RIVO-Noord Zorgviewer Implementation Guide
1.7.0 - CI build Netherlands flag

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.7.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RIVO-Noord/zorgviewer-ig/ and changes regularly. See the Directory of published versions

Resource Profile: Patient - Detailed Descriptions

Active as of 2024-11-06

Definitions for the Patient resource profile.

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

0. Patient
2. Patient.identifier:BSN
Slice NameBSN
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..?
Must Supporttrue
4. Patient.name
Control1..?
Must Supporttrue
Invariantszv-pat-1: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present. ((family.exists() or given.exists() or text.exists()))
zv-pat-2: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. (text.exists())
6. Patient.gender
Must Supporttrue
8. Patient.birthDate
Must Supporttrue
LOINC Code
10. Patient.deceased[x]
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Must Supporttrue
12. Patient.managingOrganization
Must Supporttrue

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.

ShortPatientInformation about an individual or animal receiving health care services
Control0..*
Alternate NamesSubjectOfCare Client Resident, Patiënt
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
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.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. Patient.extension:preferredPharmacy
Slice NamepreferredPharmacy
Definition

Optional Extension Element - found in all resources.

ShortReferences a patient's preferered pharmacy
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(nl-core-preferred-pharmacy) (Extension Type: Reference)
Alternate NamesVerwijst naar de voorkeursapotheek van de patiënt
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Patient.extension:nationality
Slice Namenationality
Definition

The nationality of the patient.

ShortNationality
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(nationality) (Complex Extension)
Alternate NamesNationaliteit
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Patient.extension:nationality.extension:code
Slice Namecode
Definition

An Extension

ShortExtensionAdditional Content defined by implementations
Control0..1*
TypeExtension
10. Patient.extension:nationality.extension:code.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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valuecode
12. Patient.extension:nationality.extension:code.valueCodeableConcept:valueCodeableConcept
Slice NamevalueCodeableConcept
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

ShortValue of extension
Control0..1
BindingUnless not suitable, these codes SHALL be taken from For codes, see NationaliteitCodelijst
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.7.6.3--20171231000000)

Indicates the country of citizenship.

TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
14. Patient.extension:nationality.extension:period
Slice Nameperiod
Definition

An Extension

ShortExtensionAdditional Content defined by implementations
Control0..1*
TypeExtension
16. Patient.extension:nationality.extension:period.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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valueperiod
18. Patient.extension:nationality.extension:period.valuePeriod:valuePeriod
Slice NamevaluePeriod
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

ShortValue of extension
Control0..1
TypePeriod, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
20. Patient.extension:nationality.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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valuehttp://hl7.org/fhir/StructureDefinition/patient-nationality
22. Patient.extension:nationality.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

ShortValue of extension
Control0..01
TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
24. Patient.extension:legalStatus
Slice NamelegalStatus
Definition

The legal situation that applies to the patient during the intervention. The code of the legal status is based on the Vektis/AZR code list COD232-VEKT Legal Status.

ShortlegalStatus
Comments

The concept LegalStatus of the HCIM FreedomRestrictingMeasures plays an important role in the context of mental healthcare (GGZ). This concept will become an independent HCIM with the next release of HCIM (2018 release).

The LegalStatus concept and associated ValueSet will be split in two concepts: legal status and representative. These concepts are currently captured in one ValueSet. It is possible to have a legal status AND a representative. Therefore, we allow this extension to have a cardinality of 0..2.

Control0..2
This element is affected by the following invariants: ele-1
TypeExtension(Patient LegalStatus) (Extension Type: CodeableConcept)
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
26. Patient.extension:legalStatus.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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-patient-legalstatus
28. Patient.extension:legalStatus.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

ShortValue of extension
Control0..1
TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
SlicingThis element introduces a set of slices on Patient.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
  • 30. Patient.extension:legalStatus.value[x]:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    The legal situation that applies to the patient during the intervention. The code of the legal status is based on the Vektis/AZR code list COD232-VEKT Legal Status.


    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortLegalStatusValue of extension
    Control10..1
    BindingUnless not suitable, these codes SHALL be taken from For codes, see JuridischeStatusCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.3.2--20171231000000)
    TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Alternate NamesJuridischeStatus
    32. Patient.extension:legalStatus.value[x]:valueCodeableConcept.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.

    Control10..*
    TypeCoding
    Summarytrue
    Requirements

    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

    34. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.system
    Definition

    The identification of the code system that defines the meaning of the symbol in the code.

    ShortIdentity of the terminology system
    Comments

    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

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

    Need to be unambiguous about the source of the definition of the symbol.

    36. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.code
    Definition

    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

    ShortSymbol in syntax defined by the system
    Control10..1
    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Need to refer to a particular code in the system.

    38. Patient.extension:lifeStance
    Slice NamelifeStance
    Definition

    Optional Extension Element - found in all resources.

    ShortOptional Extensions Element
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(HCIM LifeStance) (Extension Type: CodeableConcept)
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    40. Patient.extension:lifeStance.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
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-LifeStance
    42. Patient.extension:lifeStance.value[x]
    Definition

    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortValue of extension
    Control10..1
    TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    SlicingThis element introduces a set of slices on Patient.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
    • type @ $this
    • 44. Patient.extension:lifeStance.value[x]:valueCodeableConcept
      Slice NamevalueCodeableConcept
      Definition

      Patient’s life stance and/or religion.


      Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

      ShortLifeStanceValue of extension
      Control10..1
      BindingThe codes SHOULD be taken from For codes, see LevensovertuigingCodelijst
      (preferred to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.7.5.1--20171231000000)

      LevensovertuigingCodelijst

      TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Alternate NamesLevensovertuiging
      46. Patient.extension:lifeStance.value[x]:valueCodeableConcept.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.

      Control10..1*
      TypeCoding
      Summarytrue
      Requirements

      Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

      48. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.system
      Definition

      The identification of the code system that defines the meaning of the symbol in the code.

      ShortIdentity of the terminology system
      Comments

      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

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

      Need to be unambiguous about the source of the definition of the symbol.

      50. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.code
      Definition

      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

      ShortSymbol in syntax defined by the system
      Control10..1
      Typecode
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to refer to a particular code in the system.

      52. 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. Usually modifier elements provide negation or qualification. In order 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.

      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 No Modifier Reason provideed in previous versions of FHIR
      Alternate Namesextensions, user content
      54. Patient.identifier
      Definition

      The Burgerservicenummer or BSN, as one of the possible patient identification numbers, should at least be sent unless there is a reason not to. Reasons for not sending the burgerservicenummer include but are not limited to, research and apps without a contract for processing data (Dutch: bewerkingsovereenkomst).


      An identifier for this patient.

      ShortPatientIdentificationNumberAn identifier for this patient
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..*
      TypeIdentifier
      Summarytrue
      Requirements

      Patients are almost always assigned specific numerical identifiers.

      Alternate NamesIdentificatienummer
      SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 56. Patient.identifier:BSN
        Slice NameBSN
        Definition

        An identifier for this patient.

        ShortBSNAn identifier for this patient
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..1*
        TypeIdentifier
        Must Supporttrue
        Summarytrue
        Requirements

        Patients are almost always assigned specific numerical identifiers.

        Alternate NamesBSN
        58. Patient.identifier:BSN.use
        Definition

        The purpose of this identifier.

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

        This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. 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
        (required to http://hl7.org/fhir/ValueSet/identifier-use)

        Identifies the purpose for this identifier, if known .

        Typecode
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        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.

        60. Patient.identifier:BSN.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
        Control10..1
        Typeuri
        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.

        Fixed Valuehttp://fhir.nl/fhir/NamingSystem/bsn
        Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
        62. Patient.identifier:BSN.value
        Definition

        Burgerservicenummer is the Dutch person identification number which is also allowed for use in healthcare.


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

        ShortBSN (Burgerservicenummer (Dutch person identification number))The value that is unique
        Comments

        The official format according to the 'Logisch Ontwerp BSN 1.4.pdf' is N8..9 and SHALL conform to an 11-proof algorithm. In order to check if the number is 11-proof the number, if N8, SHALL be prefixed with a leading zero. The expected format in FHIR is N9 with leading zero applied to any N8 bsn.


        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.

        Control10..1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Alternate NamesBSN
        Example<br/><b>General</b>:123456 <br/><b>Example of a burgerservicenummer</b>:123456782
        64. Patient.active
        Definition

        This field determines the status of the 'patient' record in the context of the organization that owns the record. Note that the record is not the medical record, but rather the actual patient 'resource'. Obviously when the patient 'resource' is not active, then by extension his medical record might also be inactive. Patient.active='false' may be used discourage use of the record, but that it is kept beause there is (medical) data attached to it. Another use case is a patient moving to a different GP practice. Patient.active would be 'false' in the system of the previous GP.


        Whether this patient record is in active use.

        ShortWhether this patient's record is in active use
        Comments

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

        This element is labeled as a modifier because when the patient record is marked as not active it is not expected to be used/referenced without being changed back to active.

        Control0..1
        Typeboolean
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        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.

        Default Valuetrue
        66. Patient.name
        Definition

        A human's name with the ability to identify parts and usage.


        A name associated with the individual.

        ShortNameInformationA name associated with the patient
        Comments

        Dutch names require that certain name parts are separately communicable. For this reason, extensions are added onto the base HumanName element to mark the meaning of each part. A Dutch HumanName is still a proper FHIR HumanName; however, there might be an incompatibilty with the default FHIR mechanism for communicating given names. See the compatibility note below for more information.

        The extension elements cover birth name (NL: eigennaam / geslachtsnaam) and partner/spouse name. Both may have a prefix (NL: voorvoegsel). When a person marries, he or she may keep their own name, assume the partner name, append the partner name to their own name, or the other way around.

        Incompatibility note: It has come to light that this specification deviates from the way that the HumanName datatype is normally used. This will be fixed in a future release. However, current implementations should be aware of the special considerations regarding the use of this specification.

        The issue at hand is the way alternative representations of a name, like initials or a nickname, are communicated. Normally this is done using multiple HumanName instances, which are differentiated using the .use element. However, this specification allows for including all alternative representations in the same HumanName instance, with the expectation that the extensions provide enough information for receiving systems to differentiate them. However, this means that contrary to the normal usage of this datatype, repetitions of .given names cannot be concatenated to get the full list of given names; the list might be a mix of full names, nicknames and initials.

        Since multiple implementations are based on this specification, sending systems are advised (but not required) to keep the approach with one HumanName instance, while receiving systems should be able to handle this one-instance approach. More specifically:

        • Sending and receiving systems SHOULD always use the specified extensions when using this datatype.
        • Sending systems are encouraged to populate the .text element to unambigiously communicate the person's name.
        • Sending systems are encouraged to send either the full given names or the initials, but not both. This alleviates the duplication of names in .given.
        • When a sending system uses the current one-instance approach for communicating multiple representations, .use MAY NOT be populated. After all, it is not possible to select a single .use when the instance contains different representations.
        • When a receiving system interprets the instance as the single-instance-multiple-representations approach, the .given names marked as initials SHOULD be interpreted as alternatives to the full given names. Note the underlying HCIM expects both the list of full names and list of initials to be a single string; there's no match for an initial to a full name. The instance SHOULD be regarded as using this approach when:
        • They encounter a single instance
        • And the .use element is absent
        • And all the name parts are differentiated using the specified extensions
        • In any other circumstance, receiving systems SHOULD interpret the usage as the normal use.

        Example: miss Irma Jongeneel marries mister de Haas and assumes the name Irma Jongeneel-de Haas:

        • .family = "Jongeneel-de Haas"
        • .given = "Irma" (with .given:iso21090EnQualifier = BR)
        • .family:humannameOwnName = "Jongeneel"
        • .family:humannamePartnerPrefix = "de "
        • .family:humannamePartnerName = "Haas"

        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..*
        This element is affected by the following invariants: ele-1
        TypeHumanName(nl-core-humanname)
        Must Supporttrue
        Requirements

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

        Alternate NamesNaamgegevens
        Example<br/><b>Structured HumanName (preferred above unstructured)</b>:{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode" : "NL4" }], "text" : "Irma Jongeneel-de Haas", "family" : "Jongeneel-de Haas", "_family" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString" : "Jongeneel" }, { "url" : "http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix", "valueString" : "de" }, { "url" : "http://hl7.org/fhir/StructureDefinition/humanname-partner-name", "valueString" : "Haas" }] }, "given" : ["Irma"], "_given" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier", "valueCode" : "CL" }] }] } <br/><b>Unstructured HumanName</b>:{ "text" : "Irma Jongeneel-de Haas" }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        nl-core-humanname-1: if you specify a prefix for an own name then an own name is also expected (name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty().not())
        nl-core-humanname-2: if you specify a voorvoegsel for a partner name then a partner name is also expected (name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-name').empty().not())
        zv-pat-1: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present. ((family.exists() or given.exists() or text.exists()))
        zv-pat-2: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. (text.exists())
        68. Patient.name.extension:humannameAssemblyOrder
        Slice NamehumannameAssemblyOrder
        Definition

        A code that represents the preferred display order of the components of this human name.

