CH Core (R4)
5.0.0-ci-build - ci-build Switzerland flag

CH Core (R4), published by HL7 Switzerland. This guide is not an authorized publication; it is the continuous build for version 5.0.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7ch/ch-core/ and changes regularly. See the Directory of published versions

Resource Profile: CHCorePatient - Detailed Descriptions

Active as of 2024-05-17

Definitions for the ch-core-patient resource profile.

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

0. Patient
Definition

The CH Core Patient is based upon the core FHIR Patient Resource and designed to meet the applicable patient demographic data elements in Switzerland. See also https://www.bfs.admin.ch/bfs/de/home/register/personenregister/registerharmonisierung/nomenklaturen.html for further information

ShortCH Core Patient
Invariantsch-pat-1: At least one HumanName with given and family name must be provided. (name.where(family.exists() and given.exists()).count()>0 or name.empty())
ch-pat-2: gender unknown is currently not used in Switzerland in eCH and the EPR (gender.empty() or gender!='unknown')
LOINC Code
2. Patient.extension
LOINC Code
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
  • 4. Patient.extension:placeOfBirth
    Slice NameplaceOfBirth
    ShortPlace of birth of patient
    Control0..1
    TypeExtension(Place of Birth according to eCH-0011) (Extension Type: Address(Address for Place of Birth))
    6. Patient.extension:placeOfOrigin
    Slice NameplaceOfOrigin
    ShortPlace of origin(s) of patient
    Control0..*
    TypeExtension(Place of Origin according to eCH-0011) (Extension Type: Address)
    8. Patient.extension:citizenship
    Slice Namecitizenship
    Definition

    The content of the country code element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, if the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.

    ShortCitizenship(s) of patient
    Control0..*
    TypeExtension(Patient Citizenship) (Complex Extension)
    Invariantsch-pat-3: ISO Country Alpha-2 or ISO Country Alpha-3 code (((extension.where(url='code').value.coding.code.length()=2) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2')) or ((extension.where(url='code').value.coding.code.length() = 3) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
    10. Patient.extension:religion
    Slice Namereligion
    ShortReligion of patient
    Control0..1
    TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
    12. Patient.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    LOINC Code
    SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ $this
    • 14. Patient.identifier:EPR-SPID
      Slice NameEPR-SPID
      Definition

      EPR-SPID: The Central Compensation Office (ZAS; CCO) assigns and manages the new patient identification number according to the EPRA (EPR-SPID), which is only linked internally in the CCO with the AHV number. It maintains the UPI identification database (Unique Personal Identifier Database), which the EPR communities may access. The law regulates how the the EPR-SPID can be used. SR 816.111 states (Art. 10 para. 3 EPDV) that communities must ensure that the EPR-SPID number cannot be not stored in document repositories or document registries.

      ShortEPR-SPID
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier(EPR-SPID Identifier)
      Pattern Value{
        "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3"
      }
      16. Patient.identifier:AHVN13
      Slice NameAHVN13
      Definition

      The AHVN13 / NAVS13 - (abbreviation for new thirteen-digit Social Security number) - is an administrative identifier for natural persons in Switzerland. It is issued, announced and administered by the Central Compensation Office. It is available to all organisations and communities for which there is a legal basis.

      ShortAHVN13 / NAVS13 of the patient (13 digits starting with 756, no separation points)
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier(AHVN13 / NAVS13 Identifier)
      Pattern Value{
        "system" : "urn:oid:2.16.756.5.32"
      }
      18. Patient.identifier:LocalPid
      Slice NameLocalPid
      ShortLocal patient identifier(s)
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      Pattern Value{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MR"
          }]
        }
      }
      20. Patient.identifier:LocalPid.system
      Control1..?
      22. Patient.identifier:LocalPid.value
      Control1..?
      24. Patient.identifier:insuranceCardNumber
      Slice NameinsuranceCardNumber
      Definition

