Vital Records Common Library (VRCL) FHIR Implementation Guide
2.0.0 - STU2 United States of America flag

Vital Records Common Library (VRCL) FHIR Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/vr-common-library/ and changes regularly. See the Directory of published versions

Resource Profile: PractitionerVitalRecords - Detailed Descriptions

Active as of 2024-10-11

Definitions for the Practitioner-vr resource profile.

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

0. Practitioner
2. Practitioner.identifier:NPI
Slice NameNPI
ShortPractitioner's NPI Number
NoteThis is a business identifier, not a resource identifier (see discussion)
4. Practitioner.name
Shortname
Control0..1
6. Practitioner.name.text
Shortname
8. Practitioner.address
Shortaddress
10. Practitioner.address.extension:predir
Slice Namepredir
Control0..1
TypeExtension(PreDirectional Vital Records) (Extension Type: string)
12. Practitioner.address.extension:stnum
Slice Namestnum
Control0..1
TypeExtension(StreetNumber Vital Records) (Extension Type: string)
14. Practitioner.address.extension:stname
Slice Namestname
Control0..1
TypeExtension(StreetName Vital Records) (Extension Type: string)
16. Practitioner.address.extension:stdesig
Slice Namestdesig
Control0..1
TypeExtension(StreetDesignator Vital Records) (Extension Type: string)
18. Practitioner.address.extension:postdir
Slice Namepostdir
Control0..1
TypeExtension(PostDirectional Vital Records) (Extension Type: string)
20. Practitioner.address.extension:unitnumber
Slice Nameunitnumber
Control0..1
TypeExtension(UnitOrAptNumber Vital Records) (Extension Type: string)
22. Practitioner.address.city
Shortcity
24. Practitioner.address.city.extension
SlicingThis element introduces a set of slices on Practitioner.address.city.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 26. Practitioner.address.city.extension:cityCode
    Slice NamecityCode
    Definition

    Numeric code from in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

    ShortCity Code
    Control0..1
    TypeExtension(City Code Vital Records) (Extension Type: positiveInt)
    LabelCity Code
    28. Practitioner.address.district
    Shortcounty
    30. Practitioner.address.district.extension
    SlicingThis element introduces a set of slices on Practitioner.address.district.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 32. Practitioner.address.district.extension:districtCode
      Slice NamedistrictCode
      Definition

      Numeric code in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

      ShortCounty code
      Control0..1
      TypeExtension(District Code Vital Records) (Extension Type: positiveInt)
      LabelCounty code
      34. Practitioner.address.state
      BindingThe codes SHALL be taken from Value Set - States, Territories and Provinces Vital Records
      (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
      36. Practitioner.address.postalCode
      Shortzip
      38. Practitioner.address.country
      BindingThe codes SHALL be taken from Value Set - Residence Country Vital Records
      (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-residence-country-vr)
      40. Practitioner.qualification
      ShortPractitioner's certification, licenses, or training pertaining to the provision of care

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

      0. Practitioner
      Definition

      -


      A person who is directly or indirectly involved in the provisioning of healthcare.

      ShortA person with a formal responsibility in the provisioning of healthcare or related services
      Comments

      -

      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate NamesProvider
      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())
      2. Practitioner.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. Practitioner.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())
      6. Practitioner.identifier
      Definition

      An identifier that applies to this person in this role.

      ShortAn identifier for the person as this agent
      Comments

      NPI must be supported as the identifier system in the US, Tax id is allowed, Local id is allowed in addition to another identifier supplied by a jurisdictional authority such as a practitioner's Drug Enforcement Administration (DEA) number.

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

      Often, specific identities are assigned for the agent.

      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 Practitioner.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • pattern @ $this
      • 8. Practitioner.identifier:NPI
        Slice NameNPI
        Definition

        An identifier that applies to this person in this role.

        ShortPractitioner's NPI NumberAn identifier for the person as this agent
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..1*
        TypeIdentifier
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Often, specific identities are assigned for the agent.

        Pattern Value{
          "system" : "http://hl7.org/fhir/sid/us-npi"
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. Practitioner.name
        Definition

        The name(s) associated with the practitioner.

        ShortnameThe name(s) associated with the practitioner
        Comments

        The selection of the use property should ensure that there is a single usual name specified, and others use the nickname (alias), old, or other values as appropriate.

        In general, select the value to be used in the ResourceReference.display based on this:

        1. There is more than 1 name
        2. Use = usual
        3. Period is current to the date of the usage
        4. Use = official
        5. Other order as decided by internal business rules.
        Control10..1*
        TypeHumanName
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. Practitioner.name.use
        Definition

        Identifies the purpose for this name.

