Vital Records Death Reporting (VRDR) FHIR Implementation Guide
0.0.0-current - ci-build International flag

Vital Records Death Reporting (VRDR) FHIR Implementation Guide, published by IHE Quality, Research and Public Health Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.0.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/QRPH.VRDR/ and changes regularly. See the Directory of published versions

Resource Profile: Decedent - Detailed Descriptions

Active as of 2024-03-11

Definitions for the vrdr-decedent resource profile.

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

0. Patient
2. Patient.extension
LOINC Code
SlicingThis element introduces a set of slices on Patient.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Patient.extension:NVSS-SexAtDeath
    Slice NameNVSS-SexAtDeath
    ShortNVSS Sex at Death
    Control0..1
    TypeExtension(NVSS SexAtDeath) (Extension Type: CodeableConcept)
    6. Patient.extension:Spouse-Alive
    Slice NameSpouse-Alive
    ShortSpouse Alive?
    Control0..1
    TypeExtension(Spouse Is Alive) (Extension Type: CodeableConcept)
    8. Patient.extension:Patient-BirthPlace
    Slice NamePatient-BirthPlace
    ShortDecedent birthplace
    Control0..1
    TypeExtension(Birth Place) (Extension Type: Address)
    10. Patient.extension:Patient-BirthPlace.value[x]
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    12. Patient.extension:Patient-BirthPlace.value[x].city
    14. Patient.extension:Patient-BirthPlace.value[x].city.extension
    SlicingThis element introduces a set of slices on Patient.extension.value[x].city.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 16. Patient.extension:Patient-BirthPlace.value[x].city.extension:cityCode
      Slice NamecityCode
      ShortCity Code
      Control0..1
      TypeExtension(City Code) (Extension Type: positiveInt)
      LabelCity Code
      18. Patient.extension:Patient-BirthPlace.value[x].state
      BindingThe codes SHALL be taken from States, Territories and Provinces Value Set
      (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-states-territories-provinces-vs)
      20. Patient.extension:Patient-BirthPlace.value[x].country
      BindingThe codes SHALL be taken from Birthplace Country Value Set
      (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-birthplace-country-vs)
      22. Patient.identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control1..?
      LOINC Code
      SlicingThis element introduces a set of slices on Patient.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • pattern @ system
      • 24. Patient.identifier:ni
        Slice Nameni
        ShortNational Identifier
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..1
        26. Patient.identifier:ni.type
        Pattern Value{
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "NI"
          }]
        }
        28. Patient.name
        Control1..?
        LOINC Code
        30. Patient.birthDate
        ShortDate of Birth
        LOINC Code
        32. Patient.birthDate.extension
        SlicingThis element introduces a set of slices on Patient.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 34. Patient.birthDate.extension:partialDate
          Slice NamepartialDate
          Definition

          Alternative component representation of date.

          ShortpartialDate
          Control0..1
          TypeExtension(Partial Date) (Complex Extension)
          36. Patient.address
          ShortDecedent's Residence
          LOINC Code
          38. Patient.address.extension:withinCityLimitsIndicator
          Slice NamewithinCityLimitsIndicator
          Control0..1
          TypeExtension(Within City Limits Indicator) (Extension Type: Coding)
          40. Patient.address.extension:predir
          Slice Namepredir
          Control0..1
          TypeExtension(PreDirectional) (Extension Type: string)
          42. Patient.address.extension:stnum
          Slice Namestnum
          Control0..1
          TypeExtension(StreetNumber) (Extension Type: string)
          44. Patient.address.extension:stname
          Slice Namestname
          Control0..1
          TypeExtension(StreetName) (Extension Type: string)
          46. Patient.address.extension:stdesig
          Slice Namestdesig
          Control0..1
          TypeExtension(StreetDesignator) (Extension Type: string)
          48. Patient.address.extension:postdir
          Slice Namepostdir
          Control0..1
          TypeExtension(PostDirectional) (Extension Type: string)
          50. Patient.address.extension:unitnumber
          Slice Nameunitnumber
          Control0..1
          TypeExtension(UnitOrAptNumber) (Extension Type: string)
          52. Patient.address.city
          54. Patient.address.city.extension
          SlicingThis element introduces a set of slices on Patient.address.city.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 56. Patient.address.city.extension:cityCode
            Slice NamecityCode
            Definition

