Northern Region Implementation Guide
0.4.6 - CI Build

Northern Region Implementation Guide, published by healthAlliance. This guide is not an authorized publication; it is the continuous build for version 0.4.6 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7NZ/northernRegion/ and changes regularly. See the Directory of published versions

Resource Profile: NorthernRegionPatient - Detailed Descriptions

Active as of 2024-10-16

Definitions for the NorthernRegionPatient resource profile.

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

0. Patient
2. Patient.implicitRules
Control0..0
4. Patient.language
Control0..0
6. Patient.extension
SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. Patient.extension:nz-ethnicity
    Slice Namenz-ethnicity
    ShortThe persons ethnicity (up to 6)
    Control0..6
    TypeExtension(NZ Ethnicity) (Extension Type: CodeableConcept)
    10. Patient.extension:birth-place
    Slice Namebirth-place
    ShortWhere the person was born
    Control0..1
    TypeExtension(Patient Birth Place) (Extension Type: Address)
    12. Patient.extension:patient-iwi
    Slice Namepatient-iwi
    ShortThe Iwi the person is associated with
    Control0..*
    TypeExtension(Nz_iwi) (Extension Type: CodeableConcept)
    14. Patient.extension:nz-citizenship
    Slice Namenz-citizenship
    ShortThe New Zealand citizenship status
    Control0..1
    TypeExtension(NZ Citizenship) (Complex Extension)
    16. Patient.extension:current-occupation
    Slice Namecurrent-occupation
    Control0..1
    TypeExtension(CurrentOccupation) (Extension Type: CodeableConcept)
    18. Patient.extension:interpreter-required
    Slice Nameinterpreter-required
    Control0..1
    TypeExtension(Patient Interpreter Required) (Extension Type: boolean)
    20. Patient.extension:sex-at-birth
    Slice Namesex-at-birth
    Control0..1
    TypeExtension(Sex At Birth) (Extension Type: CodeableConcept)
    22. Patient.extension:residency-status
    Slice Nameresidency-status
    Control0..1
    TypeExtension(NZResidency) (Complex Extension)
    24. Patient.modifierExtension
    Control0..0
    26. Patient.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open at End, and can be differentiated using the following discriminators:
    • pattern @ use
    • 28. Patient.identifier:NHI
      Slice NameNHI
      ShortThe persons current NHI number
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1
      Must Supporttrue
      30. Patient.identifier:NHI.use
      Control1..?
      Fixed Valueofficial
      32. Patient.identifier:NHI.system
      Pattern Valuehttps://standards.digital.health.nz/ns/nhi-id
      34. Patient.identifier:dormantNHI
      Slice NamedormantNHI
      ShortNHI numbers that have been deprecated
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      Must Supporttrue
      36. Patient.identifier:dormantNHI.use
      Control1..?
      Fixed Valueold
      38. Patient.identifier:dormantNHI.system
      Pattern Valuehttps://standards.digital.health.nz/ns/nhi-id
      40. Patient.active
      Control0..0
      42. Patient.name
      Control1..?
      44. Patient.name.extension:preferred
      Slice Namepreferred
      Control0..1
      TypeExtension(Preferred) (Extension Type: boolean)
      46. Patient.telecom
      48. Patient.telecom.extension:authorized-by-patient
      Slice Nameauthorized-by-patient
      Definition

      Indicates that the patient has authorized the use of this method of contact.

      Control0..1
      TypeExtension(AuthorizedByPatient) (Extension Type: boolean)
      50. Patient.telecom.extension:validated-by-patient
      Slice Namevalidated-by-patient
      Definition

      Indicates that the patient has confirmed that this method of contact is correct.

      Control0..1
      TypeExtension(ValidatedByPatient) (Extension Type: boolean)
      52. Patient.telecom.extension:contact-point-purpose
      Slice Namecontact-point-purpose
      Definition

      The reason for using this contact point

      Control0..1
      TypeExtension(A specific purpose for which this ContactPoint dataType would be used) (Extension Type: CodeableConcept)
      54. Patient.gender
      Control1..?
      56. Patient.birthDate
      Control1..?
      LOINC Code
      58. Patient.address
      TypeAddress(Common NZ Address datatype)
      60. Patient.address.extension:authorized-by-patient
      Slice Nameauthorized-by-patient
      Definition

      Indicates that the patient has authorized the use of this address.

