<?xml version="1.0" encoding="UTF-8"?>

<Patient xmlns="http://hl7.org/fhir">
  <id value="patient-example-sex-and-gender"/>
  <extension url="http://hl7.org/fhir/StructureDefinition/individual-genderIdentity">
    <extension url="value">
      <valueCodeableConcept>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="446141000124107"/>
          <display value="Female gender identity"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="period">
      <valuePeriod>
        <start value="2001-05-06"/>
      </valuePeriod>
    </extension>
    <extension url="comment">
      <valueString value="Patient transitioned from male to female in 2001."/>
    </extension>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/individual-pronouns">
    <extension url="value">
      <valueCodeableConcept>
        <coding>
          <system value="http://loinc.org"/>
          <code value="LA29519-8"/>
          <display value="she/her/her/hers/herself"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="period">
      <valuePeriod>
        <start value="2001-05-06"/>
      </valuePeriod>
    </extension>
    <extension url="comment">
      <valueString value="Patient transitioned from male to female in 2001."/>
    </extension>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender">
    <extension url="value">
      <valueCodeableConcept>
        <coding>
          <system value="http://hl7.org/fhir/administrative-gender"/>
          <code value="male"/>
          <display value="Male"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="type">
      <valueCodeableConcept>
        <coding>
          <system value="http://loinc.org"/>
          <code value="76689-9"/>
          <display value="Sex Assigned At Birth"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="effectivePeriod">
      <valuePeriod>
        <start value="1974-12-25"/>
      </valuePeriod>
    </extension>
    <extension url="acquisitionDate">
      <valueDateTime value="2005-12-06"/>
    </extension>
    <extension url="sourceDocument">
      <!--  Reference to a scan of the birth certificate  -->
      <valueReference>
        <reference value="DocumentReference/1"/>
      </valueReference>
    </extension>
    <extension url="sourceField">
      <valueString value="SEX"/>
    </extension>
    <extension url="jurisdiction">
      <valueCodeableConcept>
        <coding>
          <system value="https://www.usps.com/"/>
          <code value="OH"/>
          <display value="Ohio"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="comment">
      <valueString value="Patient transitioned from male to female in 2001, but their birth certificate still indicates male."/>
    </extension>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender">
    <extension url="value">
      <valueCodeableConcept>
        <coding>
          <system value="http://hl7.org/fhir/administrative-gender"/>
          <code value="male"/>
          <display value="Male"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="type">
      <valueCodeableConcept>
        <coding>
          <system value="http://local-code-system.org/recorded-sex-or-gender-type"/>
          <code value="insurance-card"/>
          <display value="Insurance Card"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="effectivePeriod">
      <valuePeriod>
        <start value="2021-05-25"/>
      </valuePeriod>
    </extension>
    <extension url="acquisitionDate">
      <valueDateTime value="2021-06-06"/>
    </extension>
    <extension url="sourceDocument">
      <!--  Reference to a scan of the insurance card -->
      <valueReference>
        <reference value="DocumentReference/2"/>
      </valueReference>
    </extension>
    <extension url="sourceField">
      <valueString value="SEX"/>
    </extension>
    <extension url="jurisdiction">
      <valueCodeableConcept>
        <coding>
          <system value="http://local-code-system.org/recorded-sex-or-gender-jurisdiction"/>
          <code value="ICCA-P"/>
          <display value="Indigo Crucifix Cobalt Aegis Payer"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="comment">
      <valueString value="Patient transitioned from male to female in 2001, but her insurance card still indicates male."/>
    </extension>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender">
    <extension url="value">
      <valueCodeableConcept>
        <coding>
          <system value="http://ohio.example.gov/drivers-license-sex"/>
          <code value="M"/>
          <display value="Male"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="type">
      <valueCodeableConcept>
        <coding>
          <system value="http://jurisdiction-specific.example.com/document-type-code-system"/>
          <code value="drivers-license"/>
          <display value="Driver's License"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="effectivePeriod">
      <valuePeriod>
        <start value="1974-12-25"/>
      </valuePeriod>
    </extension>
    <extension url="acquisitionDate">
      <valueDateTime value="2005-12-06"/>
    </extension>
    <extension url="sourceDocument">
      <!--  Reference to a scan of the driver's license  -->
      <valueReference>
        <reference value="DocumentReference/1"/>
      </valueReference>
    </extension>
    <extension url="jurisdiction">
      <valueCodeableConcept>
        <coding>
          <system value="https://www.usps.com/"/>
          <code value="OH"/>
          <display value="Ohio"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="comment">
      <valueString value="Patient transitioned from male to female in 2001, but their driver's license still indicates male."/>
    </extension>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/patient-sexParameterForClinicalUse">
    <extension url="value">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/sex-parameter-for-clinical-use"/>
          <code value="specified"/>
          <display value="Apply specified setting or reference range"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="period">
      <valuePeriod>
        <start value="2002-07-13"/>
      </valuePeriod>
    </extension>
    <extension url="comment">
      <valueString value="Patient transitioned from male to female in 2001."/>
    </extension>
    <extension url="supportingInfo">
      <!--  Observation about an organ inventory (prostate)  -->
      <valueReference>
        <reference value="Observation/1"/>
      </valueReference>
    </extension>
    <extension url="supportingInfo">
      <!--  MedicationStatement indicating patient underwent hormone therapy  -->
      <valueReference>
        <reference value="MedicationStatement/2"/>
      </valueReference>
    </extension>
  </extension>
  <identifier>
    <use value="usual"/>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MR"/>
      </coding>
    </type>
    <system value="urn:oid:1.2.36.146.595.217.0.1"/>
    <value value="12345"/>
  </identifier>
  <active value="true"/>
  <!--  Legal Name: Patrick Roth, goes by Patricia (formally), but also Pat (informally)  -->
  <name>
    <use value="official"/>
    <family value="Roth"/>
    <given value="Patrick"/>
  </name>
  <name>
    <use value="usual"/>
    <family value="Roth"/>
    <given value="Patricia"/>
  </name>
  <name>
    <use value="nickname"/>
    <given value="Pat"/>
  </name>
  <gender value="male"/>
  <birthDate value="1974-12-25"/>
  <deceasedBoolean value="false"/>
  <managingOrganization>
    <reference value="Organization/1"/>
  </managingOrganization>
</Patient>