RIVO-Noord Zorgviewer Implementation Guide
1.21.0 - 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 1.21.0 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 2025-10-22

Definitions for the Patient resource profile.

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

0. Patient
Definition

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


This is the base resource type for everything.

ShortPatientBase Resource
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.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
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..1
This element is affected by the following invariants: ele-1
TypeExtension(nl-core-preferred-pharmacy) (Extension Type: Reference)
Alternate Namesextensions, user content, Verwijst 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
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..*
This element is affected by the following invariants: ele-1
TypeExtension(nationality) (Complex Extension)
Alternate Namesextensions, user content, Nationaliteit
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

Code representing nationality of patient.

ShortNationality CodeAdditional 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:period
Slice Nameperiod
Definition

Period when nationality was effective.

ShortNationality PeriodAdditional Content defined by implementations
Control0..1*
TypeExtension
14. 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
16. 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
18. 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
20. 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 LegalSatus) (Extension Type: CodeableConcept)
Alternate Namesextensions, user content
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())
22. Patient.extension:lifeStance
Slice NamelifeStance
Definition

Optional Extension Element - found in all resources.

ShortOptional Extensions Element
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..*
This element is affected by the following invariants: ele-1
TypeExtension(HCIM LifeStance) (Extension Type: CodeableConcept)
Alternate Namesextensions, user content
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())
24. 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..0*
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
  • 26. 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
    28. Patient.extension:lifeStance.value[x]
    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
    30. Patient.extension:lifeStance.value[x].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.

    32. Patient.extension:lifeStance.value[x].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.

    34. Patient.extension:lifeStance.value[x].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.

    36. 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
    38. 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
    • 40. 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
      42. 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|3.0.2
      (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.

      44. 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
      ExampleGeneral: http://www.acme.com/identifiers/patient
      46. 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
      ExampleGeneral: 123456
      Example of a burgerservicenummer: 123456782
      48. 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
      50. 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 XXXHelleman marries mister de Haas and assumes the name Irma XXXHelleman-de Haas:

      • .family = "XXX_Helleman-de Haas"
      • .given = "Irma" (with .given:iso21090EnQualifier = BR)
      • .family:humannameOwnName = "XXX_Helleman"
      • .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
      Summarytrue
      Requirements

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

      Alternate NamesNaamgegevens
      ExampleStructured HumanName (preferred above unstructured): { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode" : "NL4" }], "text" : "Irma XXX_Helleman-de Haas", "family" : "XXX_Helleman-de Haas", "_family" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString" : "XXX_Helleman" }, { "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" }] }] }
      Unstructured HumanName: { "text" : "Irma XXX_Helleman-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())
      52. 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
      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..1
      This element is affected by the following invariants: ele-1
      BindingThe codes SHALL be taken from HumanNameAssemblyOrder
      (required to http://hl7.org/fhir/ValueSet/name-assembly-order)

      Human Name Assembly Order

      TypeExtension(assembly-order) (Extension Type: code)
      Alternate Namesextensions, user content, Voorkeursvolgorde van de naamdelen.
      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())
      54. 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
      56. 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
      58. 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|3.0.2
      (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.

      60. 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|3.0.2
      (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
      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
      62. Patient.gender.extension:GeslachtCodelijst
      Slice NameGeslachtCodelijst
      Definition

      Patient’s administrative gender.

      ShortGender
      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..1
      This element is affected by the following invariants: ele-1
      TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
      Alternate Namesextensions, user content, Bevat 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())
      64. 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..0*
      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
      • 66. 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
        68. 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
        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]
        70. 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
        72. 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
        74. 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)
        Summarytrue
        Requirements

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

        Alternate NamesAdresInformatie, Adresgegevens
        ExampleExample of a Vacation Home address: { "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" }
        Example of a Primary Home address: { "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())))
        76. 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()))
        78. 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
        80. 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|3.0.2
        (example to http://hl7.org/fhir/ValueSet/animal-species)

        The species of an animal.

        TypeCodeableConcept
        Summarytrue
        Requirements

        Need to know what kind of animal.

        82. 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
        84. Patient.generalPractitioner.extension:practitionerRole
        Slice NamepractitionerRole
        Definition

        Optional Extension Element - found in all resources.