      Control0..1
      TypeExtension(AuthorizedByPatient) (Extension Type: boolean)
      62. Patient.address.extension:validated-by-patient
      Slice Namevalidated-by-patient
      Definition

      Indicates that the patient has confirmed that this address is correct.

      Control0..1
      TypeExtension(ValidatedByPatient) (Extension Type: boolean)
      64. Patient.multipleBirth[x]
      Control0..0
      66. Patient.photo
      Control0..0
      68. Patient.contact
      70. Patient.contact.relationship
      BindingUnless not suitable, these codes SHALL be taken from PatientRelationshipType
      (extensible to http://hl7.org/fhir/ValueSet/relatedperson-relationshiptype)
      72. Patient.communication
      74. Patient.communication.preferred
      Control0..0
      76. Patient.generalPractitioner
      TypeReference(Northern Region PractitionerRole profile)
      78. Patient.generalPractitioner.extension:gp-practice-enrollment-date
      Slice Namegp-practice-enrollment-date
      Definition

      The date that the patient enrolled with this GP Practice

      Control0..1
      TypeExtension(EnrollmentDate) (Extension Type: date)
      80. Patient.managingOrganization
      TypeReference(Northern Region Organization profile)
      82. Patient.link
      Control0..0

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

      0. Patient
      Definition

      Demographics and other administrative information about an individual or animal receiving care or other health-related services.

      ShortInformation about an individual or animal receiving health care services
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Alternate NamesSubjectOfCare Client Resident
      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. Patient.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..01
      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. Patient.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..01
      BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages
      (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()))
      6. Patient.extension
      Definition

      An Extension


      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.

      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())
      SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 8. Patient.extension:nz-ethnicity
        Slice Namenz-ethnicity
        Definition

        The ethnic group or groups that a person identifies with or feels they belong to. Ethnicity is a measure of cultural affiliation as opposed to race, ancestry, nationality or citizen. Ethnicity is self-perceived and a person can belong to more than one group.

        The Stats New Zealand standard can be found here.

        ShortThe persons ethnicity (up to 6)
        Control0..6
        This element is affected by the following invariants: ele-1
        TypeExtension(NZ Ethnicity) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        10. Patient.extension:birth-place
        Slice Namebirth-place
        Definition

        The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements.

        ShortWhere the person was born
        Control0..1
        TypeExtension(Patient Birth Place) (Extension Type: Address)
        Is Modifierfalse
        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())
        ele-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())
        12. Patient.extension:patient-iwi
        Slice Namepatient-iwi
        Definition

        Persons Iwi affiliation

        ShortThe Iwi the person is associated with
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Nz_iwi) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        14. Patient.extension:nz-citizenship
        Slice Namenz-citizenship
        Definition

        New Zealand citizenship

        ShortThe New Zealand citizenship status
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(NZ Citizenship) (Complex Extension)
        Is Modifierfalse
        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. Patient.extension:current-occupation
        Slice Namecurrent-occupation
        Definition

        The current occupation for the patient

        ShortExtension
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(CurrentOccupation) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        18. Patient.extension:interpreter-required
        Slice Nameinterpreter-required
        Definition

        This Patient requires an interpreter to communicate healthcare information to the practitioner.

        ShortWhether the patient needs an interpreter
        Comments

        The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.

        Control0..1
        TypeExtension(Patient Interpreter Required) (Extension Type: boolean)
        Is Modifierfalse
        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())
        ele-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())
        20. Patient.extension:sex-at-birth
        Slice Namesex-at-birth
        Definition

        A person’s sex at the time of their birth (considered to be immutable).

        ShortSex At Birth
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Sex At Birth) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        22. Patient.extension:residency-status
        Slice Nameresidency-status
        Definition

        NZ Residency status

        ShortExtension
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(NZResidency) (Complex Extension)
        Is Modifierfalse
        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())
        24. Patient.modifierExtension
        Definition

        An Extension


        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).

        ShortExtensionExtensions 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..0*
        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())
        26. Patient.identifier
        Definition

        An identifier for this patient.

        ShortAn identifier for this patient
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Requirements

        Patients are almost always assigned specific numerical identifiers.

        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 Patient.identifier. The slices areUnordered and Open at End, and can be differentiated using the following discriminators:
        • pattern @ use
        • 28. Patient.identifier:NHI
          Slice NameNHI
          Definition

          An identifier for this patient.

