Da Vinci Payer Data Exchange
2.1.1 - STU 2.1

Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions

## US Core Patient

Page standards status: Informative

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The US Core 3.1.1 Patient or US Core 6.1.0 Patient resource *SHALL** be used to express a member's demographic information.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core 3.1.1 Patient or US Core 6.1.0 Patient resource are:

R4 Element | Name | Cardinality | Type
--- | --- | --- | ---
Patient.us-core-race | us-core-race | 0..1 | (Complex)
Patient.us-core-ethnicity | us-core-ethnicity | 0..1 | (Complex)
Patient.us-core-birthsex | us-core-birthsex | 0..1 | code
Patient.identifier | identifier | 1..* | Identifier
Patient.identifier.system | system | 1..1 | uri
Patient.identifier.value | value | 1..1 | string
Patient.name | name | 1..* | HumanName
Patient.name.family | family | 0..1 | string
Patient.name.given | given | 0..* | string
Patient.telecom | telecom | 0..* | ContactPoint
Patient.telecom.system | system | 1..1 | code
Patient.telecom.value | value | 1..1 | string
Patient.telecom.use | use | 0..1 | code
Patient.gender | gender | 1..1 | code
Patient.birthDate | birthDate | 0..1 | date
Patient.address | address | 0..* | Address
Patient.address.line | line | 0..* | string
Patient.address.city | city | 0..1 | string
Patient.address.state | state | 0..1 | string
Patient.address.postalCode | postalCode | 0..1 | string
Patient.address.period | period | 0..1 | Period
Patient.communication | communication | 0..* | BackboneElement
Patient.communication.language | language | 1..1 | CodeableConcept

Table Definition

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the Patient resource from the CPCDS file are:

US Core Element | Must Support | Cardinality | CARIN-BB Element | CPCDS Element Mapping or Implementer Note
--- | --- | --- | --- | ---
Patient.meta.lastUpdated |  | 0..1 | Patient.meta.lastUpdated | [{"163":"Member Demographics Last Updated Date"}]
Patient.us-core-race | S | 0..1 | Patient.us-core-race | [{"128":"Race Code"}]
Patient.us-core-ethnicity | S | 0..1 | Patient.us-core-ethnicity | [{"129":"Ethnicity"}]
Patient.us-core-birthsex | S | 0..1 | Patient.us-core-birthsex | [{"153":"Birth Sex"}]
Patient.identifier | S | 1..* | Patient.identifier | [{"MMI=1":"Member id"}, {"191":"Unique Member ID"}, {"PatnAcctNr=109, MedRecNr=110":"Patient account number, Medical record number"}]. Note: Assign Payer System URI for Member Ids in Patient.identifier.system. Set Member Id in Patient.identifier.value
Patient.identifier.system | S | 1..1 |  | Note: Assign Payer System URI for Member Ids in Patient.identifier.system
Patient.identifier.value | S | 1..1 |  | Note: Set Member Id in Patient.identifier.value
Patient.name | S | 1..* | Patient.name | [{"130":"Patient Name"}] Note: Split Member Name into Patient.name.family, Patient.name.given
Patient.name.family | S | 0..1 |  | Note: Split Member Name into Patient.name.family, Patient.name.given
Patient.name.given | S | 0..* |  | Note: Split Member Name into Patient.name.family, Patient.name.given
Patient.telecom | S | 0..* |  | Note: Provide contact information from member record, if available
Patient.telecom.system | S | 1..1 |  | Note: phone | fax | email | pager | url | sms | other - if avaiable
Patient.telecom.value | S | 1..1 |  | Note: provide contact information from member record, if available
Patient.telecom.use | S | 0..1 |  | Note: provide home | work | temp | old | mobile if known
Patient.gender | S | 1..1 | Patient.gender | [{"71":"Gender code"}]
Patient.birthDate | S | 0..1 | Patient.birthDate | [{"70":"Date of birth"}]
Patient.deceasedBoolean |  |  | Patient.deceasedBoolean | [{"150":"Deceased"}]
Patient.deceasedDateTime |  |  | Patient.deceasedDateTime | [{"124":"Date of death"}]
Patient.address | S | 0..* |  | Note: Provide address elements, if available
Patient.address.line | S | 0..* | Patient.address.line | [{"158":"Street Address"}]
Patient.address.city | S | 0..1 |  | Note: Provide city, if available
Patient.address.district |  | 0..1 | Patient.address.district | [{"125":"County"}]
Patient.address.state | S | 0..1 | Patient.address.state | [{"126":"State"}]
Patient.address.postalCode | S | 0..1 | Patient.address.postalCode | [{"131":"Zip"}]
Patient.address.country |  | 0..1 | Patient.address.country | [{"127":"Country"}]
Patient.address.period | S | 0..1 |  | Note: Provide validity period for address, if available
Patient.communication | S | 0..* |  | . Note: Provide preferred communication language via language code below, if available
Patient.communication.language | S | 1..1 |  | Note: Provide preferred communication language, if available