        ShortPreferred display order of name parts
        Control0..*
        TypeExtension(assembly-order) (Extension Type: code)
        70. Patient.name.extension:humannameAssemblyOrder.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
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-assembly-order
        72. Patient.name.extension:humannameAssemblyOrder.valueCode:valueCode
        Slice NamevalueCode
        Definition

        Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

        ShortValue of extension
        Control0..1
        BindingThe codes SHALL be taken from For codes, see HumanNameAssemblyOrder
        (required to http://hl7.org/fhir/ValueSet/name-assembly-order)

        A code that represents the preferred display order of the components of a human name

        Typecode, date, dateTime, Meta, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        74. Patient.name.use
        Definition

        Identifies the purpose for this name.

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

        This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

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

        The use of a human name

        Typecode
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

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

        76. Patient.gender
        Definition

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

        ShortGendermale | female | other | unknown
        Comments

        The gender may 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 M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, 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, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error.

        Control0..1
        BindingThe codes SHALL be taken from AdministrativeGenderhttp://hl7.org/fhir/ValueSet/administrative-gender
        (required to http://hl7.org/fhir/ValueSet/administrative-gender)
        Typecode
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.

        Alternate NamesGeslacht
        78. Patient.gender.extension:GeslachtCodelijst
        Slice NameGeslachtCodelijst
        Definition

        Patient’s administrative gender.

        ShortGender
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
        Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., Geslacht
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        80. Patient.gender.extension:GeslachtCodelijst.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
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/code-specification
        82. Patient.gender.extension:GeslachtCodelijst.value[x]
        Definition

        Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

        ShortValue of extension
        Control10..1
        TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        SlicingThis element introduces a set of slices on Patient.gender.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
        • type @ $this
        • 84. Patient.gender.extension:GeslachtCodelijst.value[x]:valueCodeableConcept
          Slice NamevalueCodeableConcept
          Definition

          Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

          ShortValue of extension
          Control10..1
          BindingUnless not suitable, these codes SHALL be taken from For codes, see GeslachtCodelijst
          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.0.1.1--20171231000000)

          GeslachtCodelijst

          TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          86. Patient.birthDate
          Definition

          The date of birth for the individual.

          ShortPatients date of birth. The date of birth is mandatory for a patient. An incomplete date, e.g. only year or only year + month, is permitted.The 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 maternaty/infant care systems).

          Control0..1
          Typedate
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Age of the individual drives many clinical processes.

          Alternate NamesGeboortedatum
          LOINC Code21112-8
          88. Patient.deceased[x]
          Definition

          Indicates if the individual is deceased or not.

          ShortDeathIndicator/DateOfDeathIndicates 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.

          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.

          Control0..1
          TypeChoice of: boolean, dateTime
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          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.

          Alternate NamesOverlijdensindicator/DatumOverlijden
          90. Patient.address
          Definition

          This datatype defines a common basis for expressing all addresses around the world, but adds extensions to express Dutch addresses specifically, according to the HCIM AddressInformation (v1.0, 2017). A Dutch Address still is a proper FHIR Address, which means that systems that cannot interpret the extensions will still be able to render and work with this datatype.

          To have true compatibility an implementer SHOULD use the core Address parts as intended. To have addresses work for Dutch context, the implementer SHOULD in addition use the extension elements.

          Separate address parts

          The first addition is that Dutch addresses make certain address parts separately communicable. These parts are required for use in true Dutch systems when dealing with Dutch addresses, but may not have value for international systems when information gets sent abroad.

          Custom address types

          The second addition is that the HCIM defines its own ValueSet for address types, which can only be partially expressed using the FHIR Address datatype and requires a mapping to multiple elements. The table below explains how the HCIM concepts are mapped to the various FHIR elements (see the ConceptMaps <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressUse> and <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressType> as well). The HCIM code itself should also be included using the AddressType extension.

          | HCIM |.ext:AddressType | .ext:official | .use | .type | |-----------------------------------|:------------------:|:---------------:|:------:|:----------:| | Postal Address/Postadres | PST | | | postal | | Primary Home/Officieel adres | HP | true | home | | | Visit Address/Woon-/verblijfadres | PHYS | | home | physical | | Temporary Address/Tijdelijk adres | TMP | | temp | | | Work Place/Werkadres | WP | | work | | | Vacation Home/Vakantie adres | HV | | temp | |

          If Address.type is both then this is to be understood as a dual purpose address (postal and physical). Systems that support importing it like this are encouraged to do so, otherwise they may need to import this as two separate addresses.

          NOTE: FHIR core defines the AD-use extension to further specify the postal address type. However, the ValueSet used in that extension doesn't completely match the HCIM ValueSet. Therefore, a custom extension has been made. This doesn't preclude the use of the AD-use extension.


          Addresses for the individual.

          ShortAddressInformationAddresses for the individual
          Comments

          Note: address is for postal addresses, not physical locations.


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

          Control0..*
          This element is affected by the following invariants: ele-1, nl-streetname-if-official-and-other-line-parts
          TypeAddress(nl-core-address)
          Requirements

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

          Alternate NamesAdresInformatie, Adresgegevens
          Example<br/><b>Example of a Vacation Home address</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-AddressInformation-AddressType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "HV", "display" : "Vakantie adres" }] } }], "use" : "temp", "line" : ["Binnenkant 12A Hoog"], "_line" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString" : "Binnenkant" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString" : "12" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix", "valueString" : "A" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID", "valueString" : "Hoog" }] }], "city" : "Amsterdam", "state" : "NH", "postalCode" : "1000AA", "country" : "NLD" } <br/><b>Example of a Primary Home address</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-AddressInformation-AddressType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "HP", "display" : "Officieel adres" }] } }, { "url" : "http://fhir.nl/fhir/StructureDefinition/nl-core-address-official", "valueBoolean" : true }], "use" : "home", "line" : ["Binnenkant to 10"], "_line" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString" : "Binnenkant" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator", "valueString" : "to" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString" : "10" }] }], "city" : "Amsterdam", "state" : "NH", "postalCode" : "1001AA", "country" : "NLD" }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          nl-streetname-if-official-and-other-line-parts: Address.streetName in an official address SHALL have a value if one of houseNumber|buildingNumberSuffix|additionalLocator has a value ((extension.where(url = 'http://fhir.nl/fhir/StructureDefinition/nl-core-address-official').where(value = true)).empty() or (line.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty().not() and (line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty().not())))
          92. Patient.animal
          Definition

          This patient is known to be an animal.

          ShortThis patient is known to be an animal (non-human)
          Comments

          The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

          Control0..1
          TypeBackboneElement
          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
          Summarytrue
          Requirements

          Many clinical systems are extended to care for animal patients as well as human.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          94. Patient.animal.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

          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 No Modifier Reason provideed in previous versions of FHIR
          Summarytrue
          Alternate Namesextensions, user content, modifiers
          96. Patient.animal.species
          Definition

          Identifies the high level taxonomic categorization of the kind of animal.

          ShortE.g. Dog, Cow
          Comments

          If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).

          Control1..1
          BindingFor example codes, see AnimalSpecieshttp://hl7.org/fhir/ValueSet/animal-species
          (example to http://hl7.org/fhir/ValueSet/animal-species)

          The species of an animal.

          TypeCodeableConcept
          Summarytrue
          Requirements

          Need to know what kind of animal.

          98. Patient.generalPractitioner
          Definition

          Patient's nominated care provider.

          ShortGeneralPractitionerPatient'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/disablity 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.

          Control0..1*
          TypeReference(nl-core-organization, nl-core-practitioner, Organization, Practitioner)
          Alternate NamescareProvider, Huisarts
          100. Patient.generalPractitioner.extension:practitionerRole
          Slice NamepractitionerRole
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Control0..1
          TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
          102. 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)
          Must Supporttrue
          Summarytrue
          Requirements

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

          104. 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.

          This element is labelled as a modifier because it may 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'.

          Control0..*
          TypeBackboneElement
          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
          Summarytrue
          Requirements

          There are multiple usecases:

          • 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() | (children().count() > id.count()))
          ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          106. 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

          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 No Modifier Reason provideed in previous versions of FHIR
          Summarytrue
          Alternate Namesextensions, user content, modifiers
          108. 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)
          Summarytrue
          110. Patient.link.type
          Definition

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

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

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

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

          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.

          ShortPatient
          Control0..*
          Alternate NamesSubjectOfCare Client Resident, Patiënt
          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
          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
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          4. Patient.meta
          Definition

          The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

          ShortMetadata about the resource
          Control0..1
          TypeMeta
          Summarytrue
          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.

          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.

          This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

          Control0..1
          Typeuri
          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          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
          BindingUnless not suitable, these codes SHALL be taken from Common Languages
          (extensible to http://hl7.org/fhir/ValueSet/languages)

          A human language.

          Additional BindingsPurpose
          AllLanguagesMax Binding
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          10. Patient.text
          Definition

          A human-readable narrative that contains a summary of the resource, and may 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 in formation is added later.

          Control0..1
          This element is affected by the following invariants: dom-1
          TypeNarrative
          Alternate Namesnarrative, html, xhtml, display
          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.

          Control0..*
          TypeResource
          Alternate Namesinline resources, anonymous resources, contained resources
          14. Patient.extension
          Definition

          An Extension

          ShortExtension
          Control0..*
          TypeExtension
          SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. Patient.extension:preferredPharmacy
            Slice NamepreferredPharmacy
            Definition

            Optional Extension Element - found in all resources.

            ShortReferences a patient's preferered pharmacy
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(nl-core-preferred-pharmacy) (Extension Type: Reference)
            Alternate NamesVerwijst naar de voorkeursapotheek van de patiënt
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            18. Patient.extension:nationality
            Slice Namenationality
            Definition

            The nationality of the patient.

            ShortNationality
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(nationality) (Complex Extension)
            Alternate NamesNationaliteit
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            20. Patient.extension:nationality.id
            Definition

            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            Shortxml:id (or equivalent in JSON)
            Control0..1
            Typestring
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            22. Patient.extension:nationality.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

            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
            Alternate Namesextensions, user content
            SlicingThis element introduces a set of slices on Patient.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 24. Patient.extension:nationality.extension:code
              Slice Namecode
              Definition

              An Extension

              ShortExtension
              Control0..1
              TypeExtension
              26. Patient.extension:nationality.extension:code.id
              Definition

              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Shortxml:id (or equivalent in JSON)
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              28. Patient.extension:nationality.extension:code.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

              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
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on Patient.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 30. Patient.extension:nationality.extension:code.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
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuecode
                32. Patient.extension:nationality.extension:code.valueCodeableConcept:valueCodeableConcept
                Slice NamevalueCodeableConcept
                Definition

                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                ShortValue of extension
                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from NationaliteitCodelijst
                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.7.6.3--20171231000000)

                Indicates the country of citizenship.

                TypeCodeableConcept
                34. Patient.extension:nationality.extension:period
                Slice Nameperiod
                Definition

                An Extension

                ShortExtension
                Control0..1
                TypeExtension
                36. Patient.extension:nationality.extension:period.id
                Definition

                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                Shortxml:id (or equivalent in JSON)
                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                38. Patient.extension:nationality.extension:period.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                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
                Alternate Namesextensions, user content
                SlicingThis element introduces a set of slices on Patient.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 40. Patient.extension:nationality.extension:period.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
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Fixed Valueperiod
                  42. Patient.extension:nationality.extension:period.valuePeriod:valuePeriod
                  Slice NamevaluePeriod
                  Definition

                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                  ShortValue of extension
                  Control0..1
                  TypePeriod
                  44. Patient.extension:nationality.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
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Fixed Valuehttp://hl7.org/fhir/StructureDefinition/patient-nationality
                  46. Patient.extension:nationality.value[x]
                  Definition

                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                  ShortValue of extension
                  Control0..0
                  TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  48. Patient.extension:legalStatus
                  Slice NamelegalStatus
                  Definition

                  The legal situation that applies to the patient during the intervention. The code of the legal status is based on the Vektis/AZR code list COD232-VEKT Legal Status.