      Cardnumber Swiss insurance card v1

      ShortInsurance card number of the patient (20 digits)
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier(Insurance Card Number (Identifier))
      Pattern Value{
        "system" : "urn:oid:2.16.756.5.30.1.123.100.1.1.1"
      }
      26. Patient.name
      TypeHumanName(Human Name)
      LOINC Code
      28. Patient.telecom
      LOINC Code
      SlicingThis element introduces a set of slices on Patient.telecom. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 30. Patient.telecom.system
        Control1..?
        32. Patient.telecom.value
        Control1..?
        34. Patient.telecom:email
        Slice Nameemail
        Control0..*
        TypeContactPoint(CH Core ContactPoint eCH-0046 Email)
        36. Patient.telecom:phone
        Slice Namephone
        Control0..*
        TypeContactPoint(CH Core ContactPoint eCH-0046 Phone)
        38. Patient.telecom:internet
        Slice Nameinternet
        Control0..*
        TypeContactPoint(CH Core ContactPoint eCH-0046 Internet)
        40. Patient.gender
        Shortmale | female | other
        LOINC Code
        42. Patient.birthDate
        LOINC Code
        44. Patient.deceased[x]
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        LOINC Code
        46. Patient.address
        TypeAddress(CH Core Address)
        LOINC Code
        48. Patient.maritalStatus
        BindingUnless not suitable, these codes SHALL be taken from ChCoreMaritalStatus
        (extensible to http://fhir.ch/ig/ch-core/ValueSet/ch-core-maritalstatus)
        LOINC Code
        50. Patient.maritalStatus.extension:maritalDataSeparation
        Slice NamemaritalDataSeparation
        ShortMaritalData Separation
        Control0..1
        TypeExtension(Marital Data - Separation Type) (Extension Type: CodeableConcept)
        52. Patient.contact
        LOINC Code
        SlicingThis element introduces a set of slices on Patient.contact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ relationship
        • 54. Patient.contact:contact
          Slice Namecontact
          ShortContact data if it is not address of patient
          Control0..1
          56. Patient.contact:contact.relationship
          Control1..1
          Pattern Value{
            "coding" : [{
              "system" : "http://fhir.ch/ig/ch-core/CodeSystem/ech-11",
              "code" : "contactData"
            }]
          }
          58. Patient.contact:contact.telecom
          Control0..0
          60. Patient.contact:contact.address
          Control1..?
          TypeAddress(CH Core Postal Address)
          62. Patient.contact:nameOfParent
          Slice NamenameOfParent
          ShortName of parent
          Control0..*
          64. Patient.contact:nameOfParent.relationship
          Control1..1
          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
              "code" : "PRN"
            }]
          }
          66. Patient.contact:nameOfParent.name
          Control1..?
          68. Patient.communication
          LOINC Code
          SlicingThis element introduces a set of slices on Patient.communication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ preferred
          • 70. Patient.communication:languageOfCorrespondence
            Slice NamelanguageOfCorrespondence
            ShortLanguage of correspondence
            Control0..1
            72. Patient.communication:languageOfCorrespondence.preferred
            Control1..?
            Fixed Valuetrue

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

            0. Patient
            Definition

            The CH Core Patient is based upon the core FHIR Patient Resource and designed to meet the applicable patient demographic data elements in Switzerland. See also https://www.bfs.admin.ch/bfs/de/home/register/personenregister/registerharmonisierung/nomenklaturen.html for further information


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

            ShortCH Core PatientInformation about an individual or animal receiving health care services
            Control0..*
            Is Modifierfalse
            Summaryfalse
            Alternate NamesSubjectOfCare Client Resident
            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
            dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
            dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
            dom-6: A resource should have narrative for robust management (text.`div`.exists())
            ch-pat-1: At least one HumanName with given and family name must be provided. (name.where(family.exists() and given.exists()).count()>0 or name.empty())
            ch-pat-2: gender unknown is currently not used in Switzerland in eCH and the EPR (gender.empty() or gender!='unknown')
            2. Patient.implicitRules
            Definition

            A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

            ShortA set of rules under which this content was created
            Comments

            Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

            Control0..1
            Typeuri
            Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            4. Patient.extension
            Definition

            An Extension


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

            ShortExtensionAdditional content defined by implementations
            Comments

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

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

              The registered place of birth of the patient.