          ShortThe persons current NHI numberAn identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..1*
          TypeIdentifier
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Patients are almost always assigned specific numerical identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          30. Patient.identifier:NHI.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control10..1
          BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

          Identifies the purpose for this identifier, if known .

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

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

          Fixed Valueofficial
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          32. Patient.identifier:NHI.system
          Definition

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          ShortThe namespace for the identifier value
          Comments

          Identifier.system is always case sensitive.

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

          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

          Pattern Valuehttps://standards.digital.health.nz/ns/nhi-id
          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          34. Patient.identifier:dormantNHI
          Slice NamedormantNHI
          Definition

          An identifier for this patient.

          ShortNHI numbers that have been deprecatedAn identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Patients are almost always assigned specific numerical identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          36. Patient.identifier:dormantNHI.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control10..1
          BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

          Identifies the purpose for this identifier, if known .

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

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

          Fixed Valueold
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. Patient.identifier:dormantNHI.system
          Definition

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          ShortThe namespace for the identifier value
          Comments

          Identifier.system is always case sensitive.

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

          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

          Pattern Valuehttps://standards.digital.health.nz/ns/nhi-id
          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. Patient.active
          Definition

          Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

          It is often used to filter patient lists to exclude inactive patients

          Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

          ShortWhether this patient's record is in active use
          Comments

          If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

          Control0..01
          Typeboolean
          Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to be able to mark a patient 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()))
          42. Patient.name
          Definition

          A name associated with the individual.

          ShortA name associated with the patient
          Comments

          A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

          Control10..*
          TypeHumanName
          Is Modifierfalse
          Summarytrue
          Requirements

          Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. Patient.name.extension:preferred
          Slice Namepreferred
          Definition

          Flag denoting whether parent item is preferred - e.g., a preferred address or telephone number.

          ShortPreferred
          Control0..1
          TypeExtension(Preferred) (Extension Type: boolean)
          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())
          46. Patient.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()))
          48. Patient.gender
          Definition

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

          Shortmale | female | other | unknown
          Comments

          The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

          Control10..1
          BindingThe codes SHALL be taken from AdministrativeGenderhttp://hl7.org/fhir/ValueSet/administrative-gender|4.0.1
          (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 for identification of the individual, in combination with (at least) name and birth date.

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

          The date of birth for the individual.

          ShortThe date of birth for the individual
          Comments

          At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

          Control10..1
          Typedate
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Age of the individual drives many clinical processes.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          LOINC Code21112-8
          52. Patient.deceased[x]
          Definition

          Indicates if the individual is deceased or not.

          ShortIndicates if the individual is deceased or not
          Comments

          If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

          Control0..1
          TypeChoice of: boolean, dateTime
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

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

          An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.


          An address for the individual.

          ShortAn address expressed using postal conventions (as opposed to GPS or other location definition formats)An address for the individual
          Comments

          Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).


          Patient may have multiple addresses with different uses or applicable periods.

          Control0..*
          This element is affected by the following invariants: ele-1
          TypeAddress(Common NZ Address datatype)
          Is Modifierfalse
          Requirements

          May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. Patient.address.extension:nz-geocode
          Slice Namenz-geocode
          Definition

          New Zealand Geocode. This uses a different datum from that defined in the HL7 FHIR specification for a Geocode.

          ShortA geocode using the NZ specific datum (reference point)
          Control0..1
          TypeExtension(NZ Geocode) (Complex Extension)
          Is Modifierfalse
          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())
          58. Patient.address.extension:suburb
          Slice Namesuburb
          Definition

          Suburb element of a NZ Address.

          ShortThe suburb part of the address
          Control0..1
          TypeExtension(NZ Suburb) (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())
          60. Patient.address.extension:building-name
          Slice Namebuilding-name
          Definition

          The name of a building cited in an address.

          ShortThe name of the building
          Control0..1
          TypeExtension(Building Name) (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())
          62. Patient.address.extension:domicile-code
          Slice Namedomicile-code
          Definition

          NZ Domicile Code. Derived from a patient's primary physical, home address.

          ShortThe domicile code associated with this address
          Control0..1
          TypeExtension(NZ Domicile Code) (Extension Type: CodeableConcept)
          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())
          64. Patient.address.extension:country-name
          Slice Namecountry-name
          Definition

          The display name for a country in an address.