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

            ShortCity Code
            Control0..1
            TypeExtension(City Code) (Extension Type: positiveInt)
            LabelCity Code
            58. Patient.address.district
            60. Patient.address.district.extension
            SlicingThis element introduces a set of slices on Patient.address.district.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 62. Patient.address.district.extension:districtCode
              Slice NamedistrictCode
              Definition

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

              ShortCounty code
              Control0..1
              TypeExtension(District Code) (Extension Type: positiveInt)
              LabelCounty code
              64. Patient.address.state
              BindingFor example codes, see States, Territories and Provinces Value Set
              (example to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-states-territories-provinces-vs)
              66. Patient.address.country
              BindingThe codes SHALL be taken from Residence Country Value Set
              (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-residence-country-vs)
              68. Patient.maritalStatus
              BindingThe codes SHALL be taken from Marital Status Value Set
              (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-marital-status-vs)
              LOINC Code
              70. Patient.maritalStatus.extension:bypassEditFlag
              Slice NamebypassEditFlag
              Control0..1
              TypeExtension(BypassEditFlag) (Extension Type: CodeableConcept)
              72. Patient.maritalStatus.extension:bypassEditFlag.value[x]
              BindingThe codes SHALL be taken from Edit Bypass 0124
              (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-edit-bypass-0124-vs)
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              74. Patient.maritalStatus.text
              ShortMarital Description
              76. Patient.contact
              ShortInformant information
              LOINC Code
              78. Patient.contact.relationship
              ShortInformant Relationship (INFORMRELATE)
              Control0..1
              LOINC Code
              80. Patient.contact.relationship.text
              ShortInformant Relationship (INFORMRELATE) - first 30 characters will be used

              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..1
              Typeuri
              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              4. 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 are unordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 6. Patient.extension:NVSS-SexAtDeath
                Slice NameNVSS-SexAtDeath
                Definition

                Sex on visual inspection at the time of death by the funeral home

                ShortNVSS Sex at Death
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(NVSS SexAtDeath) (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())
                LOINC Code
                8. Patient.extension:Spouse-Alive
                Slice NameSpouse-Alive
                Definition

                Spouse is Alive.

                ShortSpouse Alive?
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Spouse Is Alive) (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())
                LOINC Code
                10. Patient.extension:Patient-BirthPlace
                Slice NamePatient-BirthPlace
                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.

                ShortDecedent birthplace
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(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())
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                LOINC Code
                12. Patient.extension:Patient-BirthPlace.extension
                Definition

                An Extension


                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortExtensionAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..0*
                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.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 14. Patient.extension:Patient-BirthPlace.url
                  Definition

                  Source of the definition for the extension code - a logical name or a URL.

                  Shortidentifies the meaning of the extension
                  Comments

                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                  Control1..1
                  Typeuri
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  Fixed Valuehttp://hl7.org/fhir/StructureDefinition/patient-birthPlace
                  16. Patient.extension:Patient-BirthPlace.value[x]
                  Definition

                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                  ShortValue of extension
                  Control10..1
                  TypeAddress, date, Meta, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  18. Patient.extension:Patient-BirthPlace.value[x].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()))
                  20. Patient.extension:Patient-BirthPlace.value[x].state
                  Definition

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

                  ShortSub-unit of country (abbreviations ok)
                  Control0..1
                  BindingThe codes SHALL be taken from For codes, see States, Territories and Provinces Value Set
                  (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-states-territories-provinces-vs)
                  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()))
                  22. Patient.extension:Patient-BirthPlace.value[x].country
                  Definition

                  Country - a nation as commonly understood or generally accepted.

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

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

                  Control0..1
                  BindingThe codes SHALL be taken from For codes, see Birthplace Country Value Set
                  (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-birthplace-country-vs)
                  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()))
                  24. Patient.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  Summaryfalse
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  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)
                  Control10..*
                  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 are unordered and Open, and can be differentiated using the following discriminators:
                  • pattern @ system
                  • 28. Patient.identifier:ni
                    Slice Nameni
                    Definition

                    An identifier for this patient.