        Shortusual | official | temp | nickname | anonymous | old | maiden
        Comments

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

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

        The use of a human name.

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

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. Practitioner.name.text
        Definition

        Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

        ShortnameText representation of the full name
        Comments

        Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

        A renderable, unencoded form.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Practitioner.name.family
        Definition

        The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

        ShortFamily name (often called 'Surname')
        Comments

        Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

        Control10..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Alternate Namessurname
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. Practitioner.telecom
        Definition

        A contact detail for the practitioner, e.g. a telephone number or an email address.

        ShortA contact detail for the practitioner (that apply to all roles)
        Comments

        Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

        Control0..*
        TypeContactPoint
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Need to know how to reach a practitioner independent to any roles the practitioner may have.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Practitioner.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
        Control0..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
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Practitioner.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.

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        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()))
        24. Practitioner.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()))
        26. Practitioner.address
        Definition

        Address(es) of the practitioner that are not role specific (typically home address). Work addresses are not typically entered in this property as they are usually role dependent.

        ShortaddressAddress(es) of the practitioner that are not role specific (typically home address)
        Comments

        The PractitionerRole does not have an address value on it, as it is expected that the location property be used for this purpose (which has an address).

        Control0..*
        TypeAddress
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. Practitioner.address.extension:predir
        Slice Namepredir
        Definition

        PreDirectional component of address as defined by USPS

        ShortPreDirectional Vital Records
        Control0..1
        TypeExtension(PreDirectional Vital Records) (Extension Type: string)
        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())
        30. Practitioner.address.extension:stnum
        Slice Namestnum
        Definition

        StreetNumber component of address as defined by USPS

        ShortStreetNumber Vital Records
        Control0..1
        TypeExtension(StreetNumber Vital Records) (Extension Type: string)
        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())
        32. Practitioner.address.extension:stname
        Slice Namestname
        Definition

        StreetName component of address as defined by USPS

        ShortStreetName Vital Records
        Control0..1
        TypeExtension(StreetName Vital Records) (Extension Type: string)
        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())
        34. Practitioner.address.extension:stdesig
        Slice Namestdesig
        Definition

        StreetDesignator component of address as defined by USPS

        ShortStreetDesignator Vital Records
        Control0..1
        TypeExtension(StreetDesignator Vital Records) (Extension Type: string)
        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())
        36. Practitioner.address.extension:postdir
        Slice Namepostdir
        Definition

        PostDirectional component of address as defined by USPS

        ShortPostDirectional Vital Records
        Control0..1
        TypeExtension(PostDirectional Vital Records) (Extension Type: string)
        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())
        38. Practitioner.address.extension:unitnumber
        Slice Nameunitnumber
        Definition

        UnitOrAptNumber component of address as defined by USPS

        ShortUnitOrAptNumber Vital Records
        Control0..1
        TypeExtension(UnitOrAptNumber Vital Records) (Extension Type: string)
        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())
        40. Practitioner.address.use
        Definition

        The purpose of this address.

        Shorthome | work | temp | old | billing - purpose of this address
        Comments

        Applications can assume that an address is current unless it explicitly says that it is temporary or old.

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

        The use of an address.

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

        Allows an appropriate address to be chosen from a list of many.

        Example<br/><b>General</b>:home
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Practitioner.address.line
        Definition

        This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

        ShortStreet name, number, direction & P.O. Box etc.
        Control0..4*
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Example<br/><b>General</b>:137 Nowhere Street
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Practitioner.address.city
        Definition

        The name of the city, town, suburb, village or other community or delivery center.

        ShortcityName of city, town etc.
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Alternate NamesMunicpality
        Example<br/><b>General</b>:Erewhon
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. Practitioner.address.city.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional 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())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Practitioner.address.city.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 48. Practitioner.address.city.extension:cityCode
          Slice NamecityCode
          Definition

          Numeric code from in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

          ShortCity Code
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(City Code Vital Records) (Extension Type: positiveInt)
          Is Modifierfalse
          LabelCity Code
          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())
          50. Practitioner.address.district
          Definition

          The name of the administrative area (county).

          ShortcountyDistrict name (aka county)
          Comments

          District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Alternate NamesCounty
          Example<br/><b>General</b>:Madison
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Practitioner.address.district.extension
          Definition

          An Extension


          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.

