# Patient example - Da Vinci - Coverage Requirements Discovery v2.2.1

## Example Patient: Patient example

Language: en

Amy V. Shaw Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))

-------

| | |
| :--- | :--- |
| Active: | true |
| Alt. Name: | Amy V. Baxter |
| Contact Detail | * ph: 555-555-5555(Home)
* [amy.shaw@example.org](mailto:amy.shaw@example.org)
* 49 Meadow St Mounds OK 74047 US 
* 183 Mountain View St Mounds OK 74048 US 
 |
| US Core Ethnicity Extension: | * ombCategory: [Race & Ethnicity - CDC: 2135-2](http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2135-2) (Hispanic or Latino)
* detailed: [Race & Ethnicity - CDC: 2148-5](http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2148-5) (Mexican)
* text: Hispanic or Latino
 |
| [US Core Birth Sex Extension](http://hl7.org/fhir/us/core/STU7/StructureDefinition-us-core-birthsex.html) | F |
| US Core Race Extension: | * ombCategory: [Race & Ethnicity - CDC: 2028-9](http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2028-9) (Asian)
* detailed: [Race & Ethnicity - CDC: 2036-2](http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-cdcrec.html#cdcrec-2036-2) (Filipino)
* text: Mixed
 |



## Resource Content

```json
{
  "resourceType" : "Patient",
  "id" : "example",
  "language" : "en",
  "extension" : [{
    "extension" : [{
      "url" : "ombCategory",
      "valueCoding" : {
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2028-9",
        "display" : "Asian"
      }
    },
    {
      "url" : "detailed",
      "valueCoding" : {
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2036-2",
        "display" : "Filipino"
      }
    },
    {
      "url" : "text",
      "valueString" : "Mixed"
    }],
    "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
  },
  {
    "extension" : [{
      "url" : "ombCategory",
      "valueCoding" : {
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2135-2",
        "display" : "Hispanic or Latino"
      }
    },
    {
      "url" : "detailed",
      "valueCoding" : {
        "system" : "urn:oid:2.16.840.1.113883.6.238",
        "code" : "2148-5",
        "display" : "Mexican"
      }
    },
    {
      "url" : "text",
      "valueString" : "Hispanic or Latino"
    }],
    "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
  },
  {
    "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
    "valueCode" : "F"
  }],
  "identifier" : [{
    "use" : "usual",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code" : "MR"
      }],
      "text" : "Medical Record Number"
    },
    "system" : "http://example.org/NamingSystem/mrn",
    "value" : "1032702"
  }],
  "active" : true,
  "name" : [{
    "family" : "Shaw",
    "given" : ["Amy", "V."],
    "period" : {
      "start" : "2016-12-06",
      "end" : "2020-07-22"
    }
  },
  {
    "family" : "Baxter",
    "given" : ["Amy", "V."],
    "suffix" : ["PharmD"],
    "period" : {
      "start" : "2020-07-22"
    }
  }],
  "telecom" : [{
    "system" : "phone",
    "value" : "555-555-5555",
    "use" : "home"
  },
  {
    "system" : "email",
    "value" : "amy.shaw@example.org"
  }],
  "gender" : "female",
  "birthDate" : "1987-02-20",
  "address" : [{
    "line" : ["49 Meadow St"],
    "city" : "Mounds",
    "state" : "OK",
    "postalCode" : "74047",
    "country" : "US",
    "period" : {
      "start" : "2016-12-06",
      "end" : "2020-07-22"
    }
  },
  {
    "line" : ["183 Mountain View St"],
    "city" : "Mounds",
    "state" : "OK",
    "postalCode" : "74048",
    "country" : "US",
    "period" : {
      "start" : "2020-07-22"
    }
  }]
}

```
