patient (20 digits)An identifier for this patient
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeIdentifier(Insurance Card Number (Identifier))
      Is Modifierfalse
      Requirements

      Patients are almost always assigned specific numerical identifiers.

      Pattern Value{
        "system" : "urn:oid:2.16.756.5.30.1.123.100.1.1.1"
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Patient.active
      Definition

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

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

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

      ShortWhether this patient's record is in active use
      Comments

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

      Control0..1
      Typeboolean
      Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to be able to mark a patient 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()))
      32. Patient.name
      Definition

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


      A name associated with the individual.

      ShortName of a human - parts and usageA name associated with the patient
      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.


      A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

      Control10..*
      This element is affected by the following invariants: ele-1
      TypeHumanName(Human Name)
      Is Modifierfalse
      Must Supporttrue
      Requirements

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

      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())
      SlicingThis element introduces a set of slices on Patient.name. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • profile @ $this
      • 34. Patient.name:HumanName
        Slice NameHumanName
        Definition

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


        A name associated with the individual.

        ShortA name associated with the patient
        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.


        A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

        Control10..*
        This element is affected by the following invariants: ele-1
        TypeHumanName(CH EPR FHIR HumanName)
        Is Modifierfalse
        Must Supporttrue
        Requirements

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

        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())
        ch-epr-fhir-1: For birth name (iso21090-EN-qualifier BR) use slice 'name:BirthName' (family.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier' and value='BR').exists()=false)
        36. Patient.name:BirthName
        Slice NameBirthName
        Definition

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


        A name associated with the individual.

        ShortThe birthname of the patientA name associated with the patient
        Comments

        The birthname is added with the ISO 21090 qualifier https://www.hl7.org/fhir/extension-iso21090-en-qualifier.html BR


        A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

        Control0..1*
        This element is affected by the following invariants: ele-1
        TypeHumanName(CH EPR FHIR BirthName)
        Is Modifierfalse
        Must Supporttrue
        Requirements

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

        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())
        38. Patient.telecom
        Definition

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

        ShortA contact detail for the individual
        Comments

        A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

        Control0..*
        TypeContactPoint
        Is Modifierfalse
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Patient.telecom. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ system
        • 40. Patient.telecom.system
          Definition

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

          Shortphone | fax | email | pager | url | sms | other
          Control10..1
          This element is affected by the following invariants: cpt-2
          BindingThe codes SHALL be taken from ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
          (required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1)

          Telecommunications form for contact point.

          Typecode
          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()))
          42. Patient.telecom.value
          Definition

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

          ShortThe actual contact point details
          Comments

          Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

          Control10..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

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

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

          Identifies the purpose for the contact point.

          Shorthome | work | temp | old | mobile - purpose of this contact point
          Comments

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

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

          Use of contact point.

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

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

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. Patient.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 (e.g. a telephone number or an email address) by which the individual may be contacted.

          ShortCH Core ContactPoint eCH-0046 EmailA contact detail for the individual
          Comments

          A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

          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()))
          48. Patient.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 (e.g. a telephone number or an email address) by which the individual may be contacted.

          ShortCH Core ContactPoint eCH-0046 PhoneA contact detail for the individual
          Comments

          A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

          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()))
          50. Patient.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 (e.g. a telephone number or an email address) by which the individual may be contacted.

          ShortCH Core ContactPoint eCH-0046 InternetA contact detail for the individual
          Comments

          A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

          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()))
          52. Patient.deceased[x]
          Definition

          Indicates if the individual is deceased or not.