              ShortPlace of birth of patient
              Control0..1
              TypeExtension(Place of Birth according to eCH-0011) (Extension Type: Address(Address for Place of Birth))
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              LOINC Code
              8. Patient.extension:placeOfOrigin
              Slice NameplaceOfOrigin
              Definition

              The registered place of origin of the patient.

              ShortPlace of origin(s) of patient
              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(Place of Origin according to eCH-0011) (Extension Type: Address)
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              LOINC Code
              10. Patient.extension:citizenship
              Slice Namecitizenship
              Definition

              The content of the country code element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, if the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.

              ShortCitizenship(s) of patient
              Control0..*
              TypeExtension(Patient Citizenship) (Complex Extension)
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              ch-pat-3: ISO Country Alpha-2 or ISO Country Alpha-3 code (((extension.where(url='code').value.coding.code.length()=2) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2')) or ((extension.where(url='code').value.coding.code.length() = 3) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
              LOINC Code
              12. Patient.extension:religion
              Slice Namereligion
              Definition

              The patient's professed religious affiliations.

              ShortReligion of patient
              Control0..1
              TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              LOINC Code
              14. Patient.modifierExtension
              Definition

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

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

              ShortExtensions that cannot be ignored
              Comments

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

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

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

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

              An identifier for this patient.

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

              Patients are almost always assigned specific numerical identifiers.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • pattern @ $this
              • 18. Patient.identifier:EPR-SPID
                Slice NameEPR-SPID
                Definition

                EPR-SPID: The Central Compensation Office (ZAS; CCO) assigns and manages the new patient identification number according to the EPRA (EPR-SPID), which is only linked internally in the CCO with the AHV number. It maintains the UPI identification database (Unique Personal Identifier Database), which the EPR communities may access. The law regulates how the the EPR-SPID can be used. SR 816.111 states (Art. 10 para. 3 EPDV) that communities must ensure that the EPR-SPID number cannot be not stored in document repositories or document registries.


                An identifier for this patient.

                ShortEPR-SPIDAn identifier for this patient
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeIdentifier(EPR-SPID Identifier)
                Is Modifierfalse
                Requirements

                Patients are almost always assigned specific numerical identifiers.

                Pattern Value{
                  "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3"
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                20. Patient.identifier:AHVN13
                Slice NameAHVN13
                Definition

                The AHVN13 / NAVS13 - (abbreviation for new thirteen-digit Social Security number) - is an administrative identifier for natural persons in Switzerland. It is issued, announced and administered by the Central Compensation Office. It is available to all organisations and communities for which there is a legal basis.


                An identifier for this patient.

                ShortAHVN13 / NAVS13 of the patient (13 digits starting with 756, no separation points)An identifier for this patient
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeIdentifier(AHVN13 / NAVS13 Identifier)
                Is Modifierfalse
                Requirements

                Patients are almost always assigned specific numerical identifiers.

                Pattern Value{
                  "system" : "urn:oid:2.16.756.5.32"
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                22. Patient.identifier:LocalPid
                Slice NameLocalPid
                Definition

                An identifier for this patient.

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

                Patients are almost always assigned specific numerical identifiers.

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

                The purpose of this identifier.

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

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

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

                Identifies the purpose for this identifier, if known .

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

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

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

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

                ShortThe namespace for the identifier value
                Comments

                Identifier.system is always case sensitive.

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

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

                Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                28. Patient.identifier:LocalPid.value
                Definition

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

                ShortThe value that is unique
                Comments

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

                Control10..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Example<br/><b>General</b>:123456
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                30. Patient.identifier:insuranceCardNumber
                Slice NameinsuranceCardNumber
                Definition

                Cardnumber Swiss insurance card v1


                An identifier for this patient.