          ShortExtensionAdditional 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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on Practitioner.address.district.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 54. Practitioner.address.district.extension:districtCode
            Slice NamedistrictCode
            Definition

            Numeric code in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

            ShortCounty code
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(District Code Vital Records) (Extension Type: positiveInt)
            Is Modifierfalse
            LabelCounty code
            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())
            56. Practitioner.address.state
            Definition

            Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

            ShortSub-unit of country (abbreviations ok)
            Control0..1
            BindingThe codes SHALL be taken from For codes, see Value Set - States, Territories and Provinces Vital Records
            (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate NamesProvince, Territory
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. Practitioner.address.postalCode
            Definition

            A postal code designating a region defined by the postal service.

            ShortzipPostal code for area
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Alternate NamesZip
            Example<br/><b>General</b>:9132
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. Practitioner.address.country
            Definition

            Country - a nation as commonly understood or generally accepted.

            ShortCountry (e.g. can be ISO 3166 2 or 3 letter code)
            Comments

            ISO 3166 3 letter codes can be used in place of a human readable country name.

            Control0..1
            BindingThe codes SHALL be taken from For codes, see Value Set - Residence Country Vital Records
            (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-residence-country-vr)
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. Practitioner.qualification
            Definition

            The official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.

            ShortPractitioner's certification, licenses, or training pertaining to the provision of careCertification, licenses, or training pertaining to the provision of care
            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            64. Practitioner.qualification.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())
            66. Practitioner.qualification.code
            Definition

            Coded representation of the qualification.

            ShortCoded representation of the qualification
            Control1..1
            BindingFor example codes, see v2 table 0360, Version 2.7http://terminology.hl7.org/ValueSet/v2-2.7-0360
            (example to http://terminology.hl7.org/ValueSet/v2-2.7-0360)

            Specific qualification the practitioner has to provide a service.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            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. Practitioner
            Definition

            -

            ShortA person with a formal responsibility in the provisioning of healthcare or related services
            Comments

            -

            Control0..*
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Alternate NamesProvider
            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())
            2. Practitioner.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. Practitioner.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. Practitioner.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. Practitioner.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. Practitioner.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. Practitioner.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. Practitioner.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the resource. 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())
            16. Practitioner.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())
            18. Practitioner.identifier
            Definition

            An identifier that applies to this person in this role.

            ShortAn identifier for the person as this agent
            Comments

            NPI must be supported as the identifier system in the US, Tax id is allowed, Local id is allowed in addition to another identifier supplied by a jurisdictional authority such as a practitioner's Drug Enforcement Administration (DEA) number.

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

            Often, specific identities are assigned for the agent.

            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 Practitioner.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ $this
            • 20. Practitioner.identifier:NPI
              Slice NameNPI
              Definition

              An identifier that applies to this person in this role.

              ShortPractitioner's NPI Number
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..1
              TypeIdentifier
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Often, specific identities are assigned for the agent.

              Pattern Value{
                "system" : "http://hl7.org/fhir/sid/us-npi"
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. Practitioner.active
              Definition

              Whether this practitioner's record is in active use.

              ShortWhether this practitioner's record is in active use
              Comments

              If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.

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

              Need to be able to mark a practitioner 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()))
              24. Practitioner.name
              Definition

              The name(s) associated with the practitioner.

              Shortname
              Comments

              The selection of the use property should ensure that there is a single usual name specified, and others use the nickname (alias), old, or other values as appropriate.

              In general, select the value to be used in the ResourceReference.display based on this:

              1. There is more than 1 name
              2. Use = usual
              3. Period is current to the date of the usage
              4. Use = official
              5. Other order as decided by internal business rules.
              Control1..1
              TypeHumanName
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. Practitioner.name.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
              28. Practitioner.name.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 Practitioner.name.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 30. Practitioner.name.use
                Definition

                Identifies the purpose for this name.

                Shortusual | official | temp | nickname | anonymous | old | maiden
                Comments

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

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

                The use of a human name.

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

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                32. Practitioner.name.text
                Definition

                Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

                Shortname
                Comments

                Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

                A renderable, unencoded form.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                34. Practitioner.name.family
                Definition

                The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

                ShortFamily name (often called 'Surname')
                Comments

                Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

                Control1..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Alternate Namessurname
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                36. Practitioner.name.given
                Definition

                Given name.

                ShortGiven names (not always 'first'). Includes middle names
                Comments

                If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

                Control0..*
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Alternate Namesfirst name, middle name
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. Practitioner.name.prefix
                Definition

                Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

                ShortParts that come before the name
                Control0..*
                Typestring
                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()))
                40. Practitioner.name.suffix
                Definition

                Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

                ShortParts that come after the name
                Control0..*
                Typestring
                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. Practitioner.name.period
                Definition

                Indicates the period of time when this name was valid for the named person.