          ShortIndicates if the individual is deceased or not
          Comments

          If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

          Control0..1
          TypeChoice of: boolean, dateTime
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

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

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

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

          Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

          Control0..0*
          TypeBackboneElement
          Is Modifierfalse
          Summaryfalse
          Requirements

          Need to track people you can contact about the patient.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
          pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
          SlicingThis element introduces a set of slices on Patient.contact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ relationship
          • 57. Patient.contact:contact
            Slice Namecontact
            Definition

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

            ShortContact data if it is not address of patientA contact party (e.g. guardian, partner, friend) for the patient
            Comments

            Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

            Control0..0*
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Requirements

            Need to track people you can contact about the patient.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
            pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
            63. Patient.contact:nameOfParent
            Slice NamenameOfParent
            Definition

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

            ShortName of parentA contact party (e.g. guardian, partner, friend) for the patient
            Comments

            Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

            Control0..0*
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Requirements

            Need to track people you can contact about the patient.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
            pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
            68. Patient.communication
            Definition

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

            ShortA language which may be used to communicate with the patient about his or her health
            Comments

            If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Requirements

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

            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 Patient.communication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ preferred
            • 70. Patient.communication.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              72. Patient.communication.language
              Definition

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

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

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

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

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. Patient.communication:languageOfCorrespondence
              Slice NamelanguageOfCorrespondence
              Definition

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

              ShortLanguage of correspondenceA language which may be used to communicate with the patient about his or her health
              Comments

              If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

              Control0..1*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. Patient.communication:languageOfCorrespondence.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())
              78. Patient.communication:languageOfCorrespondence.language
              Definition

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

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

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

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

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

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

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

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

              ShortLanguage preference indicator
              Comments

              This language is specifically identified for communicating healthcare information.

              Control10..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

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

              Fixed Valuetrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              82. Patient.managingOrganization
              Definition

              Organization that is the custodian of the patient record.

              ShortProvider organization of the patientOrganization that is the custodian of the patient record
              Comments

              There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

              Control0..1
              TypeReference(CH PDQm Provider Organization, Organization)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

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

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

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

              ShortLink to another patient resource that concerns the same actual person
              Comments

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

              Control0..*
              TypeBackboneElement
              Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
              Summarytrue
              Requirements

              There are multiple use cases:

              • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
              • Distribution of patient information across multiple servers.
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              86. Patient.link.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())
              88. Patient.link.other
              Definition

              The other patient resource that the link refers to.

              ShortThe other patient or related person resource that the link refers to
              Comments

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

              Control1..1
              TypeReference(Patient, RelatedPerson)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              90. Patient.link.type
              Definition

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

              Shortreplaced-by | replaces | refer | seealso
              Control1..1
              BindingThe codes SHALL be taken from LinkTypehttp://hl7.org/fhir/ValueSet/link-type|4.0.1
              (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

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

              Typecode
              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()))

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

              0. Patient
              Definition

              The CH Core Patient is based upon the core FHIR Patient Resource and designed to meet the applicable patient 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 Patient
              Control0..*
              Is Modifierfalse
              Summaryfalse
              Alternate NamesSubjectOfCare Client Resident
              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-pat-1: At least one HumanName with given and family name must be provided. (name.where(family.exists() and given.exists()).count()>0 or name.empty())
              ch-pat-2: gender unknown is currently not used in Switzerland in eCH and the EPR (gender.empty() or gender!='unknown')
              2. Patient.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. Patient.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. Patient.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

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

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

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

              A human language.

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

              A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

              ShortText summary of the resource, for human interpretation
              Comments

              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

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

              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

              ShortContained, inline Resources
              Comments

              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

              Control0..*
              TypeResource
              Is Modifierfalse
              Summaryfalse
              Alternate Namesinline resources, anonymous resources, contained resources
              14. Patient.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 Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 16. Patient.extension:placeOfBirth
                Slice NameplaceOfBirth
                Definition

                The registered place of birth of the patient.

                ShortPlace of birth of patient
                Control0..1
                TypeExtension(Place of Birth according to eCH-0011) (Extension Type: Address(Address for Place of Birth))
                Is Modifierfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                18. Patient.extension:placeOfOrigin
                Slice NameplaceOfOrigin
                Definition

                The registered place of origin of the patient.

                ShortPlace of origin(s) of patient
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension(Place of Origin according to eCH-0011) (Extension Type: Address)
                Is Modifierfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                20. Patient.extension:citizenship
                Slice Namecitizenship
                Definition

                The content of the country code element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, if the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.