        ShortOptional Extensions Element
        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..1
        This element is affected by the following invariants: ele-1
        TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
        Alternate Namesextensions, user content
        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())
        86. 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.

        88. Patient.link
        Definition

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

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

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

        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()))
        90. Patient.link.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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
        92. Patient.link.other
        Definition

        The other patient resource that the link refers to.

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

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

        Control1..1
        TypeReference(Patient, RelatedPerson)
        Summarytrue
        94. 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|3.0.2
        (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 foundhere

        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
        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 foundhere

        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
        All LanguagesMax 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

        icon Changed:

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

        Shorticon Changed:Additional Content defined by implementations
        Comments

        icon Added:

        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. 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
          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..1
          This element is affected by the following invariants: ele-1
          TypeExtension(nl-core-preferred-pharmacy) (Extension Type: Reference)
          Alternate Namesextensions, user content, Verwijst 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
          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..*
          This element is affected by the following invariants: ele-1
          TypeExtension(nationality) (Complex Extension)
          Alternate Namesextensions, user content, Nationaliteit
          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

            Code representing nationality of patient.

            ShortNationality Code
            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
              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

              Period when nationality was effective.

              ShortNationality Period
              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
                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 LegalSatus) (Extension Type: CodeableConcept)
                Alternate Namesextensions, user content
                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:lifeStance
                Slice NamelifeStance
                Definition

                Optional Extension Element - found in all resources.

                ShortOptional Extensions Element
                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..*
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM LifeStance) (Extension Type: CodeableConcept)
                Alternate Namesextensions, user content
                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())
                52. 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.
                54. 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..0
                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
                • 56. 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
                  58. Patient.extension:lifeStance.value[x]
                  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
                  60. Patient.extension:lifeStance.value[x].id
                  Definition

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

                  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:lifeStance.value[x].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:lifeStance.value[x].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.

                    66. Patient.extension:lifeStance.value[x].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:lifeStance.value[x].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:lifeStance.value[x].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:lifeStance.value[x].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:lifeStance.value[x].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:lifeStance.value[x].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:lifeStance.value[x].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:lifeStance.value[x].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.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
                      84. 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
                      • 86. 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
                        88. 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.
                        90. 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
                        • 92. 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.

                          94. 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.

                          96. 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
                          ExampleGeneral: http://www.acme.com/identifiers/patient
                          98. 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
                          ExampleGeneral: 123456
                          Example of a burgerservicenummer: 123456782
                          100. 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
                          102. 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
                          104. 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
                          106. Patient.name
                          Definition

                          icon Changed:

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

                          ShortNameInformation
                          Comments

                          icon Changed:

                          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 XXXHelleman marries mister de Haas and assumes the name Irma XXXHelleman-de Haas:

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

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

                          Alternate NamesNaamgegevens
                          ExampleStructured HumanName (preferred above unstructured): { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode" : "NL4" }], "text" : "Irma XXX_Helleman-de Haas", "family" : "XXX_Helleman-de Haas", "_family" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString" : "XXX_Helleman" }, { "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" }] }] }
                          Unstructured HumanName: { "text" : "Irma XXX_Helleman-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())
                          108. 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.
                          110. Patient.name.extension
                          Definition

                          icon Changed:

                          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.

                          Shorticon Changed:Additional Content defined by implementations
                          Comments

                          icon Added:

                          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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 112. 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
                            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..1
                            This element is affected by the following invariants: ele-1
                            BindingThe codes SHALL be taken from HumanNameAssemblyOrder
                            (required to http://hl7.org/fhir/ValueSet/name-assembly-order)

                            Human Name Assembly Order

                            TypeExtension(assembly-order) (Extension Type: code)
                            Alternate Namesextensions, user content, Voorkeursvolgorde van de naamdelen.
                            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())
                            114. 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.
                            116. 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
                            • 118. 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
                              120. 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
                              122. 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.

                              124. 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.