                ShortTime period when name was/is in use
                Control0..1
                TypePeriod
                Is Modifierfalse
                Summarytrue
                Requirements

                Allows names to be placed in historical context.

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

                A contact detail for the practitioner, e.g. a telephone number or an email address.

                ShortA contact detail for the practitioner (that apply to all roles)
                Comments

                Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

                Control0..*
                TypeContactPoint
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Need to know how to reach a practitioner independent to any roles the practitioner may have.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                46. Practitioner.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
                48. Practitioner.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 Practitioner.telecom.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 50. Practitioner.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
                  Control0..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
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  52. Practitioner.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.

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  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()))
                  54. Practitioner.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()))
                  56. Practitioner.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()))
                  58. Practitioner.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()))
                  60. Practitioner.address
                  Definition

                  Address(es) of the practitioner that are not role specific (typically home address). Work addresses are not typically entered in this property as they are usually role dependent.

                  Shortaddress
                  Comments

                  The PractitionerRole does not have an address value on it, as it is expected that the location property be used for this purpose (which has an address).

                  Control0..*
                  TypeAddress
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  62. Practitioner.address.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. Practitioner.address.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 Practitioner.address.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 66. Practitioner.address.extension:predir
                    Slice Namepredir
                    Definition

                    PreDirectional component of address as defined by USPS

                    ShortPreDirectional Vital Records
                    Control0..1
                    TypeExtension(PreDirectional Vital Records) (Extension Type: string)
                    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())
                    68. Practitioner.address.extension:stnum
                    Slice Namestnum
                    Definition

                    StreetNumber component of address as defined by USPS

                    ShortStreetNumber Vital Records
                    Control0..1
                    TypeExtension(StreetNumber Vital Records) (Extension Type: string)
                    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())
                    70. Practitioner.address.extension:stname
                    Slice Namestname
                    Definition

                    StreetName component of address as defined by USPS

                    ShortStreetName Vital Records
                    Control0..1
                    TypeExtension(StreetName Vital Records) (Extension Type: string)
                    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())
                    72. Practitioner.address.extension:stdesig
                    Slice Namestdesig
                    Definition

                    StreetDesignator component of address as defined by USPS

                    ShortStreetDesignator Vital Records
                    Control0..1
                    TypeExtension(StreetDesignator Vital Records) (Extension Type: string)
                    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())
                    74. Practitioner.address.extension:postdir
                    Slice Namepostdir
                    Definition

                    PostDirectional component of address as defined by USPS

                    ShortPostDirectional Vital Records
                    Control0..1
                    TypeExtension(PostDirectional Vital Records) (Extension Type: string)
                    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())
                    76. Practitioner.address.extension:unitnumber
                    Slice Nameunitnumber
                    Definition

                    UnitOrAptNumber component of address as defined by USPS

                    ShortUnitOrAptNumber Vital Records
                    Control0..1
                    TypeExtension(UnitOrAptNumber Vital Records) (Extension Type: string)
                    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())
                    78. Practitioner.address.use
                    Definition

                    The purpose of this address.

                    Shorthome | work | temp | old | billing - purpose of this address
                    Comments

                    Applications can assume that an address is current unless it explicitly says that it is temporary or old.

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

                    The use of an address.

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

                    Allows an appropriate address to be chosen from a list of many.

                    Example<br/><b>General</b>:home
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    80. Practitioner.address.type
                    Definition

                    Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

                    Shortpostal | physical | both
                    Comments

                    The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

                    Control0..1
                    BindingThe codes SHALL be taken from AddressType
                    (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1)

                    The type of an address (physical / postal).

                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Example<br/><b>General</b>:both
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    82. Practitioner.address.text
                    Definition

                    Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

                    ShortText representation of the address
                    Comments

                    Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

                    A renderable, unencoded form.

                    Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    84. Practitioner.address.line
                    Definition

                    This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

                    ShortStreet name, number, direction & P.O. Box etc.
                    Control0..4
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Example<br/><b>General</b>:137 Nowhere Street
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    86. Practitioner.address.city
                    Definition

                    The name of the city, town, suburb, village or other community or delivery center.

                    Shortcity
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Alternate NamesMunicpality
                    Example<br/><b>General</b>:Erewhon
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    88. Practitioner.address.city.id
                    Definition

                    unique id for the element within a resource (for internal references)

                    Shortxml:id (or equivalent in JSON)
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    90. Practitioner.address.city.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 Practitioner.address.city.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 92. Practitioner.address.city.extension:cityCode
                      Slice NamecityCode
                      Definition

                      Numeric code from in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

                      ShortCity Code
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(City Code Vital Records) (Extension Type: positiveInt)
                      Is Modifierfalse
                      LabelCity Code
                      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())
                      94. Practitioner.address.city.value
                      Definition

                      The actual value

                      ShortPrimitive value for string
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      Max Length:1048576
                      96. Practitioner.address.district
                      Definition

                      The name of the administrative area (county).