Table Definition

The Member Number will be entered in the identifier field. The code MB SHALL be used to identify the member identifier. See the example below:

    {
          "use" : "member",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/v2/0203",
                "code" : "MB",
                "display" : "Member Number"
              }
            ],
            "text" : "Health Plan Member Number"
          },
          "system" : "http://plan.healthplan.com",
          "value" : "987654321"
        }

#### Example Patient Resource

An example mapping of a Patient resource is shown here:

    {
      "resourceType" : "Patient",
      "id" : "example",
      "meta" : {
        "profile" : [
          "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "

    				Generated Narrative with Details

    				id: example

    				identifier: Medical Record Number = 1032702 (USUAL)

    				identifier: Health Plan Member Number = 987654321 (USUAL)

    				active: true

    				name: Arthur B. Dent

    				telecom: ph: 555-555-5555(HOME), amy.shaw@example.com

    				gender:

    				birthsex: Male

    				birthDate: Jan 22, 1953

    				address: 6518 Meadowridge Rd, Elkridge, MD 21075 US

    				race: White, American Indian or Alaska Native, Asian, Shoshone, Filipino

    				ethnicity: Hispanic or Latino, Dominican, Mexican
    		"
      },
      "extension" : [
        {
          "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" : "2106-3",
                "display" : "White"
              }
            },
            {
              "url" : "ombCategory",
              "valueCoding" : {
                "system" : "urn:oid:2.16.840.1.113883.6.238",
                "code" : "1002-5",
                "display" : "American Indian or Alaska Native"
              }
            },
            {
              "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" : "1586-7",
                "display" : "Shoshone"
              }
            },
            {
              "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-ethnicity",
          "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" : "2184-0",
                "display" : "Dominican"
              }
            },
            {
              "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-birthsex",
          "valueCode" : "M"
        }
      ],
      "identifier" : [
        {
          "use" : "member",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/v2/0203",
                "code" : "MB",
                "display" : "Member Number"
              }
            ],
            "text" : "Health Plan Member Number"
          },
          "system" : "http://plan.healthplan.com",
          "value" : "987654321"
        },
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/v2/0203",
                "code" : "MR",
                "display" : "Medical Record Number"
              }
            ],
            "text" : "Medical Record Number"
          },
          "system" : "http://hospital.smarthealthit.org",
          "value" : "1032702"
        }
      ],
      "active" : true,
      "name" : [
        {
          "family" : "Dent",
          "given" : [
            "Arthur",
            "B."
          ]
        }
      ],
      "telecom" : [
        {
          "system" : "phone",
          "value" : "555-555-5555",
          "use" : "home"
        },
        {
          "system" : "email",
          "value" : "arthur.dent@example.com"
        }
      ],
      "gender" : "male",
      "birthDate" : "1953-01-22",
      "address" : [
        {
          "line" : [
            "6518 Meadowridge Rd"
          ],
          "city" : "Elkridge",
          "state" : "MD",
          "postalCode" : "21075",
          "country" : "US"
        }
      ]
    }

Refer to the US Core Additional examples of the US Core 3.1.1 or US Core 6.1.0 Implementation Guide for further examples of completed Patient Profiles.

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