                ShortCitizenship(s) of patient
                Control0..*
                TypeExtension(Patient Citizenship) (Complex Extension)
                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())
                ch-pat-3: ISO Country Alpha-2 or ISO Country Alpha-3 code (((extension.where(url='code').value.coding.code.length()=2) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2')) or ((extension.where(url='code').value.coding.code.length() = 3) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
                22. Patient.extension:religion
                Slice Namereligion
                Definition

                The patient's professed religious affiliations.

                ShortThe patient's professed religious affiliations
                Control0..0
                TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
                Is Modifierfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                24. Patient.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())
                26. Patient.identifier
                Definition

                An identifier for this patient.

                ShortAn identifier for this patient
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control1..*
                TypeIdentifier
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Patients are almost always assigned specific numerical identifiers.

                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 Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ $this
                • 28. Patient.identifier:EPR-SPID
                  Slice NameEPR-SPID
                  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(EPR-SPID Identifier)
                  Is Modifierfalse
                  Must Supporttrue
                  Requirements

                  Patients are almost always assigned specific numerical identifiers.

                  Pattern Value{
                    "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  30. Patient.identifier:AHVN13
                  Slice NameAHVN13
                  Definition

                  The AHVN13 / NAVS13 - (abbreviation for new thirteen-digit Social Security number) - is an administrative identifier for natural persons in Switzerland. It is issued, announced and administered by the Central Compensation Office. It is available to all organisations and communities for which there is a legal basis.

                  ShortAHVN13 / NAVS13 of the patient (13 digits starting with 756, no separation points)
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeIdentifier(AHVN13 / NAVS13 Identifier)
                  Is Modifierfalse
                  Requirements

                  Patients are almost always assigned specific numerical identifiers.

                  Pattern Value{
                    "system" : "urn:oid:2.16.756.5.32"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  32. Patient.identifier:LocalPid
                  Slice NameLocalPid
                  Definition

                  An identifier for this patient.

                  ShortLocal patient identifier(s)
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..*
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Patients are almost always assigned specific numerical identifiers.

                  Pattern Value{
                    "type" : {
                      "coding" : [{
                        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code" : "MR"
                      }]
                    }
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  34. Patient.identifier:LocalPid.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
                  36. Patient.identifier:LocalPid.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 Patient.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 38. Patient.identifier:LocalPid.use
                    Definition

                    The purpose of this identifier.

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

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

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

                    Identifies the purpose for this identifier, if known .

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

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

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

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

                    ShortDescription of identifier
                    Comments

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

                    Control0..1
                    BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                    (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summarytrue
                    Requirements

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    42. Patient.identifier:LocalPid.system
                    Definition

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

                    ShortThe namespace for the identifier value
                    Comments

                    Identifier.system is always case sensitive.

                    Control1..1
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

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

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

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

                    ShortThe value that is unique
                    Comments

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

                    Control1..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Example<br/><b>General</b>:123456
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    46. Patient.identifier:LocalPid.period
                    Definition

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

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

                    Organization that issued/manages the identifier.

                    ShortOrganization that issued id (may be just text)
                    Comments

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

                    Control0..1
                    TypeReference(Organization)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    50. Patient.identifier:insuranceCardNumber
                    Slice NameinsuranceCardNumber
                    Definition

                    Cardnumber Swiss insurance card v1

                    ShortInsurance card number of the patient (20 digits)
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeIdentifier(Insurance Card Number (Identifier))
                    Is Modifierfalse
                    Requirements

                    Patients are almost always assigned specific numerical identifiers.