                ShortInsurance card number of the patient (20 digits)An identifier for this patient
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeIdentifier(Insurance Card Number (Identifier))
                Is Modifierfalse
                Requirements

                Patients are almost always assigned specific numerical identifiers.

                Pattern Value{
                  "system" : "urn:oid:2.16.756.5.30.1.123.100.1.1.1"
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                32. Patient.active
                Definition

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

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

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

                ShortWhether this patient's record is in active use
                Comments

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

                Control0..1
                Typeboolean
                Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to be able to mark a patient record as not to be used because it was created in error.

                Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                34. Patient.name
                Definition

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


                A name associated with the individual.

                ShortName of a human - parts and usageA name associated with the patient
                Comments

                Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.


                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.

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeHumanName(Human Name)
                Is Modifierfalse
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ch-core-hm-1: if officalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is official (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').empty() or (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').exists() and use='official'))
                ch-core-hm-2: if orginalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is maiden (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').empty() or ((family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').exists() and use='maiden')))
                ch-core-hm-3: ch-ext-ech-11-name can only be put on a family name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count()=family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count())
                ch-core-hm-4: ch-ext-ech-11-firstname can only be put on a given name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count()=given.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count())
                36. Patient.telecom
                Definition

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

                ShortA contact detail for the individual
                Comments

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

                Control0..*
                TypeContactPoint
                Is Modifierfalse
                Summarytrue
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Patient.telecom. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ system
                • 38. Patient.telecom.system
                  Definition

                  Telecommunications form for contact point - what communications system is required to make use of the contact.

                  Shortphone | fax | email | pager | url | sms | other
                  Control10..1
                  This element is affected by the following invariants: cpt-2
                  BindingThe codes SHALL be taken from ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1)

                  Telecommunications form for contact point.

                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  40. Patient.telecom.value
                  Definition

                  The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

                  ShortThe actual contact point details
                  Comments

                  Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

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

                  Need to support legacy numbers that are not in a tightly controlled format.

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

                  Identifies the purpose for the contact point.

                  Shorthome | work | temp | old | mobile - purpose of this contact point
                  Comments

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

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

                  Use of contact point.

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

                  Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

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

                  Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.


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

                  ShortCH Core ContactPoint eCH-0046 EmailA contact detail for the individual
                  Comments

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

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeContactPoint(CH Core ContactPoint eCH-0046 Email)
                  Is Modifierfalse
                  Requirements

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

                  Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  46. Patient.telecom:phone
                  Slice Namephone
                  Definition

                  Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.


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

                  ShortCH Core ContactPoint eCH-0046 PhoneA contact detail for the individual
                  Comments

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

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeContactPoint(CH Core ContactPoint eCH-0046 Phone)
                  Is Modifierfalse
                  Requirements

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

                  Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  48. Patient.telecom:internet
                  Slice Nameinternet
                  Definition

                  Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.


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

                  ShortCH Core ContactPoint eCH-0046 InternetA contact detail for the individual
                  Comments

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

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeContactPoint(CH Core ContactPoint eCH-0046 Internet)
                  Is Modifierfalse
                  Requirements

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

                  Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  50. Patient.gender
                  Definition

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

                  Shortmale | female | othermale | female | other | unknown
                  Comments

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

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

                  The gender of a person used for administrative purposes.

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

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

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

                  The date of birth for the individual.

                  ShortThe date of birth for the individual
                  Comments

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

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

                  Age of the individual drives many clinical processes.

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

                  Indicates if the individual is deceased or not.

                  ShortIndicates if the individual is deceased or not
                  Comments

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

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

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

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

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


                  An address for the individual.