                              126. 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
                              128. 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.
                              130. Patient.name.family.extension
                              Definition

                              icon Changed:

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

                              Shorticon Changed:Additional Content defined by implementations
                              Comments

                              icon Added:

                              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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 132. 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 Namesextensions, user content, VoorvoegselGeslachtsnaam
                                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())
                                134. 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.
                                136. 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
                                • 138. 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
                                  140. 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
                                  142. 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 Namesextensions, user content, Geslachtsnaam
                                  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())
                                  144. 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.
                                  146. 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
                                  • 148. 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
                                    150. 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
                                    152. 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 Namesextensions, user content, VoorvoegselGeslachtsnaamPartner
                                    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())
                                    154. 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.
                                    156. 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
                                    • 158. 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
                                      160. 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
                                      162. 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 Namesextensions, user content, GeslachtsnaamPartner
                                      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())
                                      164. 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.
                                      166. 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
                                      • 168. 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
                                        170. 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
                                        172. 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
                                        174. 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
                                        176. 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.
                                        178. Patient.name.given.extension
                                        Definition

                                        icon Changed:

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

                                        Shorticon Changed:Additional Content defined by implementations
                                        Comments

                                        icon Added:

                                        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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 180. 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
                                          Alternate Namesextensions, user content
                                          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())
                                          182. 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.
                                          184. 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
                                          • 186. 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
                                            188. 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
                                            190. 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
                                            192. 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
                                            194. 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
                                            196. 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.

                                            198. Patient.telecom
                                            Definition

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

                                            Shorticon Changed:ContactInformation
                                            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)
                                            Summarytrue
                                            Requirements

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

                                            Alternate NamesContactgegevens
                                            ExampleMobile business phone number. Note: the mobile nature stems from the number being an 06-* number.: { "system" : "phone", "value" : "+31611234567", "use" : "work" }
                                            Mobile phone number undetermined private/business. Note: the mobile nature stems from the number being an 06-* number.: { "system" : "phone", "value" : "+31611234567", "use" : "mobile" }
                                            Primary Home Land Line: { "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" }
                                            Temporary Land Line: { "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" }
                                            Primary Work Land Line: { "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" }
                                            Primary Home Fax: { "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" }
                                            Temporary Fax: { "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" }
                                            Primary Work Fax: { "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" }
                                            Primary Home Mobile Phone: { "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" }
                                            Temporary Mobile Phone: { "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" }
                                            Primary Work Mobile Phone: { "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" }
                                            Primary Home Pager: { "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" }
                                            Temporary Pager: { "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" }
                                            Primary Work Pager: { "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" }
                                            Private email address: { "system" : "email", "value" : "giesput@myweb.nl", "use" : "home" }
                                            Work email address: { "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())
                                            200. 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)

                                            The gender of a person used for administrative purposes.

                                            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
                                            202. 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.
                                            204. Patient.gender.extension
                                            Definition

                                            icon Changed:

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

                                            Shorticon Changed:Additional Content defined by implementations
                                            Comments

                                            icon Added:

                                            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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 206. Patient.gender.extension:GeslachtCodelijst
                                              Slice NameGeslachtCodelijst
                                              Definition

                                              Patient’s administrative gender.

                                              ShortGender
                                              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..1
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
                                              Alternate Namesextensions, user content, Bevat 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())
                                              208. 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.
                                              210. 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..0
                                              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
                                              • 212. 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
                                                214. 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
                                                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]
                                                216. 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.
                                                218. 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
                                                220. 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
                                                222. Patient.address
                                                Definition

                                                icon Changed:

                                                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

                                                icon Changed:

                                                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)
                                                Summarytrue
                                                Requirements

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

                                                Alternate NamesAdresInformatie, Adresgegevens
                                                ExampleExample of a Vacation Home address: { "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" }
                                                Example of a Primary Home address: { "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())))
                                                224. 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)

                                                The domestic partnership status of a person.

                                                TypeCodeableConcept
                                                Requirements

                                                Most, if not all systems capture it.

                                                Alternate NamesBurgerlijkeStaat
                                                226. 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
                                                228. 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.

                                                230. 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())
                                                232. 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.
                                                234. 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
                                                236. 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
                                                238. 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
                                                • 240. 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)

                                                  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.

                                                  Alternate NamesRelatie
                                                  242. 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)

                                                  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.