                    Pattern Value{
                      "system" : "urn:oid:2.16.756.5.30.1.123.100.1.1.1"
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    52. Patient.active
                    Definition

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

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

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

                    ShortWhether this patient's record is in active use
                    Comments

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

                    Control0..1
                    Typeboolean
                    Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to be able to mark a patient 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()))
                    54. Patient.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
                    Must Supporttrue
                    Requirements

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

                    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())
                    SlicingThis element introduces a set of slices on Patient.name. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • profile @ $this
                    • 56. Patient.name:HumanName
                      Slice NameHumanName
                      Definition

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

                      ShortA name associated with the patient
                      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(CH EPR FHIR HumanName)
                      Is Modifierfalse
                      Must Supporttrue
                      Requirements

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

                      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())
                      ch-epr-fhir-1: For birth name (iso21090-EN-qualifier BR) use slice 'name:BirthName' (family.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier' and value='BR').exists()=false)
                      58. Patient.name:BirthName
                      Slice NameBirthName
                      Definition

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

                      ShortThe birthname of the patient
                      Comments

                      The birthname is added with the ISO 21090 qualifier https://www.hl7.org/fhir/extension-iso21090-en-qualifier.html BR

                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeHumanName(CH EPR FHIR BirthName)
                      Is Modifierfalse
                      Must Supporttrue
                      Requirements

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

                      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())
                      60. Patient.telecom
                      Definition

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

                      ShortA contact detail for the individual
                      Comments

                      A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

                      Control0..*
                      TypeContactPoint
                      Is Modifierfalse
                      Summarytrue
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Patient.telecom. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ system
                      • 62. Patient.telecom.id
                        Definition

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

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        64. Patient.telecom.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 Patient.telecom.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 66. Patient.telecom.system
                          Definition

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

                          Shortphone | fax | email | pager | url | sms | other
                          Control1..1
                          This element is affected by the following invariants: cpt-2
                          BindingThe codes SHALL be taken from ContactPointSystem
                          (required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1)

                          Telecommunications form for contact point.

                          Typecode
                          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()))
                          68. Patient.telecom.value
                          Definition

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

                          ShortThe actual contact point details
                          Comments

                          Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

                          Control1..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

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

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

                          Identifies the purpose for the contact point.

                          Shorthome | work | temp | old | mobile - purpose of this contact point
                          Comments

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

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

                          Use of contact point.

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

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

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

                          Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

                          ShortSpecify preferred order of use (1 = highest)
                          Comments

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

                          Control0..1
                          TypepositiveInt
                          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()))
                          74. Patient.telecom.period
                          Definition

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

                          ShortTime period when the contact point was/is in use
                          Control0..1
                          TypePeriod
                          Is Modifierfalse
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          76. Patient.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

                          A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

                          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()))
                          78. Patient.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

                          A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

                          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()))
                          80. Patient.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

                          A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

                          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()))
                          82. Patient.gender
                          Definition

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

                          Shortmale | female | other
                          Comments

                          The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

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

                          The gender of a person used for administrative purposes.

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

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

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

                          The date of birth for the individual.

                          ShortThe date of birth for the individual
                          Comments

                          At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

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

                          Age of the individual drives many clinical processes.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          LOINC Code21112-8
                          86. Patient.deceased[x]
                          Definition

                          Indicates if the individual is deceased or not.

                          ShortIndicates if the individual is deceased or not
                          Comments

                          If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

                          Control0..1
                          TypeChoice of: boolean, dateTime
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

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

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

                          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'))))
                          90. Patient.maritalStatus
                          Definition

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

                          ShortMarital (civil) status of a patient
                          Control0..1
                          BindingUnless not suitable, these codes SHALL be taken from ChCoreMaritalStatus
                          (extensible to http://fhir.ch/ig/ch-core/ValueSet/ch-core-maritalstatus)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Most, if not all systems capture it.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          92. Patient.maritalStatus.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
                          94. Patient.maritalStatus.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 Patient.maritalStatus.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 96. Patient.maritalStatus.extension:maritalDataSeparation
                            Slice NamemaritalDataSeparation
                            Definition

                            Extension for eCH-0011 - MaritalData - separation

                            ShortMaritalData Separation
                            Control0..1
                            TypeExtension(Marital Data - Separation Type) (Extension Type: CodeableConcept)
                            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())
                            98. Patient.maritalStatus.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()))
                            100. Patient.maritalStatus.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()))
                            102. Patient.multipleBirth[x]
                            Definition

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

                            ShortWhether patient is part of a multiple birth
                            Comments

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

                            Control0..1
                            TypeChoice of: boolean, integer
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

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

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

                            Image of the patient.