                  ShortlegalStatus
                  Comments

                  The concept LegalStatus of the HCIM FreedomRestrictingMeasures plays an important role in the context of mental healthcare (GGZ). This concept will become an independent HCIM with the next release of HCIM (2018 release).

                  The LegalStatus concept and associated ValueSet will be split in two concepts: legal status and representative. These concepts are currently captured in one ValueSet. It is possible to have a legal status AND a representative. Therefore, we allow this extension to have a cardinality of 0..2.

                  Control0..2
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Patient LegalStatus) (Extension Type: CodeableConcept)
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  50. Patient.extension:legalStatus.id
                  Definition

                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  Shortxml:id (or equivalent in JSON)
                  Control0..1
                  Typestring
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  52. Patient.extension:legalStatus.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                  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
                  Alternate Namesextensions, user content
                  SlicingThis element introduces a set of slices on Patient.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 54. Patient.extension:legalStatus.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
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-patient-legalstatus
                    56. Patient.extension:legalStatus.value[x]
                    Definition

                    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                    ShortValue of extension
                    Control0..1
                    TypeCodeableConcept
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    SlicingThis element introduces a set of slices on Patient.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 58. Patient.extension:legalStatus.value[x]:valueCodeableConcept
                      Slice NamevalueCodeableConcept
                      Definition

                      The legal situation that applies to the patient during the intervention. The code of the legal status is based on the Vektis/AZR code list COD232-VEKT Legal Status.

                      ShortLegalStatus
                      Control1..1
                      BindingUnless not suitable, these codes SHALL be taken from JuridischeStatusCodelijst
                      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.3.2--20171231000000)
                      TypeCodeableConcept
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Alternate NamesJuridischeStatus
                      60. Patient.extension:legalStatus.value[x]:valueCodeableConcept.id
                      Definition

                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      Shortxml:id (or equivalent in JSON)
                      Control0..1
                      Typestring
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      62. Patient.extension:legalStatus.value[x]:valueCodeableConcept.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                      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
                      Alternate Namesextensions, user content
                      SlicingThis element introduces a set of slices on Patient.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 64. Patient.extension:legalStatus.value[x]:valueCodeableConcept.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.

                        Control1..*
                        TypeCoding
                        Summarytrue
                        Requirements

                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                        66. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.id
                        Definition

                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        Shortxml:id (or equivalent in JSON)
                        Control0..1
                        Typestring
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        68. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                        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
                        Alternate Namesextensions, user content
                        SlicingThis element introduces a set of slices on Patient.extension.value[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 70. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.system
                          Definition

                          The identification of the code system that defines the meaning of the symbol in the code.

                          ShortIdentity of the terminology system
                          Comments

                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

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

                          Need to be unambiguous about the source of the definition of the symbol.

                          72. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.version
                          Definition

                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                          ShortVersion of the system - if relevant
                          Comments

                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                          NoteThis is a business version Id, not a resource version Id (see discussion)
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          74. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.code
                          Definition

                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                          ShortSymbol in syntax defined by the system
                          Control1..1
                          Typecode
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Need to refer to a particular code in the system.

                          76. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.display
                          Definition

                          A representation of the meaning of the code in the system, following the rules of the system.

                          ShortRepresentation defined by the system
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                          78. Patient.extension:legalStatus.value[x]:valueCodeableConcept.coding.userSelected
                          Definition

                          Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                          ShortIf this coding was chosen directly by the user
                          Comments

                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                          80. Patient.extension:legalStatus.value[x]:valueCodeableConcept.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.

                          ShortPlain text representation of the concept
                          Comments

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

                          Control0..1
                          Typestring
                          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.

                          82. Patient.extension:lifeStance
                          Slice NamelifeStance
                          Definition

                          Optional Extension Element - found in all resources.

                          ShortOptional Extensions Element
                          Control0..*
                          This element is affected by the following invariants: ele-1
                          TypeExtension(HCIM LifeStance) (Extension Type: CodeableConcept)
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          84. Patient.extension:lifeStance.id
                          Definition

                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          Shortxml:id (or equivalent in JSON)
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          86. Patient.extension:lifeStance.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                          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
                          Alternate Namesextensions, user content
                          SlicingThis element introduces a set of slices on Patient.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 88. Patient.extension:lifeStance.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
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-LifeStance
                            90. Patient.extension:lifeStance.value[x]
                            Definition

                            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                            ShortValue of extension
                            Control1..1
                            TypeCodeableConcept
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            SlicingThis element introduces a set of slices on Patient.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 92. Patient.extension:lifeStance.value[x]:valueCodeableConcept
                              Slice NamevalueCodeableConcept
                              Definition

                              Patient’s life stance and/or religion.

                              ShortLifeStance
                              Control1..1
                              BindingThe codes SHOULD be taken from LevensovertuigingCodelijst
                              (preferred to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.7.5.1--20171231000000)

                              LevensovertuigingCodelijst

                              TypeCodeableConcept
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Alternate NamesLevensovertuiging
                              94. Patient.extension:lifeStance.value[x]:valueCodeableConcept.id
                              Definition

                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              Shortxml:id (or equivalent in JSON)
                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              XML FormatIn the XML format, this property is represented as an attribute.
                              96. Patient.extension:lifeStance.value[x]:valueCodeableConcept.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                              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
                              Alternate Namesextensions, user content
                              SlicingThis element introduces a set of slices on Patient.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 98. Patient.extension:lifeStance.value[x]:valueCodeableConcept.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.

                                Control1..1
                                TypeCoding
                                Summarytrue
                                Requirements

                                Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                100. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.id
                                Definition

                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                Shortxml:id (or equivalent in JSON)
                                Control0..1
                                Typestring
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                XML FormatIn the XML format, this property is represented as an attribute.
                                102. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                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
                                Alternate Namesextensions, user content
                                SlicingThis element introduces a set of slices on Patient.extension.value[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 104. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.system
                                  Definition

                                  The identification of the code system that defines the meaning of the symbol in the code.

                                  ShortIdentity of the terminology system
                                  Comments

                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

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

                                  Need to be unambiguous about the source of the definition of the symbol.

                                  106. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.version
                                  Definition

                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                  ShortVersion of the system - if relevant
                                  Comments

                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  108. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.code
                                  Definition

                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                  ShortSymbol in syntax defined by the system
                                  Control1..1
                                  Typecode
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to refer to a particular code in the system.

                                  110. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.display
                                  Definition

                                  A representation of the meaning of the code in the system, following the rules of the system.

                                  ShortRepresentation defined by the system
                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                  112. Patient.extension:lifeStance.value[x]:valueCodeableConcept.coding.userSelected
                                  Definition

                                  Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                  ShortIf this coding was chosen directly by the user
                                  Comments

                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                  114. Patient.extension:lifeStance.value[x]:valueCodeableConcept.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.

                                  ShortPlain text representation of the concept
                                  Comments

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

                                  Control0..1
                                  Typestring
                                  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.

                                  116. 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. Usually modifier elements provide negation or qualification. In order 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.

                                  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 No Modifier Reason provideed in previous versions of FHIR
                                  Alternate Namesextensions, user content
                                  118. Patient.identifier
                                  Definition

                                  The Burgerservicenummer or BSN, as one of the possible patient identification numbers, should at least be sent unless there is a reason not to. Reasons for not sending the burgerservicenummer include but are not limited to, research and apps without a contract for processing data (Dutch: bewerkingsovereenkomst).

                                  ShortPatientIdentificationNumber
                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Control1..*
                                  TypeIdentifier
                                  Summarytrue
                                  Requirements

                                  Patients are almost always assigned specific numerical identifiers.

                                  Alternate NamesIdentificatienummer
                                  SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ system
                                  • 120. Patient.identifier:BSN
                                    Slice NameBSN
                                    Definition

                                    An identifier for this patient.

                                    ShortBSN
                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control1..1
                                    TypeIdentifier
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Patients are almost always assigned specific numerical identifiers.

                                    Alternate NamesBSN
                                    122. Patient.identifier:BSN.id
                                    Definition

                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    Shortxml:id (or equivalent in JSON)
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    124. Patient.identifier:BSN.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                    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
                                    Alternate Namesextensions, user content
                                    SlicingThis element introduces a set of slices on Patient.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 126. Patient.identifier:BSN.use
                                      Definition

                                      The purpose of this identifier.

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

                                      This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. 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)

                                      Identifies the purpose for this identifier, if known .

                                      Typecode
                                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                      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.

                                      128. Patient.identifier:BSN.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
                                      Summarytrue
                                      Requirements

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

                                      130. Patient.identifier:BSN.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
                                      Control1..1
                                      Typeuri
                                      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.

                                      Fixed Valuehttp://fhir.nl/fhir/NamingSystem/bsn
                                      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                      132. Patient.identifier:BSN.value
                                      Definition

                                      Burgerservicenummer is the Dutch person identification number which is also allowed for use in healthcare.

                                      ShortBSN (Burgerservicenummer (Dutch person identification number))
                                      Comments

                                      The official format according to the 'Logisch Ontwerp BSN 1.4.pdf' is N8..9 and SHALL conform to an 11-proof algorithm. In order to check if the number is 11-proof the number, if N8, SHALL be prefixed with a leading zero. The expected format in FHIR is N9 with leading zero applied to any N8 bsn.

                                      Control1..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Alternate NamesBSN
                                      Example<br/><b>General</b>:123456 <br/><b>Example of a burgerservicenummer</b>:123456782
                                      134. Patient.identifier:BSN.period
                                      Definition

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

                                      ShortTime period when id is/was valid for use
                                      Control0..1
                                      TypePeriod
                                      Summarytrue
                                      136. Patient.identifier:BSN.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)
                                      Summarytrue
                                      138. Patient.active
                                      Definition

                                      This field determines the status of the 'patient' record in the context of the organization that owns the record. Note that the record is not the medical record, but rather the actual patient 'resource'. Obviously when the patient 'resource' is not active, then by extension his medical record might also be inactive. Patient.active='false' may be used discourage use of the record, but that it is kept beause there is (medical) data attached to it. Another use case is a patient moving to a different GP practice. Patient.active would be 'false' in the system of the previous GP.

                                      ShortWhether this patient's record is in active use
                                      Comments

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

                                      This element is labeled as a modifier because when the patient record is marked as not active it is not expected to be used/referenced without being changed back to active.

                                      Control0..1
                                      Typeboolean
                                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                      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.

                                      Default Valuetrue
                                      140. Patient.name
                                      Definition

                                      A human's name with the ability to identify parts and usage.

                                      ShortNameInformation
                                      Comments

                                      Dutch names require that certain name parts are separately communicable. For this reason, extensions are added onto the base HumanName element to mark the meaning of each part. A Dutch HumanName is still a proper FHIR HumanName; however, there might be an incompatibilty with the default FHIR mechanism for communicating given names. See the compatibility note below for more information.

                                      The extension elements cover birth name (NL: eigennaam / geslachtsnaam) and partner/spouse name. Both may have a prefix (NL: voorvoegsel). When a person marries, he or she may keep their own name, assume the partner name, append the partner name to their own name, or the other way around.

                                      Incompatibility note: It has come to light that this specification deviates from the way that the HumanName datatype is normally used. This will be fixed in a future release. However, current implementations should be aware of the special considerations regarding the use of this specification.

                                      The issue at hand is the way alternative representations of a name, like initials or a nickname, are communicated. Normally this is done using multiple HumanName instances, which are differentiated using the .use element. However, this specification allows for including all alternative representations in the same HumanName instance, with the expectation that the extensions provide enough information for receiving systems to differentiate them. However, this means that contrary to the normal usage of this datatype, repetitions of .given names cannot be concatenated to get the full list of given names; the list might be a mix of full names, nicknames and initials.

                                      Since multiple implementations are based on this specification, sending systems are advised (but not required) to keep the approach with one HumanName instance, while receiving systems should be able to handle this one-instance approach. More specifically:

                                      • Sending and receiving systems SHOULD always use the specified extensions when using this datatype.
                                      • Sending systems are encouraged to populate the .text element to unambigiously communicate the person's name.
                                      • Sending systems are encouraged to send either the full given names or the initials, but not both. This alleviates the duplication of names in .given.
                                      • When a sending system uses the current one-instance approach for communicating multiple representations, .use MAY NOT be populated. After all, it is not possible to select a single .use when the instance contains different representations.
                                      • When a receiving system interprets the instance as the single-instance-multiple-representations approach, the .given names marked as initials SHOULD be interpreted as alternatives to the full given names. Note the underlying HCIM expects both the list of full names and list of initials to be a single string; there's no match for an initial to a full name. The instance SHOULD be regarded as using this approach when:
                                      • They encounter a single instance
                                      • And the .use element is absent
                                      • And all the name parts are differentiated using the specified extensions
                                      • In any other circumstance, receiving systems SHOULD interpret the usage as the normal use.