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

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


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

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

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ch-addr-2: For a Swiss address, a canton abbreviation from the value set 'eCH-0007 Canton Abbreviation' must be used. (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').empty() or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH') = false) or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH').exists() and (state.empty() or state.memberOf('http://fhir.ch/ig/ch-core/ValueSet/ech-7-cantonabbreviation'))))
                  58. Patient.maritalStatus
                  Definition

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

                  ShortMarital (civil) status of a patient
                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from ChCoreMaritalStatushttp://hl7.org/fhir/ValueSet/marital-status
                  (extensible to http://fhir.ch/ig/ch-core/ValueSet/ch-core-maritalstatus)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Most, if not all systems capture it.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  60. Patient.maritalStatus.extension:maritalDataSeparation
                  Slice NamemaritalDataSeparation
                  Definition

                  Extension for eCH-0011 - MaritalData - separation

                  ShortMaritalData Separation
                  Control0..1
                  TypeExtension(Marital Data - Separation Type) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  LOINC Code
                  62. Patient.contact
                  Definition

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

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

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

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Need to track people you can contact about the patient.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                  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())
                  SlicingThis element introduces a set of slices on Patient.contact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ relationship
                  • 64. Patient.contact.modifierExtension
                    Definition

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

                    ShortContact data if it is not address of patientA contact party (e.g. guardian, partner, friend) for the patient
                    Comments

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

                    Control0..1*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to track people you can contact about the patient.

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

                    ShortThe kind of relationship
                    Control10..1*
                    BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationshiphttp://hl7.org/fhir/ValueSet/patient-contactrelationship
                    (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

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

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://fhir.ch/ig/ch-core/CodeSystem/ech-11",
                        "code" : "contactData"
                      }]
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    72. Patient.contact:contact.telecom
                    Definition

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

                    ShortA contact detail for the person
                    Comments

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

                    Control0..0*
                    TypeContactPoint
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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


                    Address for the contact person.

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

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

                    Control10..1
                    This element is affected by the following invariants: ele-1
                    TypeAddress(CH Core Postal Address)
                    Is Modifierfalse
                    Requirements

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ch-addr-2: For a Swiss address, a canton abbreviation from the value set 'eCH-0007 Canton Abbreviation' must be used. (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').empty() or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH') = false) or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH').exists() and (state.empty() or state.memberOf('http://fhir.ch/ig/ch-core/ValueSet/ech-7-cantonabbreviation'))))
                    76. Patient.contact:nameOfParent
                    Slice NamenameOfParent
                    Definition

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

                    ShortName of parentA contact party (e.g. guardian, partner, friend) for the patient
                    Comments

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

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to track people you can contact about the patient.

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

                    ShortThe kind of relationship
                    Control10..1*
                    BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationshiphttp://hl7.org/fhir/ValueSet/patient-contactrelationship
                    (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

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

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                        "code" : "PRN"
                      }]
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    82. Patient.contact:nameOfParent.name
                    Definition

                    A name associated with the contact person.

                    ShortA name associated with the contact person
                    Control10..1
                    TypeHumanName
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

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

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Patient.communication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ preferred
                    • 86. Patient.communication.modifierExtension
                      Definition

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

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

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

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

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

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

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

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

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

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

                      Control1..1
                      BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages
                      (preferred to http://hl7.org/fhir/ValueSet/languages)

                      A human language.

                      Additional BindingsPurpose
                      AllLanguagesMax Binding
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

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

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

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

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

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

                      Control0..1*
                      TypeBackboneElement
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

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

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

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

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

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

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

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

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

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

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

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

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

                      Control1..1
                      BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages
                      (preferred to http://hl7.org/fhir/ValueSet/languages)

                      A human language.

                      Additional BindingsPurpose
                      AllLanguagesMax Binding
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

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

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

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

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

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

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

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

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

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

                      There are multiple use cases:

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

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

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

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

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

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

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

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

                      The other patient resource that the link refers to.