                    ShortNational IdentifierAn identifier for this patient
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..1*
                    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()))
                    30. Patient.identifier:ni.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.

                    Control0..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.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    32. Patient.identifier:ni.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 Codeshttp://hl7.org/fhir/ValueSet/identifier-type
                    (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.

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code" : "NI"
                      }]
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    34. 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..1
                    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()))
                    36. 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()))
                    38. Patient.birthDate
                    Definition

                    The date of birth for the individual.

                    ShortDate of BirthThe 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).

                    Control0..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
                    40. Patient.birthDate.extension
                    Definition

                    An Extension


                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortExtensionAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    SlicingThis element introduces a set of slices on Patient.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 42. Patient.birthDate.extension:partialDate
                      Slice NamepartialDate
                      Definition

                      Alternative component representation of date.

                      ShortpartialDate
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Partial Date) (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())
                      LOINC Code
                      44. 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] NoteSee Choice of Data Types for 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()))
                      46. Patient.address
                      Definition

                      An address for the individual.

                      ShortDecedent's ResidenceAn address for the individual
                      Comments

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

                      Control0..*
                      TypeAddress
                      Is Modifierfalse
                      Summarytrue
                      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()))
                      48. Patient.address.extension:withinCityLimitsIndicator
                      Slice NamewithinCityLimitsIndicator
                      Definition

                      Within City Limits Indicator (Extension)

                      ShortWithin City Limits Indicator
                      Control0..1
                      TypeExtension(Within City Limits Indicator) (Extension Type: Coding)
                      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())
                      LOINC Code
                      50. Patient.address.extension:predir
                      Slice Namepredir
                      Definition

                      PreDirectional

                      ShortPreDirectional
                      Control0..1
                      TypeExtension(PreDirectional) (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())
                      LOINC Code
                      52. Patient.address.extension:stnum
                      Slice Namestnum
                      Definition

                      StreetNumber

                      ShortStreetNumber
                      Control0..1
                      TypeExtension(StreetNumber) (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())
                      LOINC Code
                      54. Patient.address.extension:stname
                      Slice Namestname
                      Definition

                      StreetName

                      ShortStreetName
                      Control0..1
                      TypeExtension(StreetName) (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())
                      LOINC Code
                      56. Patient.address.extension:stdesig
                      Slice Namestdesig
                      Definition

                      StreetDesignator

                      ShortStreetDesignator
                      Control0..1
                      TypeExtension(StreetDesignator) (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())
                      LOINC Code
                      58. Patient.address.extension:postdir
                      Slice Namepostdir
                      Definition

                      PostDirectional

                      ShortPostDirectional
                      Control0..1
                      TypeExtension(PostDirectional) (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())
                      LOINC Code
                      60. Patient.address.extension:unitnumber
                      Slice Nameunitnumber
                      Definition

                      UnitOrAptNumber

                      ShortUnitOrAptNumber
                      Control0..1
                      TypeExtension(UnitOrAptNumber) (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())
                      LOINC Code
                      62. 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()))
                      64. 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
                      BindingFor example codes, see For codes, see States, Territories and Provinces Value Set
                      (example to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-states-territories-provinces-vs)
                      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()))
                      66. Patient.address.country
                      Definition

                      Country - a nation as commonly understood or generally accepted.

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

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

                      Control0..1
                      BindingThe codes SHALL be taken from For codes, see Residence Country Value Set
                      (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-residence-country-vs)
                      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()))
                      68. Patient.maritalStatus
                      Definition

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

                      ShortMarital (civil) status of a patient
                      Control0..1
                      BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from Marital Status Value Sethttp://hl7.org/fhir/ValueSet/marital-status
                      (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-marital-status-vs)
                      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()))
                      70. Patient.maritalStatus.extension:bypassEditFlag
                      Slice NamebypassEditFlag
                      Definition

                      Extension to hold a codeable concept from one of several valuesets.