                                                  Alternate NamesRol
                                                  244. Patient.contact.name
                                                  Definition

                                                  icon Changed:

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

                                                  ShortNameInformation
                                                  Comments

                                                  icon Added:

                                                  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 XXXHelleman marries mister de Haas and assumes the name Irma XXXHelleman-de Haas:

                                                  • .family = "XXX_Helleman-de Haas"
                                                  • .given = "Irma" (with .given:iso21090EnQualifier = BR)
                                                  • .family:humannameOwnName = "XXX_Helleman"
                                                  • .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
                                                  ExampleStructured HumanName (preferred above unstructured): { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-assembly-order", "valueCode" : "NL4" }], "text" : "Irma XXX_Helleman-de Haas", "family" : "XXX_Helleman-de Haas", "_family" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/humanname-own-name", "valueString" : "XXX_Helleman" }, { "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" }] }] }
                                                  Unstructured HumanName: { "text" : "Irma XXX_Helleman-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())
                                                  246. 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.
                                                  248. Patient.contact.name.extension
                                                  Definition

                                                  icon Changed:

                                                  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.

                                                  Shorticon Changed:Additional Content defined by implementations
                                                  Comments

                                                  icon Added:

                                                  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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 250. 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
                                                    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..1
                                                    This element is affected by the following invariants: ele-1
                                                    BindingThe codes SHALL be taken from HumanNameAssemblyOrder
                                                    (required to http://hl7.org/fhir/ValueSet/name-assembly-order)

                                                    Human Name Assembly Order

                                                    TypeExtension(assembly-order) (Extension Type: code)
                                                    Alternate Namesextensions, user content, Voorkeursvolgorde van de naamdelen.
                                                    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())
                                                    252. 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.
                                                    254. 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
                                                    • 256. 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
                                                      258. 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
                                                      260. 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.

                                                      262. 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.

                                                      264. 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
                                                      266. 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.
                                                      268. Patient.contact.name.family.extension
                                                      Definition

                                                      icon Changed:

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

                                                      Shorticon Changed:Additional Content defined by implementations
                                                      Comments

                                                      icon Added:

                                                      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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 270. 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 Namesextensions, user content, VoorvoegselGeslachtsnaam
                                                        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())
                                                        272. 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.
                                                        274. 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
                                                        • 276. 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
                                                          278. 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
                                                          280. 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 Namesextensions, user content, Geslachtsnaam
                                                          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())
                                                          282. 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.
                                                          284. 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
                                                          • 286. 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
                                                            288. 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
                                                            290. 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 Namesextensions, user content, VoorvoegselGeslachtsnaamPartner
                                                            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())
                                                            292. 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.
                                                            294. 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
                                                            • 296. 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
                                                              298. 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
                                                              300. 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 Namesextensions, user content, GeslachtsnaamPartner
                                                              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())
                                                              302. 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.
                                                              304. 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
                                                              • 306. 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
                                                                308. 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
                                                                310. 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
                                                                312. 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
                                                                314. 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.
                                                                316. Patient.contact.name.given.extension
                                                                Definition

                                                                icon Changed:

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

                                                                Shorticon Changed:Additional Content defined by implementations
                                                                Comments

                                                                icon Added:

                                                                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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 318. 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
                                                                  Alternate Namesextensions, user content
                                                                  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())
                                                                  320. 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.
                                                                  322. 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
                                                                  • 324. 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
                                                                    326. 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
                                                                    328. 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
                                                                    330. 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
                                                                    332. 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
                                                                    334. 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.

                                                                    336. Patient.contact.telecom
                                                                    Definition

                                                                    icon Changed:

                                                                    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 |

                                                                    Shorticon Changed:ContactInformation
                                                                    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
                                                                    ExampleMobile business phone number. Note: the mobile nature stems from the number being an 06-* number.: { "system" : "phone", "value" : "+31611234567", "use" : "work" }
                                                                    Mobile phone number undetermined private/business. Note: the mobile nature stems from the number being an 06-* number.: { "system" : "phone", "value" : "+31611234567", "use" : "mobile" }
                                                                    Primary Home Land Line: { "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" }
                                                                    Temporary Land Line: { "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" }
                                                                    Primary Work Land Line: { "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" }
                                                                    Primary Home Fax: { "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" }
                                                                    Temporary Fax: { "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" }
                                                                    Primary Work Fax: { "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" }
                                                                    Primary Home Mobile Phone: { "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" }
                                                                    Temporary Mobile Phone: { "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" }
                                                                    Primary Work Mobile Phone: { "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" }
                                                                    Primary Home Pager: { "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" }
                                                                    Temporary Pager: { "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" }
                                                                    Primary Work Pager: { "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" }
                                                                    Private email address: { "system" : "email", "value" : "giesput@myweb.nl", "use" : "home" }
                                                                    Work email address: { "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())
                                                                    338. Patient.contact.address
                                                                    Definition

                                                                    icon Changed:

                                                                    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

                                                                    icon Added:

                                                                    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
                                                                    ExampleExample of a Vacation Home address: { "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" }
                                                                    Example of a Primary Home address: { "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())))
                                                                    340. 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.