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

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

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

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

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

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

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

                      0. Patient
                      Definition

                      The CH Core Patient is based upon the core FHIR Patient Resource and designed to meet the applicable patient demographic data elements in Switzerland. See also https://www.bfs.admin.ch/bfs/de/home/register/personenregister/registerharmonisierung/nomenklaturen.html for further information

                      ShortCH Core Patient
                      Control0..*
                      Is Modifierfalse
                      Summaryfalse
                      Alternate NamesSubjectOfCare Client Resident
                      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                      dom-6: A resource should have narrative for robust management (text.`div`.exists())
                      ch-pat-1: At least one HumanName with given and family name must be provided. (name.where(family.exists() and given.exists()).count()>0 or name.empty())
                      ch-pat-2: gender unknown is currently not used in Switzerland in eCH and the EPR (gender.empty() or gender!='unknown')
                      2. Patient.id
                      Definition

                      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                      ShortLogical id of this artifact
                      Comments

                      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                      Control0..1
                      Typeid
                      Is Modifierfalse
                      Summarytrue
                      4. Patient.meta
                      Definition

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

                      ShortMetadata about the resource
                      Control0..1
                      TypeMeta
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      6. Patient.implicitRules
                      Definition

                      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                      ShortA set of rules under which this content was created
                      Comments

                      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                      Control0..1
                      Typeuri
                      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      8. Patient.language
                      Definition

                      The base language in which the resource is written.

                      ShortLanguage of the resource content
                      Comments

                      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                      Control0..1
                      BindingThe codes SHOULD be taken from CommonLanguages
                      (preferred to http://hl7.org/fhir/ValueSet/languages)

                      A human language.

                      Additional BindingsPurpose
                      AllLanguagesMax Binding
                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      10. Patient.text
                      Definition

                      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                      ShortText summary of the resource, for human interpretation
                      Comments

                      Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                      Control0..1
                      TypeNarrative
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesnarrative, html, xhtml, display
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      12. Patient.contained
                      Definition

                      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                      ShortContained, inline Resources
                      Comments

                      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

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

                      An Extension

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

                        The registered place of birth of the patient.

                        ShortPlace of birth of patient
                        Control0..1
                        TypeExtension(Place of Birth according to eCH-0011) (Extension Type: Address(Address for Place of Birth))
                        Is Modifierfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        18. Patient.extension:placeOfOrigin
                        Slice NameplaceOfOrigin
                        Definition

                        The registered place of origin of the patient.

                        ShortPlace of origin(s) of patient
                        Control0..*
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Place of Origin according to eCH-0011) (Extension Type: Address)
                        Is Modifierfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        20. Patient.extension:citizenship
                        Slice Namecitizenship
                        Definition

                        The content of the country code element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, if the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.

                        ShortCitizenship(s) of patient
                        Control0..*
                        TypeExtension(Patient Citizenship) (Complex Extension)
                        Is Modifierfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        ch-pat-3: ISO Country Alpha-2 or ISO Country Alpha-3 code (((extension.where(url='code').value.coding.code.length()=2) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2')) or ((extension.where(url='code').value.coding.code.length() = 3) and extension.where(url='code').value.coding.code.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
                        22. Patient.extension:religion
                        Slice Namereligion
                        Definition

                        The patient's professed religious affiliations.

                        ShortReligion of patient
                        Control0..1
                        TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
                        Is Modifierfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        24. Patient.modifierExtension
                        Definition

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

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

                        ShortExtensions that cannot be ignored
                        Comments

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

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

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

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

                        An identifier for this patient.

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

                        Patients are almost always assigned specific numerical identifiers.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • pattern @ $this
                        • 28. Patient.identifier:EPR-SPID
                          Slice NameEPR-SPID
                          Definition

                          EPR-SPID: The Central Compensation Office (ZAS; CCO) assigns and manages the new patient identification number according to the EPRA (EPR-SPID), which is only linked internally in the CCO with the AHV number. It maintains the UPI identification database (Unique Personal Identifier Database), which the EPR communities may access. The law regulates how the the EPR-SPID can be used. SR 816.111 states (Art. 10 para. 3 EPDV) that communities must ensure that the EPR-SPID number cannot be not stored in document repositories or document registries.