                      ShortBypassEditFlag
                      Control0..1
                      TypeExtension(BypassEditFlag) (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())
                      LOINC Code
                      72. Patient.maritalStatus.extension:bypassEditFlag.extension
                      Definition

                      An Extension


                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortExtensionAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..0*
                      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.maritalStatus.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 74. Patient.maritalStatus.extension:bypassEditFlag.url
                        Definition

                        Source of the definition for the extension code - a logical name or a URL.

                        Shortidentifies the meaning of the extension
                        Comments

                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Fixed Valuehttp://profiles.ihe.net/QRPH/VRDR/StructureDefinition/BypassEditFlag
                        76. Patient.maritalStatus.extension:bypassEditFlag.value[x]
                        Definition

                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                        ShortValue of extension
                        Control10..1
                        BindingThe codes SHALL be taken from For codes, see Edit Bypass 0124
                        (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-edit-bypass-0124-vs)
                        TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        78. Patient.maritalStatus.text
                        Definition

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortMarital DescriptionPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

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

                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

                        ShortInformant informationA 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())
                        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())
                        82. 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())
                        84. Patient.contact.relationship
                        Definition

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

                        ShortInformant Relationship (INFORMRELATE)The kind of relationship
                        Control0..1*
                        BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationshiphttp://hl7.org/fhir/ValueSet/patient-contactrelationship
                        (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

                        The nature of the relationship between a patient and a contact person for that patient.

                        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()))
                        86. Patient.contact.relationship.text
                        Definition

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortInformant Relationship (INFORMRELATE) - first 30 characters will be usedPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

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

                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        88. 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..*
                        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()))
                        90. Patient.link.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())
                        92. Patient.link.other
                        Definition

                        The other patient resource that the link refers to.

                        ShortThe other patient or related person resource that the link refers to
                        Comments

                        Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

                        Control1..1
                        TypeReference(Patient, RelatedPerson)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        94. Patient.link.type
                        Definition

                        The type of link between this patient resource and another patient resource.

                        Shortreplaced-by | replaces | refer | seealso
                        Control1..1
                        BindingThe codes SHALL be taken from LinkTypehttp://hl7.org/fhir/ValueSet/link-type|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

                        The type of link between this patient resource and another patient resource.

                        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()))

                        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..1
                        Typeuri
                        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        8. 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..1
                        BindingThe codes SHOULD be taken from CommonLanguages
                        (preferred to http://hl7.org/fhir/ValueSet/languages)

                        A human language.

                        Additional BindingsPurpose
                        AllLanguagesMax Binding
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        10. 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 are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 16. Patient.extension:NVSS-SexAtDeath
                          Slice NameNVSS-SexAtDeath
                          Definition

                          Sex on visual inspection at the time of death by the funeral home

                          ShortNVSS Sex at Death
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(NVSS SexAtDeath) (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:Spouse-Alive
                          Slice NameSpouse-Alive
                          Definition

                          Spouse is Alive.

                          ShortSpouse Alive?
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(Spouse Is Alive) (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())
                          20. Patient.extension:Patient-BirthPlace
                          Slice NamePatient-BirthPlace
                          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.

                          ShortDecedent birthplace
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(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())
                          22. Patient.extension:Patient-BirthPlace.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
                          24. Patient.extension:Patient-BirthPlace.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control0..0
                          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.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 26. Patient.extension:Patient-BirthPlace.url
                            Definition

                            Source of the definition for the extension code - a logical name or a URL.

                            Shortidentifies the meaning of the extension
                            Comments

                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/patient-birthPlace
                            28. Patient.extension:Patient-BirthPlace.value[x]
                            Definition

                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                            ShortValue of extension
                            Control1..1
                            TypeAddress
                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            30. Patient.extension:Patient-BirthPlace.value[x].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
                            32. Patient.extension:Patient-BirthPlace.value[x].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.extension.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 34. Patient.extension:Patient-BirthPlace.value[x].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()))
                              36. Patient.extension:Patient-BirthPlace.value[x].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()))
                              38. Patient.extension:Patient-BirthPlace.value[x].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()))
                              40. Patient.extension:Patient-BirthPlace.value[x].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()))
                              42. Patient.extension:Patient-BirthPlace.value[x].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()))
                              44. Patient.extension:Patient-BirthPlace.value[x].city.id
                              Definition