                      Shortcounty
                      Comments

                      District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Alternate NamesCounty
                      Example<br/><b>General</b>:Madison
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      98. Practitioner.address.district.id
                      Definition

                      unique id for the element within a resource (for internal references)

                      Shortxml:id (or equivalent in JSON)
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      100. Practitioner.address.district.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 Practitioner.address.district.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 102. Practitioner.address.district.extension:districtCode
                        Slice NamedistrictCode
                        Definition

                        Numeric code in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014 (https://www.cdc.gov/nchs/data/dvs/IMP8_2014.pdf) and https://ftp.cdc.gov/pub/health_Statistics/nchs/Manuals/Mortality/PLACE_CODES.txt.

                        ShortCounty code
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(District Code Vital Records) (Extension Type: positiveInt)
                        Is Modifierfalse
                        LabelCounty code
                        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())
                        104. Practitioner.address.district.value
                        Definition

                        The actual value

                        ShortPrimitive value for string
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Max Length:1048576
                        106. Practitioner.address.state
                        Definition

                        Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

                        ShortSub-unit of country (abbreviations ok)
                        Control0..1
                        BindingThe codes SHALL be taken from Value Set - States, Territories and Provinces Vital Records
                        (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-states-territories-provinces-vr)
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Alternate NamesProvince, Territory
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        108. Practitioner.address.postalCode
                        Definition

                        A postal code designating a region defined by the postal service.

                        Shortzip
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Alternate NamesZip
                        Example<br/><b>General</b>:9132
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        110. Practitioner.address.country
                        Definition

                        Country - a nation as commonly understood or generally accepted.

                        ShortCountry (e.g. can be ISO 3166 2 or 3 letter code)
                        Comments

                        ISO 3166 3 letter codes can be used in place of a human readable country name.

                        Control0..1
                        BindingThe codes SHALL be taken from Value Set - Residence Country Vital Records
                        (required to http://hl7.org/fhir/us/vr-common-library/ValueSet/ValueSet-residence-country-vr)
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        112. Practitioner.address.period
                        Definition

                        Time period when address was/is in use.

                        ShortTime period when address was/is in use
                        Control0..1
                        TypePeriod
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows addresses to be placed in historical context.

                        Example<br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        114. Practitioner.gender
                        Definition

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

                        Shortmale | female | other | unknown
                        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 to address the person correctly.

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

                        The date of birth for the practitioner.

                        ShortThe date on which the practitioner was born
                        Control0..1
                        Typedate
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Needed for identification.

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

                        Image of the person.

                        ShortImage of the person
                        Control0..*
                        TypeAttachment
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        120. Practitioner.qualification
                        Definition

                        The official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.

                        ShortPractitioner's certification, licenses, or training pertaining to the provision of care
                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        122. Practitioner.qualification.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
                        124. Practitioner.qualification.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())
                        126. Practitioner.qualification.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())
                        128. Practitioner.qualification.identifier
                        Definition

                        An identifier that applies to this person's qualification in this role.

                        ShortAn identifier for this qualification for the practitioner
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control0..*
                        TypeIdentifier
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Often, specific identities are assigned for the qualification.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        130. Practitioner.qualification.code
                        Definition

                        Coded representation of the qualification.

                        ShortCoded representation of the qualification
                        Control1..1
                        BindingFor example codes, see v2 table 0360, Version 2.7
                        (example to http://terminology.hl7.org/ValueSet/v2-2.7-0360)

                        Specific qualification the practitioner has to provide a service.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        132. Practitioner.qualification.period
                        Definition

                        Period during which the qualification is valid.

                        ShortPeriod during which the qualification is valid
                        Control0..1
                        TypePeriod
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Qualifications are often for a limited period of time, and can be revoked.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        134. Practitioner.qualification.issuer
                        Definition

                        Organization that regulates and issues the qualification.

                        ShortOrganization that regulates and issues the qualification
                        Control0..1
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        136. Practitioner.communication
                        Definition

                        A language the practitioner can use in patient communication.

                        ShortA language the practitioner can use in patient communication
                        Comments

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

                        Control0..*
                        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

                        Knowing which language a practitioner speaks can help in facilitating communication with patients.

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