          ShortThe name of the country. The ISO code should be in the country property
          Control0..1
          TypeExtension(Country Name) (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())
          66. Patient.address.extension:authorized-by-patient
          Slice Nameauthorized-by-patient
          Definition

          Indicates that the patient has authorized the use of this address.

          ShortExtension
          Control0..1
          TypeExtension(AuthorizedByPatient) (Extension Type: boolean)
          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. Patient.address.extension:validated-by-patient
          Slice Namevalidated-by-patient
          Definition

          Indicates that the patient has confirmed that this address is correct.

          ShortExtension
          Control0..1
          TypeExtension(ValidatedByPatient) (Extension Type: boolean)
          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. Patient.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()))
          72. Patient.multipleBirth[x]
          Definition

          Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

          ShortWhether patient is part of a multiple birth
          Comments

          Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

          Control0..01
          TypeChoice of: boolean, integer
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

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

          Image of the patient.

          ShortImage of the patient
          Comments

          Guidelines:

          • Use id photos, not clinical photos.
          • Limit dimensions to thumbnail.
          • Keep byte count low to ease resource updates.
          Control0..0*
          TypeAttachment
          Is Modifierfalse
          Summaryfalse
          Requirements

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

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

          Patient's nominated care provider.

          ShortPatient's nominated primary care provider
          Comments

          This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

          Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

          Control0..*
          TypeReference(Northern Region PractitionerRole profile, Organization, Practitioner, PractitionerRole)
          Is Modifierfalse
          Summaryfalse
          Alternate NamescareProvider
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          78. Patient.generalPractitioner.extension:gp-practice-enrollment-date
          Slice Namegp-practice-enrollment-date
          Definition

          The date that the patient enrolled with this GP Practice

          ShortExtension
          Control0..1
          TypeExtension(EnrollmentDate) (Extension Type: date)
          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())
          80. Patient.managingOrganization
          Definition

          Organization that is the custodian of the patient record.

          ShortOrganization that is the custodian of the patient record
          Comments

          There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

          Control0..1
          TypeReference(Northern Region Organization profile, Organization)
          Is Modifierfalse
          Summarytrue
          Requirements

          Need to know who recognizes this patient record, manages and updates it.

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

          Link to another patient resource that concerns the same actual patient.

          ShortLink to another patient resource that concerns the same actual person
          Comments

          There is no assumption that linked patient records have mutual links.

          Control0..0*
          TypeBackboneElement
          Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
          Summarytrue
          Requirements

          There are multiple use cases:

          • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
          • Distribution of patient information across multiple servers.
          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. Patient
          Definition

          Demographics and other administrative information about an individual or animal receiving care or other health-related services.

          ShortInformation about an individual or animal receiving health care services
          Control0..*
          Is Modifierfalse
          Summaryfalse
          Alternate NamesSubjectOfCare Client Resident
          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. Patient.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. Patient.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. Patient.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..0
          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. Patient.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..0
          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. Patient.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. Patient.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. Patient.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 Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. Patient.extension:nz-ethnicity
            Slice Namenz-ethnicity
            Definition

            The ethnic group or groups that a person identifies with or feels they belong to. Ethnicity is a measure of cultural affiliation as opposed to race, ancestry, nationality or citizen. Ethnicity is self-perceived and a person can belong to more than one group.

            The Stats New Zealand standard can be found here.

            ShortThe persons ethnicity (up to 6)
            Control0..6
            This element is affected by the following invariants: ele-1
            TypeExtension(NZ Ethnicity) (Extension Type: CodeableConcept)
            Is Modifierfalse
            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. Patient.extension:birth-place
            Slice Namebirth-place
            Definition

            The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements.

            ShortWhere the person was born
            Control0..1
            TypeExtension(Patient Birth Place) (Extension Type: Address)
            Is Modifierfalse
            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())
            20. Patient.extension:patient-iwi
            Slice Namepatient-iwi
            Definition

            Persons Iwi affiliation

            ShortThe Iwi the person is associated with
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(Nz_iwi) (Extension Type: CodeableConcept)
            Is Modifierfalse
            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())
            22. Patient.extension:nz-citizenship
            Slice Namenz-citizenship
            Definition

            New Zealand citizenship

            ShortThe New Zealand citizenship status
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(NZ Citizenship) (Complex Extension)
            Is Modifierfalse
            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())
            24. Patient.extension:current-occupation
            Slice Namecurrent-occupation
            Definition

            The current occupation for the patient

            ShortExtension
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(CurrentOccupation) (Extension Type: CodeableConcept)
            Is Modifierfalse
            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())
            26. Patient.extension:interpreter-required
            Slice Nameinterpreter-required
            Definition

            This Patient requires an interpreter to communicate healthcare information to the practitioner.