                                      Example: miss Irma Jongeneel marries mister de Haas and assumes the name Irma Jongeneel-de Haas:

                                      • .family = "Jongeneel-de Haas"
                                      • .given = "Irma" (with .given:iso21090EnQualifier = BR)
                                      • .family:humannameOwnName = "Jongeneel"
                                      • .family:humannamePartnerPrefix = "de "
                                      • .family:humannamePartnerName = "Haas"
                                      Control1..*
                                      This element is affected by the following invariants: ele-1
                                      TypeHumanName(nl-core-humanname)
                                      Must Supporttrue
                                      Requirements

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

                                      Alternate NamesNaamgegevens
                                      Example<br/><b>Structured HumanName (preferred above unstructured)</b>:{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode" : "NL4" }], "text" : "Irma Jongeneel-de Haas", "family" : "Jongeneel-de Haas", "_family" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString" : "Jongeneel" }, { "url" : "http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix", "valueString" : "de" }, { "url" : "http://hl7.org/fhir/StructureDefinition/humanname-partner-name", "valueString" : "Haas" }] }, "given" : ["Irma"], "_given" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier", "valueCode" : "CL" }] }] } <br/><b>Unstructured HumanName</b>:{ "text" : "Irma Jongeneel-de Haas" }
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                      nl-core-humanname-1: if you specify a prefix for an own name then an own name is also expected (name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty().not())
                                      nl-core-humanname-2: if you specify a voorvoegsel for a partner name then a partner name is also expected (name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-name').empty().not())
                                      zv-pat-1: Either Patient.name.given and/or Patient.name.family and/or Patient.name.text SHALL be present. ((family.exists() or given.exists() or text.exists()))
                                      zv-pat-2: To be usable for a wide range of internationally available applications, the Patient.name.text SHOULD be present. (text.exists())
                                      142. Patient.name.id
                                      Definition

                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      Shortxml:id (or equivalent in JSON)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      144. Patient.name.extension
                                      Definition

                                      An Extension

                                      ShortExtension
                                      Control0..*
                                      TypeExtension
                                      SlicingThis element introduces a set of slices on Patient.name.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 146. Patient.name.extension:humannameAssemblyOrder
                                        Slice NamehumannameAssemblyOrder
                                        Definition

                                        A code that represents the preferred display order of the components of this human name.

                                        ShortPreferred display order of name parts
                                        Control0..*
                                        TypeExtension(assembly-order) (Extension Type: code)
                                        148. Patient.name.extension:humannameAssemblyOrder.id
                                        Definition

                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        Shortxml:id (or equivalent in JSON)
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        150. Patient.name.extension:humannameAssemblyOrder.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                        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
                                        Alternate Namesextensions, user content
                                        SlicingThis element introduces a set of slices on Patient.name.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 152. Patient.name.extension:humannameAssemblyOrder.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
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-assembly-order
                                          154. Patient.name.extension:humannameAssemblyOrder.valueCode:valueCode
                                          Slice NamevalueCode
                                          Definition

                                          Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                          ShortValue of extension
                                          Control0..1
                                          BindingThe codes SHALL be taken from HumanNameAssemblyOrder
                                          (required to http://hl7.org/fhir/ValueSet/name-assembly-order)

                                          A code that represents the preferred display order of the components of a human name

                                          Typecode
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          156. Patient.name.use
                                          Definition

                                          Identifies the purpose for this name.

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

                                          This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

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

                                          The use of a human name

                                          Typecode
                                          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

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

                                          158. Patient.name.text
                                          Definition

                                          A full text representation of the name.

                                          ShortText representation of the full name
                                          Comments

                                          Can provide both a text representation and structured parts.

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

                                          A renderable, unencoded form.

                                          160. Patient.name.family
                                          Definition

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

                                          ShortSurname
                                          Comments

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

                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Alternate Namessurname, Achternaam
                                          162. Patient.name.family.id
                                          Definition

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

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          164. Patient.name.family.extension
                                          Definition

                                          An Extension

                                          ShortExtension
                                          Control0..*
                                          TypeExtension
                                          SlicingThis element introduces a set of slices on Patient.name.family.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 166. Patient.name.family.extension:humannameOwnPrefix
                                            Slice NamehumannameOwnPrefix
                                            Definition

                                            The prefix portion (e.g. voorvoegsel) inclusive of the space between the prefix and the surname, if applicable, of the family name that is derived from the person's own surname, as distinguished from any portion that is derived from the surname of the person's partner or spouse.

                                            ShortPrefixOwnName
                                            Comments

                                            An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.

                                            Control0..1
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(own-prefix) (Extension Type: string)
                                            Alternate NamesVoorvoegselGeslachtsnaam
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            168. Patient.name.family.extension:humannameOwnPrefix.id
                                            Definition

                                            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            170. Patient.name.family.extension:humannameOwnPrefix.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                            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
                                            Alternate Namesextensions, user content
                                            SlicingThis element introduces a set of slices on Patient.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 172. Patient.name.family.extension:humannameOwnPrefix.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
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-own-prefix
                                              174. Patient.name.family.extension:humannameOwnPrefix.valueString:valueString
                                              Slice NamevalueString
                                              Definition

                                              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                              ShortValue of extension
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              176. Patient.name.family.extension:humannameOwnName
                                              Slice NamehumannameOwnName
                                              Definition

                                              The person’s official last name.

                                              ShortOwnName
                                              Comments

                                              The portion of the family name that is derived from the person's own surname, as distinguished from any portion that is derived from the surname of the person's partner or spouse. If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".

                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(own-name) (Extension Type: string)
                                              Alternate NamesGeslachtsnaam
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              178. Patient.name.family.extension:humannameOwnName.id
                                              Definition

                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              Shortxml:id (or equivalent in JSON)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              180. Patient.name.family.extension:humannameOwnName.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                              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
                                              Alternate Namesextensions, user content
                                              SlicingThis element introduces a set of slices on Patient.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 182. Patient.name.family.extension:humannameOwnName.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
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-own-name
                                                184. Patient.name.family.extension:humannameOwnName.valueString:valueString
                                                Slice NamevalueString
                                                Definition

                                                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                ShortValue of extension
                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                186. Patient.name.family.extension:humannamePartnerPrefix
                                                Slice NamehumannamePartnerPrefix
                                                Definition

                                                Voorvoegsel derived from person's partner's surname inclusive of the space between the prefix and the surname, if applicable.

                                                ShortPrefixSurname
                                                Comments

                                                An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to identify it as a separate sub-component.

                                                Control0..1
                                                This element is affected by the following invariants: ele-1
                                                TypeExtension(partner-prefix) (Extension Type: string)
                                                Alternate NamesVoorvoegselGeslachtsnaamPartner
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                188. Patient.name.family.extension:humannamePartnerPrefix.id
                                                Definition

                                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                Shortxml:id (or equivalent in JSON)
                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                190. Patient.name.family.extension:humannamePartnerPrefix.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                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
                                                Alternate Namesextensions, user content
                                                SlicingThis element introduces a set of slices on Patient.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 192. Patient.name.family.extension:humannamePartnerPrefix.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
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-partner-prefix
                                                  194. Patient.name.family.extension:humannamePartnerPrefix.valueString:valueString
                                                  Slice NamevalueString
                                                  Definition

                                                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                  ShortValue of extension
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  196. Patient.name.family.extension:humannamePartnerName
                                                  Slice NamehumannamePartnerName
                                                  Definition

                                                  Partner’s official last name.

                                                  ShortLastNamePartner
                                                  Comments

                                                  The portion of the family name that is derived from the person's partner's surname, as distinguished from any portion that is derived from the surname of the person's own name. If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".

                                                  Control0..1
                                                  This element is affected by the following invariants: ele-1
                                                  TypeExtension(partner-name) (Extension Type: string)
                                                  Alternate NamesGeslachtsnaamPartner
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  198. Patient.name.family.extension:humannamePartnerName.id
                                                  Definition

                                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  Shortxml:id (or equivalent in JSON)
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  200. Patient.name.family.extension:humannamePartnerName.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                  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
                                                  Alternate Namesextensions, user content
                                                  SlicingThis element introduces a set of slices on Patient.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 202. Patient.name.family.extension:humannamePartnerName.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
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-partner-name
                                                    204. Patient.name.family.extension:humannamePartnerName.valueString:valueString
                                                    Slice NamevalueString
                                                    Definition

                                                    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                    ShortValue of extension
                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    206. Patient.name.family.value
                                                    Definition

                                                    The actual value

                                                    ShortPrimitive value for string
                                                    Control0..1
                                                    Typestring
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Max Length:1048576
                                                    208. Patient.name.given
                                                    Definition

                                                    Note that in order to mark the type of a given name, the FHIR standard extension for ISO 21090 EN Qualifiers is to be used. Examples include call me name (Dutch: roepnaam) and initials. Each initial is expected to be delimited by a dot.

                                                    ShortGiven
                                                    Comments

                                                    Note that in order to mark the type of a given name, the FHIR standard extension for ISO 21090 EN Qualifiers is to be used. Examples include call me name (Dutch: roepnaam) and initials. Each initial is expected to be delimited by a dot. To be conformant to the HCIM for NameInformation, at least the following qualifiers SHALL be supported: BR, IN and CL. The qualifier BR maps to the HCIM concept FirstNames, IN maps to Initials and CL to GivenName.

                                                    Please see the compatibility note on the containing element as well!

                                                    Control0..*
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Alternate Namesfirst name, middle name, Voornamen, Initialen, Roepnaam
                                                    210. Patient.name.given.id
                                                    Definition

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

                                                    Shortxml:id (or equivalent in JSON)
                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    212. Patient.name.given.extension
                                                    Definition

                                                    An Extension

                                                    ShortExtension
                                                    Control0..*
                                                    TypeExtension
                                                    SlicingThis element introduces a set of slices on Patient.name.given.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 214. Patient.name.given.extension:iso21090EnQualifier
                                                      Slice Nameiso21090EnQualifier
                                                      Definition

                                                      A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type.

                                                      ShortLS | AC | NB | PR | HON | BR | AD | SP | MID | CL | IN | VV
                                                      Comments

                                                      Used to indicate additional information about the name part and how it should be used.

                                                      Control0..1
                                                      This element is affected by the following invariants: ele-1
                                                      TypeExtension(EN-qualifier) (Extension Type: code)
                                                      Is Modifierfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      216. Patient.name.given.extension:iso21090EnQualifier.id
                                                      Definition

                                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      Shortxml:id (or equivalent in JSON)
                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      218. Patient.name.given.extension:iso21090EnQualifier.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                      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
                                                      Alternate Namesextensions, user content
                                                      SlicingThis element introduces a set of slices on Patient.name.given.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 220. Patient.name.given.extension:iso21090EnQualifier.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
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier
                                                        222. Patient.name.given.extension:iso21090EnQualifier.valueCode:valueCode
                                                        Slice NamevalueCode
                                                        Definition

                                                        Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                        ShortValue of extension
                                                        Control0..1
                                                        BindingThe codes SHALL be taken from EntityNamePartQualifier
                                                        (required to http://hl7.org/fhir/ValueSet/name-part-qualifier)

                                                        A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type

                                                        Typecode
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        224. Patient.name.given.value
                                                        Definition

                                                        The actual value

                                                        ShortPrimitive value for string
                                                        Control0..1
                                                        Typestring
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Max Length:1048576
                                                        226. Patient.name.prefix
                                                        Definition

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

                                                        ShortParts that come before the name
                                                        Control0..*
                                                        Typestring
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        228. Patient.name.suffix
                                                        Definition

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

                                                        ShortParts that come after the name
                                                        Control0..*
                                                        Typestring
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        230. Patient.name.period
                                                        Definition

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

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

                                                        Allows names to be placed in historical context.

                                                        232. Patient.telecom
                                                        Definition

                                                        A contact detail for the individual. Note that there is no support for multiple use values like 'mobile business'.

