CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0 - STU 2.1 flag

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

Resource Profile: C4BB Patient

Official URL: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient Version: 2.1.0
Standards status: Trial-use Computable Name: C4BBPatient

This profile builds upon the US Core Patient profile. It is used to convey information about the patient who received the services described on the claim.

Notes on Fields

  • The Patient FHIR Resource defines a comprehensive set of data elements.  Many of them are not relevant to this use case.  When reviewing the Profile Snapshot, several data elements previously hidden are now exposed.  Fields intended for consideration to be provided in the API are marked as Must Support; i.e., a red S or have a minimum cardinality of 1.  All other data elements are not expected to be sent by a Responder; if they are sent a Requestor can choose to ignore them
  • The Member Id is the identifier payers assign to a beneficiary for a contract; it may be different for various lines of business; ie. QHP vs MA. The Unique Member Id is a mastered identifier across all lines of business.
  • Payers may decide to provide either the data that was in effect as of the date of service or the current data.
  • .meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last. Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.
  • The CPCDS data elements are defined in the data element comments.  The numbers, e.g. (1), following the data element descriptions in the comments correlate to the MapID in the CPCDS Data Dictionary and the Mapping Worksheet as described here.
  • meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest.

 

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Patient C 0..* USCorePatientProfile(6.1.0) Information about an individual or animal receiving health care services
This profile also complies with the profile US Core Patient Profile (3.1.1)
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
patient-meta-profile-version: Patient: meta.profile with canonical and major.minor. version required.
... meta SΣ 1..1 Meta Metadata about the resource
ele-1: All FHIR elements must have a @value or children
.... lastUpdated SΣ 1..1 instant When the resource version last changed
ele-1: All FHIR elements must have a @value or children
.... profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... Slices for extension Content/Rules for all slices
.... race 0..1 (Complex) (USCDI) US Core Race Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... ethnicity 0..1 (Complex) (USCDI) US Core ethnicity Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... tribalAffiliation 0..* (Complex) (USCDI) Tribal Affiliation Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... birthsex 0..1 code Birth Sex Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex
Binding: Birth Sex (required): Code for sex assigned at birth


ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sex 0..1 code (USCDI) Sex Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex
Binding: Sex . (required): Concepts limited to Male, Female, Patient Sex Unknown, asked-declined.


ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... genderIdentity 0..* CodeableConcept (USCDI) The individual's gender identity
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity
Binding: Gender Identity . (extensible)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... Slices for identifier SΣ 1..* Identifier (USCDI) An identifier for this patient
Slice: Unordered, Open by value:type
ele-1: All FHIR elements must have a @value or children
.... identifier:All Slices Content/Rules for all slices
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: C4BB Patient Identifier Type Value Set (extensible)
ele-1: All FHIR elements must have a @value or children
..... system SΣ 1..1 uri (USCDI) The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string (USCDI) The value that is unique within the system.
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... identifier:memberid SΣ 1..* Identifier Member ID
ele-1: All FHIR elements must have a @value or children
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: C4BB Patient Identifier Type Value Set (extensible)
ele-1: All FHIR elements must have a @value or children
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
..... system SΣ 1..1 uri (USCDI) The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string (USCDI) The value that is unique within the system.
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... identifier:uniquememberid SΣ 0..* Identifier Unique Member ID
ele-1: All FHIR elements must have a @value or children
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: C4BB Patient Identifier Type Value Set (extensible)
ele-1: All FHIR elements must have a @value or children
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: um
..... system SΣ 1..1 uri (USCDI) The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string (USCDI) The value that is unique within the system.
ele-1: All FHIR elements must have a @value or children
Example General: 123456
... active ?!Σ 0..1 boolean Whether this patient's record is in active use
ele-1: All FHIR elements must have a @value or children
... name SΣC 1..* HumanName (USCDI) A name associated with the patient
ele-1: All FHIR elements must have a @value or children
us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
.... use ?!Σ 0..1 code (USCDI) usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.