            ShortWhether the patient needs an interpreter
            Comments

            The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.

            Control0..1
            TypeExtension(Patient Interpreter Required) (Extension Type: boolean)
            Is Modifierfalse
            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())
            28. Patient.extension:sex-at-birth
            Slice Namesex-at-birth
            Definition

            A person’s sex at the time of their birth (considered to be immutable).

            ShortSex At Birth
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Sex At Birth) (Extension Type: CodeableConcept)
            Is Modifierfalse
            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. Patient.extension:residency-status
            Slice Nameresidency-status
            Definition

            NZ Residency status

            ShortExtension
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(NZResidency) (Complex Extension)
            Is Modifierfalse
            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. Patient.modifierExtension
            Definition

            An Extension

            ShortExtension
            Control0..0
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            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. Patient.identifier
            Definition

            An identifier for this patient.

            ShortAn identifier for this patient
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Is Modifierfalse
            Summarytrue
            Requirements

            Patients are almost always assigned specific numerical identifiers.

            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 Patient.identifier. The slices areUnordered and Open at End, and can be differentiated using the following discriminators:
            • pattern @ use
            • 36. Patient.identifier:NHI
              Slice NameNHI
              Definition

              An identifier for this patient.

              ShortThe persons current NHI number
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..1
              TypeIdentifier
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Patients are almost always assigned specific numerical identifiers.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. Patient.identifier:NHI.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
              40. Patient.identifier:NHI.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 Patient.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 42. Patient.identifier:NHI.use
                Definition

                The purpose of this identifier.

                Shortusual | official | temp | secondary | old (If known)
                Comments

                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                Control1..1
                BindingThe codes SHALL be taken from IdentifierUse
                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                Identifies the purpose for this identifier, if known .

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

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

                Fixed Valueofficial
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                44. Patient.identifier:NHI.type
                Definition

                A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                ShortDescription of identifier
                Comments

                This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                Allows users to make use of identifiers when the identifier system is not known.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                46. Patient.identifier:NHI.system
                Definition

                Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                ShortThe namespace for the identifier value
                Comments

                Identifier.system is always case sensitive.

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

                There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                Pattern Valuehttps://standards.digital.health.nz/ns/nhi-id
                Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                48. Patient.identifier:NHI.value
                Definition

                The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                ShortThe value that is unique
                Comments

                If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Example<br/><b>General</b>:123456
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. Patient.identifier:NHI.period
                Definition

                Time period during which identifier is/was valid for use.

                ShortTime period when id is/was valid for use
                Control0..1
                TypePeriod
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                52. Patient.identifier:NHI.assigner
                Definition

                Organization that issued/manages the identifier.

                ShortOrganization that issued id (may be just text)
                Comments

                The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                Control0..1
                TypeReference(Organization)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                54. Patient.identifier:dormantNHI
                Slice NamedormantNHI
                Definition

                An identifier for this patient.

                ShortNHI numbers that have been deprecated
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                TypeIdentifier
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Patients are almost always assigned specific numerical identifiers.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                56. Patient.identifier:dormantNHI.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
                58. Patient.identifier:dormantNHI.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 Patient.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 60. Patient.identifier:dormantNHI.use
                  Definition

                  The purpose of this identifier.

                  Shortusual | official | temp | secondary | old (If known)
                  Comments

                  Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                  Control1..1
                  BindingThe codes SHALL be taken from IdentifierUse
                  (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                  Identifies the purpose for this identifier, if known .

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

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

                  Fixed Valueold
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  62. Patient.identifier:dormantNHI.type
                  Definition

                  A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                  ShortDescription of identifier
                  Comments

                  This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                  (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                  A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Allows users to make use of identifiers when the identifier system is not known.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  64. Patient.identifier:dormantNHI.system
                  Definition

                  Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                  ShortThe namespace for the identifier value
                  Comments

                  Identifier.system is always case sensitive.