                                                        ShortContactInformation
                                                        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 may 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..*
                                                        This element is affected by the following invariants: ele-1
                                                        TypeContactPoint(nl-core-contactpoint)
                                                        Requirements

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

                                                        Alternate NamesContactgegevens
                                                        Example<br/><b>Mobile business phone number. Note: the mobile nature stems from the number being an 06-* number.</b>:{ "system" : "phone", "value" : "+31611234567", "use" : "work" } <br/><b>Mobile phone number undetermined private/business. Note: the mobile nature stems from the number being an 06-* number.</b>:{ "system" : "phone", "value" : "+31611234567", "use" : "mobile" } <br/><b>Primary Home Land Line</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "LL", "display" : "Land Line" }] } }], "system" : "phone", "value" : "...", "use" : "home" } <br/><b>Temporary Land Line</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "LL", "display" : "Land Line" }] } }], "system" : "phone", "value" : "...", "use" : "temp" } <br/><b>Primary Work Land Line</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "LL", "display" : "Land Line" }] } }], "system" : "phone", "value" : "...", "use" : "work" } <br/><b>Primary Home Fax</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "FAX", "display" : "Fax" }] } }], "system" : "fax", "value" : "...", "use" : "home" } <br/><b>Temporary Fax</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "FAX", "display" : "Fax" }] } }], "system" : "fax", "value" : "...", "use" : "temp" } <br/><b>Primary Work Fax</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "FAX", "display" : "Fax" }] } }], "system" : "fax", "value" : "...", "use" : "work" } <br/><b>Primary Home Mobile Phone</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "MC", "display" : "Mobile Phone" }] } }], "system" : "phone", "value" : "...", "use" : "home" } <br/><b>Temporary Mobile Phone</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "MC", "display" : "Mobile Phone" }] } }], "system" : "phone", "value" : "...", "use" : "temp" } <br/><b>Primary Work Mobile Phone</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "MC", "display" : "Mobile Phone" }] } }], "system" : "phone", "value" : "...", "use" : "work" } <br/><b>Primary Home Pager</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "PG", "display" : "Pager" }] } }], "system" : "pager", "value" : "...", "use" : "home" } <br/><b>Temporary Pager</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "PG", "display" : "Pager" }] } }], "system" : "pager", "value" : "...", "use" : "temp" } <br/><b>Primary Work Pager</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "PG", "display" : "Pager" }] } }], "system" : "pager", "value" : "...", "use" : "work" } <br/><b>Private email address</b>:{ "system" : "email", "value" : "giesput@myweb.nl", "use" : "home" } <br/><b>Work email address</b>:{ "system" : "email", "value" : "example@workplace.nl", "use" : "work" }
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                        cpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                                                        234. Patient.gender
                                                        Definition

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

                                                        ShortGender
                                                        Comments

                                                        The gender may 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 M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, 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, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error.

                                                        Control0..1
                                                        BindingThe codes SHALL be taken from AdministrativeGender
                                                        (required to http://hl7.org/fhir/ValueSet/administrative-gender)
                                                        Typecode
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.

                                                        Alternate NamesGeslacht
                                                        236. Patient.gender.id
                                                        Definition

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

                                                        Shortxml:id (or equivalent in JSON)
                                                        Control0..1
                                                        Typestring
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        238. Patient.gender.extension
                                                        Definition

                                                        An Extension

                                                        ShortExtension
                                                        Control0..*
                                                        TypeExtension
                                                        SlicingThis element introduces a set of slices on Patient.gender.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 240. Patient.gender.extension:GeslachtCodelijst
                                                          Slice NameGeslachtCodelijst
                                                          Definition

                                                          Patient’s administrative gender.

                                                          ShortGender
                                                          Control0..1
                                                          This element is affected by the following invariants: ele-1
                                                          TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
                                                          Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., Geslacht
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          242. Patient.gender.extension:GeslachtCodelijst.id
                                                          Definition

                                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          Shortxml:id (or equivalent in JSON)
                                                          Control0..1
                                                          Typestring
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          244. Patient.gender.extension:GeslachtCodelijst.extension
                                                          Definition

                                                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                          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
                                                          Alternate Namesextensions, user content
                                                          SlicingThis element introduces a set of slices on Patient.gender.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 246. Patient.gender.extension:GeslachtCodelijst.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
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/code-specification
                                                            248. Patient.gender.extension:GeslachtCodelijst.value[x]
                                                            Definition

                                                            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                            ShortValue of extension
                                                            Control1..1
                                                            TypeCodeableConcept
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            SlicingThis element introduces a set of slices on Patient.gender.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                            • type @ $this
                                                            • 250. Patient.gender.extension:GeslachtCodelijst.value[x]:valueCodeableConcept
                                                              Slice NamevalueCodeableConcept
                                                              Definition

                                                              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                              ShortValue of extension
                                                              Control1..1
                                                              BindingUnless not suitable, these codes SHALL be taken from GeslachtCodelijst
                                                              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.0.1.1--20171231000000)

                                                              GeslachtCodelijst

                                                              TypeCodeableConcept
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              252. Patient.gender.value
                                                              Definition

                                                              Primitive value for code

                                                              ShortPrimitive value for code
                                                              Control0..1
                                                              Typecode
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              254. Patient.birthDate
                                                              Definition

                                                              The date of birth for the individual.

                                                              ShortPatients date of birth. The date of birth is mandatory for a patient. An incomplete date, e.g. only year or only year + month, is permitted.
                                                              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 maternaty/infant care systems).

                                                              Control0..1
                                                              Typedate
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements

                                                              Age of the individual drives many clinical processes.

                                                              Alternate NamesGeboortedatum
                                                              LOINC Code21112-8
                                                              256. Patient.deceased[x]
                                                              Definition

                                                              Indicates if the individual is deceased or not.

                                                              ShortDeathIndicator/DateOfDeath
                                                              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.

                                                              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.

                                                              Control0..1
                                                              TypeChoice of: boolean, dateTime
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Must Support TypesNo must-support rules about the choice of types/profiles
                                                              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.

                                                              Alternate NamesOverlijdensindicator/DatumOverlijden
                                                              258. Patient.address
                                                              Definition

                                                              This datatype defines a common basis for expressing all addresses around the world, but adds extensions to express Dutch addresses specifically, according to the HCIM AddressInformation (v1.0, 2017). A Dutch Address still is a proper FHIR Address, which means that systems that cannot interpret the extensions will still be able to render and work with this datatype.

                                                              To have true compatibility an implementer SHOULD use the core Address parts as intended. To have addresses work for Dutch context, the implementer SHOULD in addition use the extension elements.

                                                              Separate address parts

                                                              The first addition is that Dutch addresses make certain address parts separately communicable. These parts are required for use in true Dutch systems when dealing with Dutch addresses, but may not have value for international systems when information gets sent abroad.

                                                              Custom address types

                                                              The second addition is that the HCIM defines its own ValueSet for address types, which can only be partially expressed using the FHIR Address datatype and requires a mapping to multiple elements. The table below explains how the HCIM concepts are mapped to the various FHIR elements (see the ConceptMaps <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressUse> and <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressType> as well). The HCIM code itself should also be included using the AddressType extension.

                                                              | HCIM |.ext:AddressType | .ext:official | .use | .type | |-----------------------------------|:------------------:|:---------------:|:------:|:----------:| | Postal Address/Postadres | PST | | | postal | | Primary Home/Officieel adres | HP | true | home | | | Visit Address/Woon-/verblijfadres | PHYS | | home | physical | | Temporary Address/Tijdelijk adres | TMP | | temp | | | Work Place/Werkadres | WP | | work | | | Vacation Home/Vakantie adres | HV | | temp | |

                                                              If Address.type is both then this is to be understood as a dual purpose address (postal and physical). Systems that support importing it like this are encouraged to do so, otherwise they may need to import this as two separate addresses.

                                                              NOTE: FHIR core defines the AD-use extension to further specify the postal address type. However, the ValueSet used in that extension doesn't completely match the HCIM ValueSet. Therefore, a custom extension has been made. This doesn't preclude the use of the AD-use extension.

                                                              ShortAddressInformation
                                                              Comments

                                                              Note: address is for postal addresses, not physical locations.

                                                              Control0..*
                                                              This element is affected by the following invariants: ele-1, nl-streetname-if-official-and-other-line-parts
                                                              TypeAddress(nl-core-address)
                                                              Requirements

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

                                                              Alternate NamesAdresInformatie, Adresgegevens
                                                              Example<br/><b>Example of a Vacation Home address</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-AddressInformation-AddressType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "HV", "display" : "Vakantie adres" }] } }], "use" : "temp", "line" : ["Binnenkant 12A Hoog"], "_line" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString" : "Binnenkant" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString" : "12" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix", "valueString" : "A" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID", "valueString" : "Hoog" }] }], "city" : "Amsterdam", "state" : "NH", "postalCode" : "1000AA", "country" : "NLD" } <br/><b>Example of a Primary Home address</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-AddressInformation-AddressType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "HP", "display" : "Officieel adres" }] } }, { "url" : "http://fhir.nl/fhir/StructureDefinition/nl-core-address-official", "valueBoolean" : true }], "use" : "home", "line" : ["Binnenkant to 10"], "_line" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString" : "Binnenkant" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator", "valueString" : "to" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString" : "10" }] }], "city" : "Amsterdam", "state" : "NH", "postalCode" : "1001AA", "country" : "NLD" }
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                              nl-streetname-if-official-and-other-line-parts: Address.streetName in an official address SHALL have a value if one of houseNumber|buildingNumberSuffix|additionalLocator has a value ((extension.where(url = 'http://fhir.nl/fhir/StructureDefinition/nl-core-address-official').where(value = true)).empty() or (line.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty().not() and (line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty().not())))
                                                              260. Patient.maritalStatus
                                                              Definition

                                                              This field contains a patient's most recent marital (civil) status. A person’s marital status according to the terms and definition in the Dutch civil code.

                                                              ShortMaritalStatus
                                                              Control0..1
                                                              BindingUnless not suitable, these codes SHALL be taken from BurgerlijkeStaatCodelijst
                                                              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.7.9.1--20171231000000)
                                                              TypeCodeableConcept
                                                              Requirements

                                                              Most, if not all systems capture it.

                                                              Alternate NamesBurgerlijkeStaat
                                                              262. Patient.multipleBirth[x]
                                                              Definition

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

                                                              ShortMultipleBirthIndicator
                                                              Comments

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

                                                              Control0..1
                                                              TypeChoice of: boolean, integer
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Requirements

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

                                                              Alternate NamesMeerlingindicator
                                                              264. Patient.photo
                                                              Definition

                                                              Image of the patient.

                                                              ShortImage of the patient
                                                              Control0..*
                                                              TypeAttachment
                                                              Requirements

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

                                                              266. Patient.contact
                                                              Definition

                                                              Contacts are related persons in some way, but not all related persons are contacts. The HCIM ContactPerson is designed to deal with both related persons and contacts. An HCIM ContactPerson who is a contact, is expected to have an NL-CM:3.1.2 Role primary contact ('Eerste relatie/contactpersoon') or secondary contact ('Tweede relatie/contactpersoon'). See Patient.contact.relationship in slice 'role'.

                                                              ShortContactPerson
                                                              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
                                                              Requirements

                                                              Need to track people you can contact about the patient.

                                                              Alternate NamesContactpersoon
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (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())
                                                              268. 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.

                                                              Shortxml:id (or equivalent in JSON)
                                                              Control0..1
                                                              Typestring
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              270. Patient.contact.extension
                                                              Definition

                                                              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                              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
                                                              Alternate Namesextensions, user content
                                                              272. 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                                              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 No Modifier Reason provideed in previous versions of FHIR
                                                              Summarytrue
                                                              Alternate Namesextensions, user content, modifiers
                                                              274. Patient.contact.relationship
                                                              Definition

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

                                                              ShortThe kind of relationship
                                                              Control0..*
                                                              BindingUnless not suitable, these codes SHALL be taken from v2 Contact Role
                                                              (extensible to http://hl7.org/fhir/ValueSet/v2-0131)

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

                                                              TypeCodeableConcept
                                                              Requirements

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

                                                              SlicingThis element introduces a set of slices on Patient.contact.relationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ $this
                                                              • 276. Patient.contact.relationship:relationship
                                                                Slice Namerelationship
                                                                Definition

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

                                                                ShortRelationship
                                                                Control0..*
                                                                BindingThe codes SHALL be taken from RelatieCodelijst
                                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.3.1.1--20171231000000)
                                                                TypeCodeableConcept
                                                                Requirements

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

                                                                Alternate NamesRelatie
                                                                278. Patient.contact.relationship:role
                                                                Slice Namerole
                                                                Definition

                                                                Expectation is to have at least one of primary contact ('Eerste relatie/contactpersoon') or secondary contact ('Tweede relatie/contactpersoon')

                                                                ShortRole
                                                                Control0..*
                                                                BindingThe codes SHALL be taken from RolCodelijst
                                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.3.1.2--20171231000000)
                                                                TypeCodeableConcept
                                                                Requirements

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

                                                                Alternate NamesRol
                                                                280. Patient.contact.name
                                                                Definition

                                                                A human's name with the ability to identify parts and usage.