ele-1: All FHIR elements must have a @value or children
.... family SΣC 0..1 string (USCDI) Family name (often called 'Surname')
ele-1: All FHIR elements must have a @value or children
.... given SΣC 0..* string (USCDI) Given names (not always 'first'). Includes middle names
ele-1: All FHIR elements must have a @value or children
This repeating element order: Given Names appear in the correct order for presenting the name
... telecom Σ 0..* ContactPoint (USCDI) A contact detail for the individual
ele-1: All FHIR elements must have a @value or children
.... system SΣC 1..1 code (USCDI) phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.


ele-1: All FHIR elements must have a @value or children
.... value SΣ 1..1 string (USCDI) The actual contact point details
ele-1: All FHIR elements must have a @value or children
.... use ?!SΣ 0..1 code (USCDI) home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required)
ele-1: All FHIR elements must have a @value or children
... gender SΣ 1..1 code (USCDI) male | female | other | unknown
Binding: AdministrativeGender (required)
ele-1: All FHIR elements must have a @value or children
... birthDate SΣ 0..1 date (USCDI) The date of birth for the individual
ele-1: All FHIR elements must have a @value or children
... Slices for deceased[x] ?!SΣ 0..1 (USCDI) Indicates if the individual is deceased or not
Slice: Unordered, Open by type:$this
ele-1: All FHIR elements must have a @value or children
.... deceasedBoolean boolean
.... deceasedDateTime dateTime
.... deceased[x]:deceasedDateTime ?!Σ 0..1 dateTime (USCDI) Indicates if the individual is deceased or not
ele-1: All FHIR elements must have a @value or children
... address SΣ 0..* Address (USCDI) An address for the individual
ele-1: All FHIR elements must have a @value or children
.... use ?!Σ 0..1 code (USCDI) home | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


ele-1: All FHIR elements must have a @value or children
Example General: home
.... line SΣ 0..* string (USCDI) Street name, number, direction & P.O. Box etc.
ele-1: All FHIR elements must have a @value or children
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ 0..1 string (USCDI) Name of city, town etc.
ele-1: All FHIR elements must have a @value or children
Example General: Erewhon
.... state SΣ 0..1 string (USCDI) Sub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.


ele-1: All FHIR elements must have a @value or children
.... postalCode SΣ 0..1 string (USCDI) US Zip Codes
ele-1: All FHIR elements must have a @value or children
Example General: 9132
.... country SΣ 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
ele-1: All FHIR elements must have a @value or children
... communication 0..* BackboneElement (USCDI) A language which may be used to communicate with the patient about his or her health
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... language S 1..1 CodeableConcept (USCDI) The language which can be used to communicate with the patient about his or her health
Binding: Language codes with language and optionally a region modifier (extensible)
ele-1: All FHIR elements must have a @value or children
... link ?!Σ 0..* BackboneElement Link to another patient resource that concerns the same actual person
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... other Σ 1..1 Reference(Patient | RelatedPerson) The other patient or related person resource that the link refers to
ele-1: All FHIR elements must have a @value or children
.... type Σ 1..1 code replaced-by | replaces | refer | seealso
Binding: LinkType (required): The type of link between this patient resource and another patient resource.


ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Patient.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Patient.identifier.typeextensibleC4BBPatientIdentifierType
http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPatientIdentifierType
from this IG
Patient.identifier:memberid.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Patient.identifier:memberid.typeextensiblePattern: MB
http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPatientIdentifierType
from this IG
Patient.identifier:uniquememberid.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Patient.identifier:uniquememberid.typeextensiblePattern: um
http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPatientIdentifierType
from this IG
Patient.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
Patient.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system
from the FHIR Standard
Patient.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use
from the FHIR Standard
Patient.genderrequiredAdministrativeGender
http://hl7.org/fhir/ValueSet/administrative-gender
from the FHIR Standard
Patient.address.userequiredAddressUse
http://hl7.org/fhir/ValueSet/address-use|4.0.1
from the FHIR Standard
Patient.address.stateextensibleUspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Patient.communication.languageextensibleLanguageCodesWithLanguageAndOptionallyARegionModifier
http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.typerequiredLinkType
http://hl7.org/fhir/ValueSet/link-type|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
patient-meta-profile-versionwarningPatientPatient: meta.profile with canonical and major.minor. version required.
: meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient|2.1'))

 

Other representations of profile: CSV, Excel, Schematron