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

                              Shortxml:id (or equivalent in JSON)
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              46. Patient.extension:Patient-BirthPlace.value[x].city.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              SlicingThis element introduces a set of slices on Patient.extension.value[x].city.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 48. Patient.extension:Patient-BirthPlace.value[x].city.extension:cityCode
                                Slice NamecityCode
                                Definition

                                City expressed as a numeric value. As of the date of publication, in accordance with the NCHS Instruction Manual Part 8, Vital Records Geographic Classification, 2014. (Extension)

                                ShortCity Code
                                Control0..1
                                This element is affected by the following invariants: ele-1
                                TypeExtension(City Code) (Extension Type: positiveInt)
                                Is Modifierfalse
                                LabelCity Code
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                50. Patient.extension:Patient-BirthPlace.value[x].city.value
                                Definition

                                The actual value

                                ShortPrimitive value for string
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                Max Length1048576
                                52. Patient.extension:Patient-BirthPlace.value[x].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()))
                                54. Patient.extension:Patient-BirthPlace.value[x].state
                                Definition

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

                                ShortSub-unit of country (abbreviations ok)
                                Control0..1
                                BindingThe codes SHALL be taken from States, Territories and Provinces Value Set
                                (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-states-territories-provinces-vs)
                                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()))
                                56. Patient.extension:Patient-BirthPlace.value[x].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()))
                                58. Patient.extension:Patient-BirthPlace.value[x].country
                                Definition

                                Country - a nation as commonly understood or generally accepted.

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

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

                                Control0..1
                                BindingThe codes SHALL be taken from Birthplace Country Value Set
                                (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-birthplace-country-vs)
                                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()))
                                60. Patient.extension:Patient-BirthPlace.value[x].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()))
                                62. Patient.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                Summaryfalse
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                64. Patient.identifier
                                Definition

                                An identifier for this patient.

                                ShortAn identifier for this patient
                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control1..*
                                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 are unordered and Open, and can be differentiated using the following discriminators:
                                • pattern @ system
                                • 66. Patient.identifier:ni
                                  Slice Nameni
                                  Definition

                                  An identifier for this patient.

                                  ShortNational Identifier
                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Control0..1
                                  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()))
                                  68. Patient.identifier:ni.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
                                  70. Patient.identifier:ni.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 are unordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 72. Patient.identifier:ni.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.

                                    Control0..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.

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

                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                        "code" : "NI"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    76. Patient.identifier:ni.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.

                                    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()))
                                    78. Patient.identifier:ni.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()))
                                    80. Patient.identifier:ni.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()))
                                    82. Patient.identifier:ni.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()))
                                    84. 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..1
                                    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()))
                                    86. 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()))
                                    88. 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()))
                                    90. 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.

                                    Control0..1
                                    BindingThe codes SHALL be taken from AdministrativeGender
                                    (required to http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1)

                                    The gender of a person used for administrative purposes.

                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Needed 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()))
                                    92. Patient.birthDate
                                    Definition

                                    The date of birth for the individual.

                                    ShortDate of Birth
                                    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).

                                    Control0..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
                                    94. Patient.birthDate.id
                                    Definition

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

                                    Shortxml:id (or equivalent in JSON)
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    96. Patient.birthDate.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.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 98. Patient.birthDate.extension:partialDate
                                      Slice NamepartialDate
                                      Definition

                                      Alternative component representation of date.

                                      ShortpartialDate
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Partial Date) (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())
                                      100. Patient.birthDate.value
                                      Definition

                                      The actual value

                                      ShortPrimitive value for date
                                      Control0..1
                                      Typedate
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      102. 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] NoteSee Choice of Data Types for 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()))
                                      104. Patient.address
                                      Definition

                                      An address for the individual.