                                                                ShortNameInformation
                                                                Comments

                                                                Dutch names require that certain name parts are separately communicable. For this reason, extensions are added onto the base HumanName element to mark the meaning of each part. A Dutch HumanName is still a proper FHIR HumanName; however, there might be an incompatibilty with the default FHIR mechanism for communicating given names. See the compatibility note below for more information.

                                                                The extension elements cover birth name (NL: eigennaam / geslachtsnaam) and partner/spouse name. Both may have a prefix (NL: voorvoegsel). When a person marries, he or she may keep their own name, assume the partner name, append the partner name to their own name, or the other way around.

                                                                Incompatibility note: It has come to light that this specification deviates from the way that the HumanName datatype is normally used. This will be fixed in a future release. However, current implementations should be aware of the special considerations regarding the use of this specification.

                                                                The issue at hand is the way alternative representations of a name, like initials or a nickname, are communicated. Normally this is done using multiple HumanName instances, which are differentiated using the .use element. However, this specification allows for including all alternative representations in the same HumanName instance, with the expectation that the extensions provide enough information for receiving systems to differentiate them. However, this means that contrary to the normal usage of this datatype, repetitions of .given names cannot be concatenated to get the full list of given names; the list might be a mix of full names, nicknames and initials.

                                                                Since multiple implementations are based on this specification, sending systems are advised (but not required) to keep the approach with one HumanName instance, while receiving systems should be able to handle this one-instance approach. More specifically:

                                                                • Sending and receiving systems SHOULD always use the specified extensions when using this datatype.
                                                                • Sending systems are encouraged to populate the .text element to unambigiously communicate the person's name.
                                                                • Sending systems are encouraged to send either the full given names or the initials, but not both. This alleviates the duplication of names in .given.
                                                                • When a sending system uses the current one-instance approach for communicating multiple representations, .use MAY NOT be populated. After all, it is not possible to select a single .use when the instance contains different representations.
                                                                • When a receiving system interprets the instance as the single-instance-multiple-representations approach, the .given names marked as initials SHOULD be interpreted as alternatives to the full given names. Note the underlying HCIM expects both the list of full names and list of initials to be a single string; there's no match for an initial to a full name. The instance SHOULD be regarded as using this approach when:
                                                                • They encounter a single instance
                                                                • And the .use element is absent
                                                                • And all the name parts are differentiated using the specified extensions
                                                                • In any other circumstance, receiving systems SHOULD interpret the usage as the normal use.

                                                                Example: miss Irma Jongeneel marries mister de Haas and assumes the name Irma Jongeneel-de Haas:

                                                                • .family = "Jongeneel-de Haas"
                                                                • .given = "Irma" (with .given:iso21090EnQualifier = BR)
                                                                • .family:humannameOwnName = "Jongeneel"
                                                                • .family:humannamePartnerPrefix = "de "
                                                                • .family:humannamePartnerName = "Haas"
                                                                Control0..1
                                                                This element is affected by the following invariants: ele-1
                                                                TypeHumanName(nl-core-humanname)
                                                                Requirements

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

                                                                Alternate NamesNaamgegevens
                                                                Example<br/><b>Structured HumanName (preferred above unstructured)</b>:{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode" : "NL4" }], "text" : "Irma Jongeneel-de Haas", "family" : "Jongeneel-de Haas", "_family" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString" : "Jongeneel" }, { "url" : "http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix", "valueString" : "de" }, { "url" : "http://hl7.org/fhir/StructureDefinition/humanname-partner-name", "valueString" : "Haas" }] }, "given" : ["Irma"], "_given" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier", "valueCode" : "CL" }] }] } <br/><b>Unstructured HumanName</b>:{ "text" : "Irma Jongeneel-de Haas" }
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                nl-core-humanname-1: if you specify a prefix for an own name then an own name is also expected (name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty().not())
                                                                nl-core-humanname-2: if you specify a voorvoegsel for a partner name then a partner name is also expected (name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix').empty().not() implies name.family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-name').empty().not())
                                                                282. Patient.contact.name.id
                                                                Definition

                                                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                Shortxml:id (or equivalent in JSON)
                                                                Control0..1
                                                                Typestring
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                284. Patient.contact.name.extension
                                                                Definition

                                                                An Extension

                                                                ShortExtension
                                                                Control0..*
                                                                TypeExtension
                                                                SlicingThis element introduces a set of slices on Patient.contact.name.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 286. Patient.contact.name.extension:humannameAssemblyOrder
                                                                  Slice NamehumannameAssemblyOrder
                                                                  Definition

                                                                  A code that represents the preferred display order of the components of this human name.

                                                                  ShortPreferred display order of name parts
                                                                  Control0..*
                                                                  TypeExtension(assembly-order) (Extension Type: code)
                                                                  288. Patient.contact.name.extension:humannameAssemblyOrder.id
                                                                  Definition

                                                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                  Shortxml:id (or equivalent in JSON)
                                                                  Control0..1
                                                                  Typestring
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  290. Patient.contact.name.extension:humannameAssemblyOrder.extension
                                                                  Definition

                                                                  May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                  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
                                                                  Alternate Namesextensions, user content
                                                                  SlicingThis element introduces a set of slices on Patient.contact.name.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 292. Patient.contact.name.extension:humannameAssemblyOrder.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
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-assembly-order
                                                                    294. Patient.contact.name.extension:humannameAssemblyOrder.valueCode:valueCode
                                                                    Slice NamevalueCode
                                                                    Definition

                                                                    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                    ShortValue of extension
                                                                    Control0..1
                                                                    BindingThe codes SHALL be taken from HumanNameAssemblyOrder
                                                                    (required to http://hl7.org/fhir/ValueSet/name-assembly-order)

                                                                    A code that represents the preferred display order of the components of a human name

                                                                    Typecode
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    296. Patient.contact.name.use
                                                                    Definition

                                                                    Identifies the purpose for this name.

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

                                                                    This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

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

                                                                    The use of a human name

                                                                    Typecode
                                                                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

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

                                                                    298. Patient.contact.name.text
                                                                    Definition

                                                                    A full text representation of the name.

                                                                    ShortText representation of the full name
                                                                    Comments

                                                                    Can provide both a text representation and structured parts.

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

                                                                    A renderable, unencoded form.

                                                                    300. Patient.contact.name.family
                                                                    Definition

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

                                                                    ShortSurname
                                                                    Comments

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

                                                                    Control0..1
                                                                    Typestring
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Alternate Namessurname, Achternaam
                                                                    302. Patient.contact.name.family.id
                                                                    Definition

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

                                                                    Shortxml:id (or equivalent in JSON)
                                                                    Control0..1
                                                                    Typestring
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    304. Patient.contact.name.family.extension
                                                                    Definition

                                                                    An Extension

                                                                    ShortExtension
                                                                    Control0..*
                                                                    TypeExtension
                                                                    SlicingThis element introduces a set of slices on Patient.contact.name.family.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 306. Patient.contact.name.family.extension:humannameOwnPrefix
                                                                      Slice NamehumannameOwnPrefix
                                                                      Definition

                                                                      The prefix portion (e.g. voorvoegsel) inclusive of the space between the prefix and the surname, if applicable, of the family name that is derived from the person's own surname, as distinguished from any portion that is derived from the surname of the person's partner or spouse.

                                                                      ShortPrefixOwnName
                                                                      Comments

                                                                      An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.

                                                                      Control0..1
                                                                      This element is affected by the following invariants: ele-1
                                                                      TypeExtension(own-prefix) (Extension Type: string)
                                                                      Alternate NamesVoorvoegselGeslachtsnaam
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      308. Patient.contact.name.family.extension:humannameOwnPrefix.id
                                                                      Definition

                                                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                      Shortxml:id (or equivalent in JSON)
                                                                      Control0..1
                                                                      Typestring
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      310. Patient.contact.name.family.extension:humannameOwnPrefix.extension
                                                                      Definition

                                                                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                      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
                                                                      Alternate Namesextensions, user content
                                                                      SlicingThis element introduces a set of slices on Patient.contact.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 312. Patient.contact.name.family.extension:humannameOwnPrefix.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
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-own-prefix
                                                                        314. Patient.contact.name.family.extension:humannameOwnPrefix.valueString:valueString
                                                                        Slice NamevalueString
                                                                        Definition

                                                                        Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                        ShortValue of extension
                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        316. Patient.contact.name.family.extension:humannameOwnName
                                                                        Slice NamehumannameOwnName
                                                                        Definition

                                                                        The person’s official last name.

                                                                        ShortOwnName
                                                                        Comments

                                                                        The portion of the family name that is derived from the person's own surname, as distinguished from any portion that is derived from the surname of the person's partner or spouse. If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".

                                                                        Control0..1
                                                                        This element is affected by the following invariants: ele-1
                                                                        TypeExtension(own-name) (Extension Type: string)
                                                                        Alternate NamesGeslachtsnaam
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        318. Patient.contact.name.family.extension:humannameOwnName.id
                                                                        Definition

                                                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        Shortxml:id (or equivalent in JSON)
                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        320. Patient.contact.name.family.extension:humannameOwnName.extension
                                                                        Definition

                                                                        May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                        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
                                                                        Alternate Namesextensions, user content
                                                                        SlicingThis element introduces a set of slices on Patient.contact.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 322. Patient.contact.name.family.extension:humannameOwnName.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
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-own-name
                                                                          324. Patient.contact.name.family.extension:humannameOwnName.valueString:valueString
                                                                          Slice NamevalueString
                                                                          Definition

                                                                          Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                          ShortValue of extension
                                                                          Control0..1
                                                                          Typestring
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          326. Patient.contact.name.family.extension:humannamePartnerPrefix
                                                                          Slice NamehumannamePartnerPrefix
                                                                          Definition

                                                                          Voorvoegsel derived from person's partner's surname inclusive of the space between the prefix and the surname, if applicable.

                                                                          ShortPrefixSurname
                                                                          Comments

                                                                          An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to identify it as a separate sub-component.

                                                                          Control0..1
                                                                          This element is affected by the following invariants: ele-1
                                                                          TypeExtension(partner-prefix) (Extension Type: string)
                                                                          Alternate NamesVoorvoegselGeslachtsnaamPartner
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          328. Patient.contact.name.family.extension:humannamePartnerPrefix.id
                                                                          Definition

                                                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                          Shortxml:id (or equivalent in JSON)
                                                                          Control0..1
                                                                          Typestring
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          330. Patient.contact.name.family.extension:humannamePartnerPrefix.extension
                                                                          Definition

                                                                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                          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
                                                                          Alternate Namesextensions, user content
                                                                          SlicingThis element introduces a set of slices on Patient.contact.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 332. Patient.contact.name.family.extension:humannamePartnerPrefix.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
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-partner-prefix
                                                                            334. Patient.contact.name.family.extension:humannamePartnerPrefix.valueString:valueString
                                                                            Slice NamevalueString
                                                                            Definition

                                                                            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                            ShortValue of extension
                                                                            Control0..1
                                                                            Typestring
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            336. Patient.contact.name.family.extension:humannamePartnerName
                                                                            Slice NamehumannamePartnerName
                                                                            Definition

                                                                            Partner’s official last name.

                                                                            ShortLastNamePartner
                                                                            Comments

                                                                            The portion of the family name that is derived from the person's partner's surname, as distinguished from any portion that is derived from the surname of the person's own name. If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".

                                                                            Control0..1
                                                                            This element is affected by the following invariants: ele-1
                                                                            TypeExtension(partner-name) (Extension Type: string)
                                                                            Alternate NamesGeslachtsnaamPartner
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            338. Patient.contact.name.family.extension:humannamePartnerName.id
                                                                            Definition

                                                                            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                            Shortxml:id (or equivalent in JSON)
                                                                            Control0..1
                                                                            Typestring
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            340. Patient.contact.name.family.extension:humannamePartnerName.extension
                                                                            Definition

                                                                            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                            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
                                                                            Alternate Namesextensions, user content
                                                                            SlicingThis element introduces a set of slices on Patient.contact.name.family.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 342. Patient.contact.name.family.extension:humannamePartnerName.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
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Fixed Valuehttp://hl7.org/fhir/StructureDefinition/humanname-partner-name
                                                                              344. Patient.contact.name.family.extension:humannamePartnerName.valueString:valueString
                                                                              Slice NamevalueString
                                                                              Definition

                                                                              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                              ShortValue of extension
                                                                              Control0..1
                                                                              Typestring
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              346. Patient.contact.name.family.value
                                                                              Definition

                                                                              The actual value

                                                                              ShortPrimitive value for string
                                                                              Control0..1
                                                                              Typestring
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Max Length:1048576
                                                                              348. Patient.contact.name.given
                                                                              Definition

                                                                              Note that in order to mark the type of a given name, the FHIR standard extension for ISO 21090 EN Qualifiers is to be used. Examples include call me name (Dutch: roepnaam) and initials. Each initial is expected to be delimited by a dot.