                                                                    342. 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.

                                                                    344. 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
                                                                    346. 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()))
                                                                    348. 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.
                                                                    350. 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
                                                                    352. 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
                                                                    354. 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.

                                                                    356. 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.

                                                                    358. 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.

                                                                    360. 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()))
                                                                    362. 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.
                                                                    364. Patient.communication.extension
                                                                    Definition

                                                                    icon Changed:

                                                                    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.

                                                                    Shorticon Changed:Additional Content defined by implementations
                                                                    Comments

                                                                    icon Added:

                                                                    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. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 366. 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)
                                                                      Alternate Namesextensions, user content
                                                                      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())
                                                                      368. 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.
                                                                      370. Patient.communication.extension:languageProficiency.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.

                                                                      Control2..*
                                                                      TypeExtension
                                                                      Alternate Namesextensions, user content
                                                                      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
                                                                      • 372. Patient.communication.extension:languageProficiency.extension:type
                                                                        Slice Nametype
                                                                        Definition

                                                                        What type of communication for the proficiency (spoken, written, etc.).

                                                                        ShortThe proficiency type of the communication
                                                                        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.

                                                                        Control1..1
                                                                        TypeExtension
                                                                        Alternate Namesextensions, user content
                                                                        374. 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.
                                                                        376. 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..0
                                                                        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
                                                                        • 378. 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
                                                                          380. Patient.communication.extension:languageProficiency.extension:type.valueCoding: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)

                                                                          The proficiency type for the communication.

                                                                          TypeCoding
                                                                          382. Patient.communication.extension:languageProficiency.extension:level
                                                                          Slice Namelevel
                                                                          Definition

                                                                          How well the patient can communicate this communication (good, poor, etc.).

                                                                          ShortThe proficiency level of the communication
                                                                          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.

                                                                          Control1..1
                                                                          TypeExtension
                                                                          Alternate Namesextensions, user content
                                                                          384. 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.
                                                                          386. 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..0
                                                                          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
                                                                          • 388. 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
                                                                            390. Patient.communication.extension:languageProficiency.extension:level.valueCoding: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)

                                                                            The proficiency level for the communication.

                                                                            TypeCoding
                                                                            392. 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
                                                                            394. 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
                                                                            396. Patient.communication.extension:comment
                                                                            Slice Namecomment
                                                                            Definition

                                                                            Optional Extension Element - found in all resources.

                                                                            ShortComment
                                                                            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..*
                                                                            This element is affected by the following invariants: ele-1
                                                                            TypeExtension(Comment) (Extension Type: string)
                                                                            Alternate Namesextensions, user content, Toelichting
                                                                            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())
                                                                            398. 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
                                                                            400. 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
                                                                            All LanguagesMax Binding
                                                                            TypeCodeableConcept
                                                                            Requirements

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

                                                                            Alternate NamesCommunicatieTaal
                                                                            402. 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.

                                                                            404. 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
                                                                            406. 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.
                                                                            408. Patient.generalPractitioner.extension
                                                                            Definition

                                                                            icon Changed:

                                                                            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.

                                                                            Shorticon Changed:Additional Content defined by implementations
                                                                            Comments

                                                                            icon Added:

                                                                            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.generalPractitioner.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 410. Patient.generalPractitioner.extension:practitionerRole
                                                                              Slice NamepractitionerRole
                                                                              Definition

                                                                              Optional Extension Element - found in all resources.

                                                                              ShortOptional Extensions Element
                                                                              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..1
                                                                              This element is affected by the following invariants: ele-1
                                                                              TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                                              Alternate Namesextensions, user content
                                                                              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())
                                                                              412. 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
                                                                              414. 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
                                                                              416. 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
                                                                              418. 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.

                                                                              420. 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()))
                                                                              422. 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.
                                                                              424. 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
                                                                              426. 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
                                                                              428. 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
                                                                              430. 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