                                      ShortDecedent's Residence
                                      Comments

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

                                      Control0..*
                                      TypeAddress
                                      Is Modifierfalse
                                      Summarytrue
                                      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()))
                                      106. 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
                                      108. 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 are unordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 110. Patient.address.extension:withinCityLimitsIndicator
                                        Slice NamewithinCityLimitsIndicator
                                        Definition

                                        Within City Limits Indicator (Extension)

                                        ShortWithin City Limits Indicator
                                        Control0..1
                                        TypeExtension(Within City Limits Indicator) (Extension Type: Coding)
                                        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())
                                        112. Patient.address.extension:predir
                                        Slice Namepredir
                                        Definition

                                        PreDirectional

                                        ShortPreDirectional
                                        Control0..1
                                        TypeExtension(PreDirectional) (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())
                                        114. Patient.address.extension:stnum
                                        Slice Namestnum
                                        Definition

                                        StreetNumber

                                        ShortStreetNumber
                                        Control0..1
                                        TypeExtension(StreetNumber) (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())
                                        116. Patient.address.extension:stname
                                        Slice Namestname
                                        Definition

                                        StreetName

                                        ShortStreetName
                                        Control0..1
                                        TypeExtension(StreetName) (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())
                                        118. Patient.address.extension:stdesig
                                        Slice Namestdesig
                                        Definition

                                        StreetDesignator

                                        ShortStreetDesignator
                                        Control0..1
                                        TypeExtension(StreetDesignator) (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())
                                        120. Patient.address.extension:postdir
                                        Slice Namepostdir
                                        Definition

                                        PostDirectional

                                        ShortPostDirectional
                                        Control0..1
                                        TypeExtension(PostDirectional) (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())
                                        122. Patient.address.extension:unitnumber
                                        Slice Nameunitnumber
                                        Definition

                                        UnitOrAptNumber

                                        ShortUnitOrAptNumber
                                        Control0..1
                                        TypeExtension(UnitOrAptNumber) (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())
                                        124. 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()))
                                        126. 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()))
                                        128. 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()))
                                        130. 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()))
                                        132. 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()))
                                        134. Patient.address.city.id
                                        Definition

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

                                        Shortxml:id (or equivalent in JSON)
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        136. Patient.address.city.extension
                                        Definition

                                        An Extension

                                        ShortExtension
                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on Patient.address.city.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 138. Patient.address.city.extension:cityCode
                                          Slice NamecityCode
                                          Definition

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

                                          ShortCity Code
                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(City Code) (Extension Type: positiveInt)
                                          Is Modifierfalse
                                          LabelCity Code
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          140. Patient.address.city.value
                                          Definition

                                          The actual value

                                          ShortPrimitive value for string
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          Max Length1048576
                                          142. 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()))
                                          144. Patient.address.district.id
                                          Definition

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

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          146. Patient.address.district.extension
                                          Definition

                                          An Extension

                                          ShortExtension
                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          SlicingThis element introduces a set of slices on Patient.address.district.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 148. Patient.address.district.extension:districtCode
                                            Slice NamedistrictCode
                                            Definition

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

                                            ShortCounty code
                                            Control0..1
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(District Code) (Extension Type: positiveInt)
                                            Is Modifierfalse
                                            LabelCounty code
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            150. Patient.address.district.value
                                            Definition

                                            The actual value

                                            ShortPrimitive value for string
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            Max Length1048576
                                            152. 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
                                            BindingFor example codes, see States, Territories and Provinces Value Set
                                            (example to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-states-territories-provinces-vs)
                                            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()))
                                            154. 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()))
                                            156. Patient.address.country
                                            Definition

                                            Country - a nation as commonly understood or generally accepted.

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

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

                                            Control0..1
                                            BindingThe codes SHALL be taken from Residence Country Value Set
                                            (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-residence-country-vs)
                                            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()))
                                            158. 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()))
                                            160. Patient.maritalStatus
                                            Definition

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

                                            ShortMarital (civil) status of a patient
                                            Control0..1
                                            BindingThe codes SHALL be taken from Marital Status Value Set
                                            (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-marital-status-vs)
                                            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()))
                                            162. Patient.maritalStatus.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
                                            164. Patient.maritalStatus.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.maritalStatus.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 166. Patient.maritalStatus.extension:bypassEditFlag
                                              Slice NamebypassEditFlag
                                              Definition

                                              Extension to hold a codeable concept from one of several valuesets.