                                                                              ShortGiven
                                                                              Comments

                                                                              Note that in order to mark the type of a given name, the FHIR standard extension for ISO 21090 EN Qualifiers is to be used. Examples include call me name (Dutch: roepnaam) and initials. Each initial is expected to be delimited by a dot. To be conformant to the HCIM for NameInformation, at least the following qualifiers SHALL be supported: BR, IN and CL. The qualifier BR maps to the HCIM concept FirstNames, IN maps to Initials and CL to GivenName.

                                                                              Please see the compatibility note on the containing element as well!

                                                                              Control0..*
                                                                              Typestring
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Alternate Namesfirst name, middle name, Voornamen, Initialen, Roepnaam
                                                                              350. Patient.contact.name.given.id
                                                                              Definition

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

                                                                              Shortxml:id (or equivalent in JSON)
                                                                              Control0..1
                                                                              Typestring
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              352. Patient.contact.name.given.extension
                                                                              Definition

                                                                              An Extension

                                                                              ShortExtension
                                                                              Control0..*
                                                                              TypeExtension
                                                                              SlicingThis element introduces a set of slices on Patient.contact.name.given.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 354. Patient.contact.name.given.extension:iso21090EnQualifier
                                                                                Slice Nameiso21090EnQualifier
                                                                                Definition

                                                                                A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type.

                                                                                ShortLS | AC | NB | PR | HON | BR | AD | SP | MID | CL | IN | VV
                                                                                Comments

                                                                                Used to indicate additional information about the name part and how it should be used.

                                                                                Control0..1
                                                                                This element is affected by the following invariants: ele-1
                                                                                TypeExtension(EN-qualifier) (Extension Type: code)
                                                                                Is Modifierfalse
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                356. Patient.contact.name.given.extension:iso21090EnQualifier.id
                                                                                Definition

                                                                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                Shortxml:id (or equivalent in JSON)
                                                                                Control0..1
                                                                                Typestring
                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                358. Patient.contact.name.given.extension:iso21090EnQualifier.extension
                                                                                Definition

                                                                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                                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
                                                                                Alternate Namesextensions, user content
                                                                                SlicingThis element introduces a set of slices on Patient.contact.name.given.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                • value @ url
                                                                                • 360. Patient.contact.name.given.extension:iso21090EnQualifier.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
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Fixed Valuehttp://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier
                                                                                  362. Patient.contact.name.given.extension:iso21090EnQualifier.valueCode:valueCode
                                                                                  Slice NamevalueCode
                                                                                  Definition

                                                                                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                                  ShortValue of extension
                                                                                  Control0..1
                                                                                  BindingThe codes SHALL be taken from EntityNamePartQualifier
                                                                                  (required to http://hl7.org/fhir/ValueSet/name-part-qualifier)

                                                                                  A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type

                                                                                  Typecode
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  364. Patient.contact.name.given.value
                                                                                  Definition

                                                                                  The actual value

                                                                                  ShortPrimitive value for string
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Max Length:1048576
                                                                                  366. Patient.contact.name.prefix
                                                                                  Definition

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

                                                                                  ShortParts that come before the name
                                                                                  Control0..*
                                                                                  Typestring
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  368. Patient.contact.name.suffix
                                                                                  Definition

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

                                                                                  ShortParts that come after the name
                                                                                  Control0..*
                                                                                  Typestring
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  370. Patient.contact.name.period
                                                                                  Definition

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

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

                                                                                  Allows names to be placed in historical context.

                                                                                  372. Patient.contact.telecom
                                                                                  Definition

                                                                                  Contact information includes a person's telephone numbers and email addresses. This datatype defines a common basis for expressing all contact information around the world, but adds extensions to express Dutch contacts specifically, according to the HCIM ContactInformation (v1.0, 2017). A Dutch ContactPoint still is a proper FHIR ContactPoint, which means that systems that cannot interpret the extensions will still be able to render and work with this datatype. The table below explains how the HCIM concepts are mapped to the various FHIR elements. The HCIM code itself should also be included using the TelecomType extension.

                                                                                  | HCIM | .ext:TelecomType | .system | .use | |----------------------------------------------------|:------------------:|:---------:|:--------:| | Primary Home Land Line | LL | phone | home | | Temporary Land Line | LL | phone | temp | | Primary Work Land Line | LL | phone | work | | | | | | | Primary Home Fax | FAX | fax | home | | Temporary Fax | FAX | fax | temp | | Primary Work Fax | FAX | fax | work | | | | | | | Primary Home Mobile Phone | MC | phone | home | | Temporary Mobile Phone | MC | phone | temp | | Primary Work Mobile Phone | MC | phone | work | | | | | | | Primary Home Pager | PG | pager | home | | Temporary Pager | PG | pager | temp | | Primary Work Pager | PG | pager | work | | | | | | | Private email address | | email | home | | Work email address | | email | work | | | | | | | Mobile phone number undetermined private/business | | phone | mobile |

                                                                                  ShortContactInformation
                                                                                  Comments

                                                                                  Telecommunication data details (phone/email) is physically modeled in the HCIM Patient, which is why the telecommunication mappings appear to be coming from the HCIM Patient instead of the HCIM ContactPerson

                                                                                  Control0..*
                                                                                  This element is affected by the following invariants: ele-1
                                                                                  TypeContactPoint(nl-core-contactpoint)
                                                                                  Requirements

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

                                                                                  Alternate NamesContactgegevens
                                                                                  Example<br/><b>Mobile business phone number. Note: the mobile nature stems from the number being an 06-* number.</b>:{ "system" : "phone", "value" : "+31611234567", "use" : "work" } <br/><b>Mobile phone number undetermined private/business. Note: the mobile nature stems from the number being an 06-* number.</b>:{ "system" : "phone", "value" : "+31611234567", "use" : "mobile" } <br/><b>Primary Home Land Line</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "LL", "display" : "Land Line" }] } }], "system" : "phone", "value" : "...", "use" : "home" } <br/><b>Temporary Land Line</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "LL", "display" : "Land Line" }] } }], "system" : "phone", "value" : "...", "use" : "temp" } <br/><b>Primary Work Land Line</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "LL", "display" : "Land Line" }] } }], "system" : "phone", "value" : "...", "use" : "work" } <br/><b>Primary Home Fax</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "FAX", "display" : "Fax" }] } }], "system" : "fax", "value" : "...", "use" : "home" } <br/><b>Temporary Fax</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "FAX", "display" : "Fax" }] } }], "system" : "fax", "value" : "...", "use" : "temp" } <br/><b>Primary Work Fax</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1", "code" : "FAX", "display" : "Fax" }] } }], "system" : "fax", "value" : "...", "use" : "work" } <br/><b>Primary Home Mobile Phone</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "MC", "display" : "Mobile Phone" }] } }], "system" : "phone", "value" : "...", "use" : "home" } <br/><b>Temporary Mobile Phone</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "MC", "display" : "Mobile Phone" }] } }], "system" : "phone", "value" : "...", "use" : "temp" } <br/><b>Primary Work Mobile Phone</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "MC", "display" : "Mobile Phone" }] } }], "system" : "phone", "value" : "...", "use" : "work" } <br/><b>Primary Home Pager</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "PG", "display" : "Pager" }] } }], "system" : "pager", "value" : "...", "use" : "home" } <br/><b>Temporary Pager</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "PG", "display" : "Pager" }] } }], "system" : "pager", "value" : "...", "use" : "temp" } <br/><b>Primary Work Pager</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-ContactInformation-TelecomType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "PG", "display" : "Pager" }] } }], "system" : "pager", "value" : "...", "use" : "work" } <br/><b>Private email address</b>:{ "system" : "email", "value" : "giesput@myweb.nl", "use" : "home" } <br/><b>Work email address</b>:{ "system" : "email", "value" : "example@workplace.nl", "use" : "work" }
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                  cpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                                                                                  374. Patient.contact.address
                                                                                  Definition

                                                                                  This datatype defines a common basis for expressing all addresses around the world, but adds extensions to express Dutch addresses specifically, according to the HCIM AddressInformation (v1.0, 2017). A Dutch Address still is a proper FHIR Address, which means that systems that cannot interpret the extensions will still be able to render and work with this datatype.

                                                                                  To have true compatibility an implementer SHOULD use the core Address parts as intended. To have addresses work for Dutch context, the implementer SHOULD in addition use the extension elements.

                                                                                  Separate address parts

                                                                                  The first addition is that Dutch addresses make certain address parts separately communicable. These parts are required for use in true Dutch systems when dealing with Dutch addresses, but may not have value for international systems when information gets sent abroad.

                                                                                  Custom address types

                                                                                  The second addition is that the HCIM defines its own ValueSet for address types, which can only be partially expressed using the FHIR Address datatype and requires a mapping to multiple elements. The table below explains how the HCIM concepts are mapped to the various FHIR elements (see the ConceptMaps <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressUse> and <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressType> as well). The HCIM code itself should also be included using the AddressType extension.

                                                                                  | HCIM |.ext:AddressType | .ext:official | .use | .type | |-----------------------------------|:------------------:|:---------------:|:------:|:----------:| | Postal Address/Postadres | PST | | | postal | | Primary Home/Officieel adres | HP | true | home | | | Visit Address/Woon-/verblijfadres | PHYS | | home | physical | | Temporary Address/Tijdelijk adres | TMP | | temp | | | Work Place/Werkadres | WP | | work | | | Vacation Home/Vakantie adres | HV | | temp | |

                                                                                  If Address.type is both then this is to be understood as a dual purpose address (postal and physical). Systems that support importing it like this are encouraged to do so, otherwise they may need to import this as two separate addresses.

                                                                                  NOTE: FHIR core defines the AD-use extension to further specify the postal address type. However, the ValueSet used in that extension doesn't completely match the HCIM ValueSet. Therefore, a custom extension has been made. This doesn't preclude the use of the AD-use extension.

                                                                                  ShortAddressInformation
                                                                                  Comments

                                                                                  Note: address is for postal addresses, not physical locations.

                                                                                  Control0..1
                                                                                  This element is affected by the following invariants: ele-1, nl-streetname-if-official-and-other-line-parts
                                                                                  TypeAddress(nl-core-address)
                                                                                  Requirements

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

                                                                                  Alternate NamesAdresInformatie, Adresgegevens
                                                                                  Example<br/><b>Example of a Vacation Home address</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-AddressInformation-AddressType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "HV", "display" : "Vakantie adres" }] } }], "use" : "temp", "line" : ["Binnenkant 12A Hoog"], "_line" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString" : "Binnenkant" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString" : "12" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix", "valueString" : "A" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-unitID", "valueString" : "Hoog" }] }], "city" : "Amsterdam", "state" : "NH", "postalCode" : "1000AA", "country" : "NLD" } <br/><b>Example of a Primary Home address</b>:{ "extension" : [{ "url" : "http://nictiz.nl/fhir/StructureDefinition/zib-AddressInformation-AddressType", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/v3/AddressUse", "code" : "HP", "display" : "Officieel adres" }] } }, { "url" : "http://fhir.nl/fhir/StructureDefinition/nl-core-address-official", "valueBoolean" : true }], "use" : "home", "line" : ["Binnenkant to 10"], "_line" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName", "valueString" : "Binnenkant" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator", "valueString" : "to" }, { "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber", "valueString" : "10" }] }], "city" : "Amsterdam", "state" : "NH", "postalCode" : "1001AA", "country" : "NLD" }
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                  nl-streetname-if-official-and-other-line-parts: Address.streetName in an official address SHALL have a value if one of houseNumber|buildingNumberSuffix|additionalLocator has a value ((extension.where(url = 'http://fhir.nl/fhir/StructureDefinition/nl-core-address-official').where(value = true)).empty() or (line.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty().not() and (line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-buildingNumberSuffix').empty().not() or line.extension.where(url='http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty().not())))
                                                                                  376. 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)

                                                                                  The gender of a person used for administrative purposes.