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

                  There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                  Pattern Valuehttps://standards.digital.health.nz/ns/nhi-id
                  Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  66. Patient.identifier:dormantNHI.value
                  Definition

                  The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                  ShortThe value that is unique
                  Comments

                  If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Example<br/><b>General</b>:123456
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  68. Patient.identifier:dormantNHI.period
                  Definition

                  Time period during which identifier is/was valid for use.

                  ShortTime period when id is/was valid for use
                  Control0..1
                  TypePeriod
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  70. Patient.identifier:dormantNHI.assigner
                  Definition

                  Organization that issued/manages the identifier.

                  ShortOrganization that issued id (may be just text)
                  Comments

                  The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                  Control0..1
                  TypeReference(Organization)
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  72. Patient.active
                  Definition

                  Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

                  It is often used to filter patient lists to exclude inactive patients

                  Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

                  ShortWhether this patient's record is in active use
                  Comments

                  If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

                  Control0..0
                  Typeboolean
                  Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to be able to mark a patient 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()))
                  74. Patient.name
                  Definition

                  A name associated with the individual.

                  ShortA name associated with the patient
                  Comments

                  A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

                  Control1..*
                  TypeHumanName
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  76. Patient.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
                  78. Patient.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 Patient.name.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 80. Patient.name.extension:preferred
                    Slice Namepreferred
                    Definition

                    Flag denoting whether parent item is preferred - e.g., a preferred address or telephone number.

                    ShortPreferred
                    Control0..1
                    TypeExtension(Preferred) (Extension Type: boolean)
                    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())
                    82. Patient.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()))
                    84. Patient.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.

                    ShortText 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()))
                    86. Patient.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).

                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Alternate Namessurname
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    88. Patient.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()))
                    90. Patient.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()))
                    92. Patient.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()))
                    94. Patient.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()))
                    96. Patient.telecom
                    Definition

                    A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

                    ShortA contact detail for the individual
                    Comments

                    A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

                    Control0..*
                    TypeContactPoint
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    People have (primary) ways to contact them in some way such as phone, email.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    98. Patient.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
                    100. Patient.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 Patient.telecom.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 102. Patient.telecom.extension:authorized-by-patient
                      Slice Nameauthorized-by-patient
                      Definition

                      Indicates that the patient has authorized the use of this method of contact.

                      ShortExtension
                      Control0..1
                      TypeExtension(AuthorizedByPatient) (Extension Type: boolean)
                      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())
                      104. Patient.telecom.extension:validated-by-patient
                      Slice Namevalidated-by-patient
                      Definition

                      Indicates that the patient has confirmed that this method of contact is correct.

                      ShortExtension
                      Control0..1
                      TypeExtension(ValidatedByPatient) (Extension Type: boolean)
                      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())
                      106. Patient.telecom.extension:contact-point-purpose
                      Slice Namecontact-point-purpose
                      Definition

                      The reason for using this contact point

                      ShortA specific purpose for which this ContactPoint dataType would be used
                      Control0..1
                      TypeExtension(A specific purpose for which this ContactPoint dataType would be used) (Extension Type: CodeableConcept)
                      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())
                      108. Patient.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
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      110. Patient.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
                      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()))
                      112. Patient.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()))
                      114. Patient.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()))
                      116. Patient.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()))
                      118. Patient.gender
                      Definition

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

                      Shortmale | female | other | unknown
                      Comments

                      The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

                      Control1..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 for identification of the individual, in combination with (at least) name and birth date.

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

                      The date of birth for the individual.

                      ShortThe date of birth for the individual
                      Comments

                      At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

                      Control1..1
                      Typedate
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Age of the individual drives many clinical processes.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      LOINC Code21112-8
                      122. Patient.deceased[x]
                      Definition

                      Indicates if the individual is deceased or not.

                      ShortIndicates if the individual is deceased or not
                      Comments

                      If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

                      Control0..1
                      TypeChoice of: boolean, dateTime
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

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

                      An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.

                      ShortAn address expressed using postal conventions (as opposed to GPS or other location definition formats)
                      Comments

                      Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

                      Control0..*
                      This element is affected by the following invariants: ele-1
                      TypeAddress(Common NZ Address datatype)
                      Is Modifierfalse
                      Requirements

                      May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      126. Patient.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
                      128. Patient.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 Patient.address.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 130. Patient.address.extension:nz-geocode
                        Slice Namenz-geocode
                        Definition

                        New Zealand Geocode. This uses a different datum from that defined in the HL7 FHIR specification for a Geocode.