                                              ShortBypassEditFlag
                                              Control0..1
                                              TypeExtension(BypassEditFlag) (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())
                                              168. Patient.maritalStatus.extension:bypassEditFlag.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
                                              170. Patient.maritalStatus.extension:bypassEditFlag.extension
                                              Definition

                                              An Extension

                                              ShortExtension
                                              Control0..0
                                              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.maritalStatus.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 172. Patient.maritalStatus.extension:bypassEditFlag.url
                                                Definition

                                                Source of the definition for the extension code - a logical name or a URL.

                                                Shortidentifies the meaning of the extension
                                                Comments

                                                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                Control1..1
                                                Typeuri
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                Fixed Valuehttp://profiles.ihe.net/QRPH/VRDR/StructureDefinition/BypassEditFlag
                                                174. Patient.maritalStatus.extension:bypassEditFlag.value[x]
                                                Definition

                                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                ShortValue of extension
                                                Control1..1
                                                BindingThe codes SHALL be taken from Edit Bypass 0124
                                                (required to http://profiles.ihe.net/QRPH/VRDR/ValueSet/vrdr-edit-bypass-0124-vs)
                                                TypeCodeableConcept
                                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                176. Patient.maritalStatus.coding
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                Control0..*
                                                TypeCoding
                                                Is Modifierfalse
                                                Summarytrue
                                                Requirements

                                                Allows for alternative encodings within a code system, and translations to other code systems.

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

                                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                ShortMarital Description
                                                Comments

                                                Very often the text is the same as a displayName of one of the codings.

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

                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                180. 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..1
                                                TypeChoice of: boolean, integer
                                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                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()))
                                                182. 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..*
                                                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()))
                                                184. Patient.contact
                                                Definition

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

                                                ShortInformant information
                                                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())
                                                186. 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
                                                188. 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())
                                                190. 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())
                                                192. Patient.contact.relationship
                                                Definition

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

                                                ShortInformant Relationship (INFORMRELATE)
                                                Control0..1
                                                BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationship
                                                (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

                                                The nature of the relationship between a patient and a contact person for that patient.

                                                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()))
                                                194. Patient.contact.relationship.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.contact.relationship.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.contact.relationship.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 198. Patient.contact.relationship.coding
                                                  Definition

                                                  A reference to a code defined by a terminology system.

                                                  ShortCode defined by a terminology system
                                                  Comments

                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                  Control0..*
                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Requirements

                                                  Allows for alternative encodings within a code system, and translations to other code systems.

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

                                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                  ShortInformant Relationship (INFORMRELATE) - first 30 characters will be used
                                                  Comments

                                                  Very often the text is the same as a displayName of one of the codings.

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

                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  202. 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()))
                                                  204. 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()))
                                                  206. 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()))
                                                  208. 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()))
                                                  210. 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()))
                                                  212. 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()))
                                                  214. 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()))
                                                  216. 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
                                                  218. 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())
                                                  220. 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())
                                                  222. 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()))
                                                  224. 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..1
                                                  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()))
                                                  226. 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(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()))
                                                  228. 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(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()))
                                                  230. 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..*
                                                  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()))
                                                  232. Patient.link.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
                                                  234. Patient.link.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())
                                                  236. Patient.link.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())
                                                  238. Patient.link.other
                                                  Definition

                                                  The other patient resource that the link refers to.

                                                  ShortThe other patient or related person resource that the link refers to
                                                  Comments

                                                  Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

                                                  Control1..1
                                                  TypeReference(Patient, RelatedPerson)
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  240. Patient.link.type
                                                  Definition

                                                  The type of link between this patient resource and another patient resource.

                                                  Shortreplaced-by | replaces | refer | seealso
                                                  Control1..1
                                                  BindingThe codes SHALL be taken from LinkType
                                                  (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

                                                  The type of link between this patient resource and another patient resource.

                                                  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()))