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

                                                                                  Needed to address the person correctly.

                                                                                  378. 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)
                                                                                  Requirements

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

                                                                                  380. 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
                                                                                  382. Patient.animal
                                                                                  Definition

                                                                                  This patient is known to be an animal.

                                                                                  ShortThis patient is known to be an animal (non-human)
                                                                                  Comments

                                                                                  The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

                                                                                  Control0..1
                                                                                  TypeBackboneElement
                                                                                  Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Many clinical systems are extended to care for animal patients as well as human.

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

                                                                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                  Shortxml:id (or equivalent in JSON)
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  386. Patient.animal.extension
                                                                                  Definition

                                                                                  May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                                  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
                                                                                  Alternate Namesextensions, user content
                                                                                  388. Patient.animal.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                                                                  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 No Modifier Reason provideed in previous versions of FHIR
                                                                                  Summarytrue
                                                                                  Alternate Namesextensions, user content, modifiers
                                                                                  390. Patient.animal.species
                                                                                  Definition

                                                                                  Identifies the high level taxonomic categorization of the kind of animal.

                                                                                  ShortE.g. Dog, Cow
                                                                                  Comments

                                                                                  If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).

                                                                                  Control1..1
                                                                                  BindingFor example codes, see AnimalSpecies
                                                                                  (example to http://hl7.org/fhir/ValueSet/animal-species)

                                                                                  The species of an animal.

                                                                                  TypeCodeableConcept
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Need to know what kind of animal.

                                                                                  392. Patient.animal.breed
                                                                                  Definition

                                                                                  Identifies the detailed categorization of the kind of animal.

                                                                                  ShortE.g. Poodle, Angus
                                                                                  Comments

                                                                                  Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.

                                                                                  Control0..1
                                                                                  BindingFor example codes, see AnimalBreeds
                                                                                  (example to http://hl7.org/fhir/ValueSet/animal-breeds)

                                                                                  The breed of an animal.

                                                                                  TypeCodeableConcept
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  May need to know the specific kind within the species.

                                                                                  394. Patient.animal.genderStatus
                                                                                  Definition

                                                                                  Indicates the current state of the animal's reproductive organs.

                                                                                  ShortE.g. Neutered, Intact
                                                                                  Control0..1
                                                                                  BindingFor example codes, see GenderStatus
                                                                                  (example to http://hl7.org/fhir/ValueSet/animal-genderstatus)

                                                                                  The state of the animal's reproductive organs.

                                                                                  TypeCodeableConcept
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Gender status can affect housing and animal behavior.

                                                                                  396. Patient.communication
                                                                                  Definition

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

                                                                                  ShortA list of Languages 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
                                                                                  Requirements

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

                                                                                  Alternate NamesTaalvaardigheid
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                  398. 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.

                                                                                  Shortxml:id (or equivalent in JSON)
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  400. Patient.communication.extension
                                                                                  Definition

                                                                                  An Extension

                                                                                  ShortExtension
                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  SlicingThis element introduces a set of slices on Patient.communication.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                  • value @ url
                                                                                  • 402. Patient.communication.extension:languageProficiency
                                                                                    Slice NamelanguageProficiency
                                                                                    Definition

                                                                                    Proficiency level of the communication.

                                                                                    ShortProficiency level of the communication
                                                                                    Comments

                                                                                    The HCIM concepts LanguageControlListening, LanguageControlReading, LanguageControlSpeaking are captuperd using a mocked offical HL7 core extension from the R4 FHIR specification. Each of these three concepts is encoded as a copy of the extension, typed using the code in the type slice according to the following mapping: * LanguaneControlListening maps to code 'RSP' (Received spoken) * LanguageControlReading maps to code 'RWR' (Received written) * LanguageControlSpeaking maps to code 'ESP' (Expressed spoken)

                                                                                    Control0..*
                                                                                    This element is affected by the following invariants: ele-1
                                                                                    TypeExtension(proficiency) (Complex Extension)
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                    404. Patient.communication.extension:languageProficiency.id
                                                                                    Definition

                                                                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                    Shortxml:id (or equivalent in JSON)
                                                                                    Control0..1
                                                                                    Typestring
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                    406. Patient.communication.extension:languageProficiency.extension
                                                                                    Definition

                                                                                    An Extension

                                                                                    ShortExtension
                                                                                    Control2..*
                                                                                    TypeExtension
                                                                                    SlicingThis element introduces a set of slices on Patient.communication.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                    • value @ url
                                                                                    • 408. Patient.communication.extension:languageProficiency.extension:type
                                                                                      Slice Nametype
                                                                                      Definition

                                                                                      An Extension

                                                                                      ShortExtension
                                                                                      Control1..1
                                                                                      TypeExtension
                                                                                      410. Patient.communication.extension:languageProficiency.extension:type.id
                                                                                      Definition

                                                                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                      Shortxml:id (or equivalent in JSON)
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                      412. Patient.communication.extension:languageProficiency.extension:type.extension
                                                                                      Definition

                                                                                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                                      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
                                                                                      Alternate Namesextensions, user content
                                                                                      SlicingThis element introduces a set of slices on Patient.communication.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                      • value @ url
                                                                                      • 414. Patient.communication.extension:languageProficiency.extension:type.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
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Fixed Valuetype
                                                                                        416. Patient.communication.extension:languageProficiency.extension:type.value[x]
                                                                                        Definition

                                                                                        Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                                        ShortValue of extension
                                                                                        Control1..1
                                                                                        TypeCoding
                                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                        SlicingThis element introduces a set of slices on Patient.communication.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                        • type @ $this
                                                                                        • 418. Patient.communication.extension:languageProficiency.extension:type.value[x]:valueCoding
                                                                                          Slice NamevalueCoding
                                                                                          Definition

                                                                                          Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                                          ShortValue of extension
                                                                                          Control1..1
                                                                                          BindingUnless not suitable, these codes SHALL be taken from LanguageAbilityMode
                                                                                          (extensible to http://hl7.org/fhir/ValueSet/v3-LanguageAbilityMode)
                                                                                          TypeCoding
                                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                          420. Patient.communication.extension:languageProficiency.extension:level
                                                                                          Slice Namelevel
                                                                                          Definition

                                                                                          An Extension

                                                                                          ShortExtension
                                                                                          Control1..1
                                                                                          TypeExtension
                                                                                          422. Patient.communication.extension:languageProficiency.extension:level.id
                                                                                          Definition

                                                                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                          Shortxml:id (or equivalent in JSON)
                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                          424. Patient.communication.extension:languageProficiency.extension:level.extension
                                                                                          Definition

                                                                                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                                          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
                                                                                          Alternate Namesextensions, user content
                                                                                          SlicingThis element introduces a set of slices on Patient.communication.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                          • value @ url
                                                                                          • 426. Patient.communication.extension:languageProficiency.extension:level.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
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                            Fixed Valuelevel
                                                                                            428. Patient.communication.extension:languageProficiency.extension:level.value[x]
                                                                                            Definition

                                                                                            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                                            ShortValue of extension
                                                                                            Control1..1
                                                                                            TypeCoding
                                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                            SlicingThis element introduces a set of slices on Patient.communication.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                            • type @ $this
                                                                                            • 430. Patient.communication.extension:languageProficiency.extension:level.value[x]:valueCoding
                                                                                              Slice NamevalueCoding
                                                                                              Definition

                                                                                              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                                              ShortValue of extension
                                                                                              Control1..1
                                                                                              BindingUnless not suitable, these codes SHALL be taken from LanguageAbilityProficiency
                                                                                              (extensible to http://hl7.org/fhir/ValueSet/v3-LanguageAbilityProficiency)
                                                                                              TypeCoding
                                                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                              432. Patient.communication.extension:languageProficiency.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
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                              Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/patient-proficiency
                                                                                              434. Patient.communication.extension:languageProficiency.value[x]
                                                                                              Definition

                                                                                              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                                                              ShortValue of extension
                                                                                              Control0..0
                                                                                              TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              436. Patient.communication.extension:comment
                                                                                              Slice Namecomment
                                                                                              Definition

                                                                                              An Extension

                                                                                              ShortComment
                                                                                              Control0..*
                                                                                              This element is affected by the following invariants: ele-1
                                                                                              TypeExtension(Comment) (Extension Type: string)
                                                                                              Alternate NamesToelichting
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                              438. 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                                                                              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 No Modifier Reason provideed in previous versions of FHIR
                                                                                              Summarytrue
                                                                                              Alternate Namesextensions, user content, modifiers
                                                                                              440. Patient.communication.language
                                                                                              Definition

                                                                                              The language of communication.

                                                                                              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.

                                                                                              ShortCommunicationLanguage
                                                                                              Comments

                                                                                              The FHIR value set http://hl7.org/fhir/valueset-languages.html is used instead of the HCIM value set CommunicationLanguageCodelist. The FHIR value set uses the code system urn:ietf:bcp:47 which includes the ISO-639-2 alpha code system used by the HCIM value set.

                                                                                              Control1..1
                                                                                              BindingUnless not suitable, these codes SHALL be taken from Common Languages
                                                                                              (extensible to http://hl7.org/fhir/ValueSet/languages)

                                                                                              A human language.

                                                                                              Additional BindingsPurpose
                                                                                              AllLanguagesMax Binding
                                                                                              TypeCodeableConcept
                                                                                              Requirements

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

                                                                                              Alternate NamesCommunicatieTaal
                                                                                              442. 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
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              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.

                                                                                              444. Patient.generalPractitioner
                                                                                              Definition

                                                                                              Patient's nominated care provider.

                                                                                              ShortGeneralPractitioner
                                                                                              Comments

                                                                                              This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity 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.

                                                                                              Control0..1
                                                                                              TypeReference(nl-core-organization, nl-core-practitioner)
                                                                                              Alternate NamescareProvider, Huisarts
                                                                                              446. Patient.generalPractitioner.id
                                                                                              Definition

                                                                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                              Shortxml:id (or equivalent in JSON)
                                                                                              Control0..1
                                                                                              Typestring
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                              448. Patient.generalPractitioner.extension
                                                                                              Definition

                                                                                              An Extension

                                                                                              ShortExtension
                                                                                              Control0..*
                                                                                              TypeExtension
                                                                                              SlicingThis element introduces a set of slices on Patient.generalPractitioner.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                              • value @ url
                                                                                              • 450. Patient.generalPractitioner.extension:practitionerRole
                                                                                                Slice NamepractitionerRole
                                                                                                Definition

                                                                                                Optional Extension Element - found in all resources.

                                                                                                ShortOptional Extensions Element
                                                                                                Control0..1
                                                                                                TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                                                                452. Patient.generalPractitioner.reference
                                                                                                Definition

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

                                                                                                ShortLiteral reference, Relative, internal or absolute URL
                                                                                                Comments

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

                                                                                                Control0..1
                                                                                                This element is affected by the following invariants: ref-1
                                                                                                Typestring
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Summarytrue
                                                                                                454. Patient.generalPractitioner.identifier
                                                                                                Definition

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

                                                                                                ShortLogical reference, when literal reference is not known
                                                                                                Comments

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

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

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

                                                                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                Control0..1
                                                                                                TypeIdentifier
                                                                                                Summarytrue
                                                                                                456. Patient.generalPractitioner.display
                                                                                                Definition

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

                                                                                                ShortText alternative for the resource
                                                                                                Comments

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

                                                                                                Control0..1
                                                                                                Typestring
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Summarytrue
                                                                                                458. 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)
                                                                                                Must Supporttrue
                                                                                                Summarytrue
                                                                                                Requirements

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

                                                                                                460. 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.

                                                                                                This element is labelled as a modifier because it may 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'.

                                                                                                Control0..*
                                                                                                TypeBackboneElement
                                                                                                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                                                                Summarytrue
                                                                                                Requirements

                                                                                                There are multiple usecases:

                                                                                                • 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() | (children().count() > id.count()))
                                                                                                462. 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.

                                                                                                Shortxml:id (or equivalent in JSON)
                                                                                                Control0..1
                                                                                                Typestring
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                464. Patient.link.extension
                                                                                                Definition

                                                                                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                                                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
                                                                                                Alternate Namesextensions, user content
                                                                                                466. 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                                                                                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 No Modifier Reason provideed in previous versions of FHIR
                                                                                                Summarytrue
                                                                                                Alternate Namesextensions, user content, modifiers
                                                                                                468. 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)
                                                                                                Summarytrue
                                                                                                470. Patient.link.type
                                                                                                Definition

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

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

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

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