                        ShortA geocode using the NZ specific datum (reference point)
                        Control0..1
                        TypeExtension(NZ Geocode) (Complex Extension)
                        Is Modifierfalse
                        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())
                        132. Patient.address.extension:suburb
                        Slice Namesuburb
                        Definition

                        Suburb element of a NZ Address.

                        ShortThe suburb part of the address
                        Control0..1
                        TypeExtension(NZ Suburb) (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())
                        134. Patient.address.extension:building-name
                        Slice Namebuilding-name
                        Definition

                        The name of a building cited in an address.

                        ShortThe name of the building
                        Control0..1
                        TypeExtension(Building Name) (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())
                        136. Patient.address.extension:domicile-code
                        Slice Namedomicile-code
                        Definition

                        NZ Domicile Code. Derived from a patient's primary physical, home address.

                        ShortThe domicile code associated with this address
                        Control0..1
                        TypeExtension(NZ Domicile Code) (Extension Type: CodeableConcept)
                        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())
                        138. Patient.address.extension:country-name
                        Slice Namecountry-name
                        Definition

                        The display name for a country in an address.

                        ShortThe name of the country. The ISO code should be in the country property
                        Control0..1
                        TypeExtension(Country Name) (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())
                        140. Patient.address.extension:authorized-by-patient
                        Slice Nameauthorized-by-patient
                        Definition

                        Indicates that the patient has authorized the use of this address.

                        ShortExtension
                        Control0..1
                        TypeExtension(AuthorizedByPatient) (Extension Type: boolean)
                        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())
                        142. Patient.address.extension:validated-by-patient
                        Slice Namevalidated-by-patient
                        Definition

                        Indicates that the patient has confirmed that this address is correct.

                        ShortExtension
                        Control0..1
                        TypeExtension(ValidatedByPatient) (Extension Type: boolean)
                        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())
                        144. Patient.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()))
                        146. Patient.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()))
                        148. Patient.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()))
                        150. Patient.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..*
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        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()))
                        152. Patient.address.city
                        Definition

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

                        ShortName of city, town etc.
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        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()))
                        154. Patient.address.district
                        Definition

                        The name of the administrative area (county).

                        ShortDistrict 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()))
                        156. Patient.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
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Alternate NamesProvince, Territory
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        158. Patient.address.postalCode
                        Definition

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

                        ShortPostal code for area
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        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()))
                        160. Patient.address.country
                        Definition

                        Country - a nation as commonly understood or generally accepted.

                        ShortShould be the ISO 3166 code
                        Comments

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

                        Control0..1
                        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()))
                        162. Patient.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()))
                        164. Patient.maritalStatus
                        Definition

                        This field contains a patient's most recent marital (civil) status.

                        ShortMarital (civil) status of a patient
                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from Marital Status Codes
                        (extensible to http://hl7.org/fhir/ValueSet/marital-status)

                        The domestic partnership status of a person.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Most, if not all systems capture it.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        166. Patient.multipleBirth[x]
                        Definition

                        Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

                        ShortWhether patient is part of a multiple birth
                        Comments

                        Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

                        Control0..0
                        TypeChoice of: boolean, integer
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

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

                        Image of the patient.

                        ShortImage of the patient
                        Comments

                        Guidelines:

                        • Use id photos, not clinical photos.
                        • Limit dimensions to thumbnail.
                        • Keep byte count low to ease resource updates.
                        Control0..0
                        TypeAttachment
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

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

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

                        A contact party (e.g. guardian, partner, friend) for the patient.

                        ShortA contact party (e.g. guardian, partner, friend) for the patient
                        Comments

                        Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Need to track people you can contact about the patient.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                        172. Patient.contact.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
                        174. Patient.contact.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())
                        176. Patient.contact.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())
                        178. Patient.contact.relationship
                        Definition

                        The nature of the relationship between the patient and the contact person.

                        ShortThe kind of relationship
                        Control0..*
                        BindingUnless not suitable, these codes SHALL be taken from PatientRelationshipType
                        (extensible to http://hl7.org/fhir/ValueSet/relatedperson-relationshiptype)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Used to determine which contact person is the most relevant to approach, depending on circumstances.