                            ShortImage of the patient
                            Comments

                            Guidelines:

                            • Use id photos, not clinical photos.
                            • Limit dimensions to thumbnail.
                            • Keep byte count low to ease resource updates.
                            Control0..*
                            TypeAttachment
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

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

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

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

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

                            Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

                            Control0..0
                            TypeBackboneElement
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Need to track people you can contact about the patient.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                            SlicingThis element introduces a set of slices on Patient.contact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ relationship
                            • 118. Patient.contact:contact
                              Slice Namecontact
                              Definition

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

                              ShortContact data if it is not address of patient
                              Comments

                              Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

                              Control0..0
                              TypeBackboneElement
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Need to track people you can contact about the patient.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                              130. Patient.contact:nameOfParent
                              Slice NamenameOfParent
                              Definition

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

                              ShortName of parent
                              Comments

                              Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

                              Control0..0
                              TypeBackboneElement
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Need to track people you can contact about the patient.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                              142. Patient.communication
                              Definition

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

                              ShortA language which may be used to communicate with the patient about his or her health
                              Comments

                              If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

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

                              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 Patient.communication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ preferred
                              • 144. Patient.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
                                146. Patient.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())
                                148. Patient.communication.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summarytrue
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Namesextensions, user content, modifiers
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                150. Patient.communication.language
                                Definition

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

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

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

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

                                A human language.

                                Additional BindingsPurpose
                                AllLanguagesMax Binding
                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

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

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

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

                                ShortLanguage preference indicator
                                Comments

                                This language is specifically identified for communicating healthcare information.

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

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

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                154. Patient.communication:languageOfCorrespondence
                                Slice NamelanguageOfCorrespondence
                                Definition

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

                                ShortLanguage of correspondence
                                Comments

                                If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

                                Control0..1
                                TypeBackboneElement
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

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

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                156. Patient.communication:languageOfCorrespondence.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
                                158. Patient.communication:languageOfCorrespondence.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())
                                160. Patient.communication:languageOfCorrespondence.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())
                                162. Patient.communication:languageOfCorrespondence.language
                                Definition

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

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

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

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

                                A human language.

                                Additional BindingsPurpose
                                AllLanguagesMax Binding
                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

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

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

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

                                ShortLanguage preference indicator
                                Comments

                                This language is specifically identified for communicating healthcare information.

                                Control1..1
                                Typeboolean
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Requirements

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

                                Fixed Valuetrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                166. Patient.generalPractitioner
                                Definition

                                Patient's nominated care provider.

                                ShortPatient's nominated primary care provider
                                Comments

                                This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

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

                                Control0..*
                                TypeReference(Organization, Practitioner, PractitionerRole)
                                Is Modifierfalse
                                Summaryfalse
                                Alternate NamescareProvider
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                168. Patient.managingOrganization
                                Definition

                                Organization that is the custodian of the patient record.

                                ShortProvider organization of the patient
                                Comments

                                There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

                                Control0..1
                                TypeReference(CH PDQm Provider Organization)
                                Is Modifierfalse
                                Must Supporttrue
                                Summarytrue
                                Requirements

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

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

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

                                ShortLink to another patient resource that concerns the same actual person
                                Comments

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

                                Control0..*
                                TypeBackboneElement
                                Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
                                Summarytrue
                                Requirements

                                There are multiple use cases:

                                • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
                                • Distribution of patient information across multiple servers.
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                172. Patient.link.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
                                174. Patient.link.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())
                                176. Patient.link.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())
                                178. Patient.link.other
                                Definition

                                The other patient resource that the link refers to.

                                ShortThe other patient or related person resource that the link refers to
                                Comments

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

                                Control1..1
                                TypeReference(Patient, RelatedPerson)
                                Is Modifierfalse
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                180. Patient.link.type
                                Definition

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

                                Shortreplaced-by | replaces | refer | seealso
                                Control1..1
                                BindingThe codes SHALL be taken from LinkType
                                (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

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

                                Typecode
                                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()))