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

                        A name associated with the contact person.

                        ShortA name associated with the contact person
                        Control0..1
                        TypeHumanName
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

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

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

                        ShortA contact detail for the person
                        Comments

                        Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

                        Control0..*
                        TypeContactPoint
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        People have (primary) ways to contact them in some way such as phone, email.

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

                        Address for the contact person.

                        ShortAddress for the contact person
                        Control0..1
                        TypeAddress
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Need to keep track where the contact person can be contacted per postal mail or visited.

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

                        Administrative Gender - the gender that the contact 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
                        Summaryfalse
                        Requirements

                        Needed to address the person correctly.

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

                        Organization on behalf of which the contact is acting or for which the contact is working.

                        ShortOrganization that is associated with the contact
                        Control0..1
                        This element is affected by the following invariants: pat-1
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        For guardians or business related contacts, the organization is relevant.

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

                        The period during which this contact person or organization is valid to be contacted relating to this patient.

                        ShortThe period during which this contact person or organization is valid to be contacted relating to this patient
                        Control0..1
                        TypePeriod
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        192. Patient.communication
                        Definition

                        A language which may be used to communicate with the patient about his or her health.

                        ShortA language which may be used to communicate with the patient about his or her health
                        Comments

                        If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        194. Patient.communication.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
                        196. Patient.communication.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())
                        198. Patient.communication.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())
                        200. Patient.communication.language
                        Definition

                        The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.

                        ShortThe language which can be used to communicate with the patient about his or her health
                        Comments

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

                        Control1..1
                        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

                        Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

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

                        Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

                        ShortLanguage preference indicator
                        Comments

                        This language is specifically identified for communicating healthcare information.

                        Control0..0
                        Typeboolean
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

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

                        Patient's nominated care provider.

                        ShortPatient's nominated primary care provider
                        Comments

                        This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

                        Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

                        Control0..*
                        TypeReference(Northern Region PractitionerRole profile)
                        Is Modifierfalse
                        Summaryfalse
                        Alternate NamescareProvider
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        206. Patient.generalPractitioner.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
                        208. Patient.generalPractitioner.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 Patient.generalPractitioner.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 210. Patient.generalPractitioner.extension:gp-practice-enrollment-date
                          Slice Namegp-practice-enrollment-date
                          Definition

                          The date that the patient enrolled with this GP Practice

                          ShortExtension
                          Control0..1
                          TypeExtension(EnrollmentDate) (Extension Type: date)
                          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())
                          212. Patient.generalPractitioner.reference
                          Definition

                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                          ShortLiteral reference, Relative, internal or absolute URL
                          Comments

                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                          Control0..1
                          This element is affected by the following invariants: ref-1
                          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()))
                          214. Patient.generalPractitioner.type
                          Definition

                          The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                          The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                          ShortType the reference refers to (e.g. "Patient")
                          Comments

                          This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                          Control0..1
                          BindingUnless not suitable, these codes SHALL be taken from ResourceType
                          (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                          Aa resource (or, for logical models, the URI of the logical model).

                          Typeuri
                          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()))
                          216. Patient.generalPractitioner.identifier
                          Definition

                          An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                          ShortLogical reference, when literal reference is not known
                          Comments

                          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                          Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                          Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control0..1
                          TypeIdentifier
                          Is Modifierfalse
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          218. Patient.generalPractitioner.display
                          Definition

                          Plain text narrative that identifies the resource in addition to the resource reference.

                          ShortText alternative for the resource
                          Comments

                          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                          Control0..1
                          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()))
                          220. Patient.managingOrganization
                          Definition

                          Organization that is the custodian of the patient record.

                          ShortOrganization that is the custodian of the patient record
                          Comments

                          There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

                          Control0..1
                          TypeReference(Northern Region Organization profile)
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          Need to know who recognizes this patient record, manages and updates it.

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

                          Link to another patient resource that concerns the same actual patient.

                          ShortLink to another patient resource that concerns the same actual person
                          Comments

                          There is no assumption that linked patient records have mutual links.

                          Control0..0
                          TypeBackboneElement
                          Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
                          Summarytrue
                          Requirements

                          There are multiple use cases:

                          • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
                          • Distribution of patient information across multiple servers.
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))