                          ShortEPR-SPID
                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control0..*
                          This element is affected by the following invariants: ele-1
                          TypeIdentifier(EPR-SPID Identifier)
                          Is Modifierfalse
                          Requirements

                          Patients are almost always assigned specific numerical identifiers.

                          Pattern Value{
                            "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3"
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          30. Patient.identifier:AHVN13
                          Slice NameAHVN13
                          Definition

                          The AHVN13 / NAVS13 - (abbreviation for new thirteen-digit Social Security number) - is an administrative identifier for natural persons in Switzerland. It is issued, announced and administered by the Central Compensation Office. It is available to all organisations and communities for which there is a legal basis.

                          ShortAHVN13 / NAVS13 of the patient (13 digits starting with 756, no separation points)
                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control0..*
                          This element is affected by the following invariants: ele-1
                          TypeIdentifier(AHVN13 / NAVS13 Identifier)
                          Is Modifierfalse
                          Requirements

                          Patients are almost always assigned specific numerical identifiers.

                          Pattern Value{
                            "system" : "urn:oid:2.16.756.5.32"
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          32. Patient.identifier:LocalPid
                          Slice NameLocalPid
                          Definition

                          An identifier for this patient.

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

                          Patients are almost always assigned specific numerical identifiers.

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

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

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          36. Patient.identifier:LocalPid.extension
                          Definition

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

                          ShortAdditional content defined by implementations
                          Comments

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

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

                            The purpose of this identifier.

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

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

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

                            Identifies the purpose for this identifier, if known .

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

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

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

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

                            ShortDescription of identifier
                            Comments

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

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

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

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

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

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

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

                            ShortThe namespace for the identifier value
                            Comments

                            Identifier.system is always case sensitive.

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

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

                            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            44. Patient.identifier:LocalPid.value
                            Definition

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

                            ShortThe value that is unique
                            Comments

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

                            Control1..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Example<br/><b>General</b>:123456
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            46. Patient.identifier:LocalPid.period
                            Definition

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

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

                            Organization that issued/manages the identifier.

                            ShortOrganization that issued id (may be just text)
                            Comments

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

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

                            Cardnumber Swiss insurance card v1

                            ShortInsurance card number of the patient (20 digits)
                            NoteThis is a business identifier, not a resource identifier (see discussion)
                            Control0..*
                            This element is affected by the following invariants: ele-1
                            TypeIdentifier(Insurance Card Number (Identifier))
                            Is Modifierfalse
                            Requirements

                            Patients are almost always assigned specific numerical identifiers.

                            Pattern Value{
                              "system" : "urn:oid:2.16.756.5.30.1.123.100.1.1.1"
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            52. Patient.active
                            Definition

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

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

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

                            ShortWhether this patient's record is in active use
                            Comments

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

                            Control0..1
                            Typeboolean
                            Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be able to mark a patient record as not to be used because it was created in error.

                            Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            54. Patient.name
                            Definition

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

                            ShortName of a human - parts and usage
                            Comments

                            Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

                            Control0..*
                            This element is affected by the following invariants: ele-1
                            TypeHumanName(Human Name)
                            Is Modifierfalse
                            Requirements

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

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ch-core-hm-1: if officalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is official (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').empty() or (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='officialName').exists() and use='official'))
                            ch-core-hm-2: if orginalName with eCH-011 Extension is specified, it can only be put on a name where use attribute is maiden (family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').empty() or ((family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name' and value='originalName').exists() and use='maiden')))
                            ch-core-hm-3: ch-ext-ech-11-name can only be put on a family name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count()=family.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-name').count())
                            ch-core-hm-4: ch-ext-ech-11-firstname can only be put on a given name (descendants().extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count()=given.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-ech-11-firstname').count())
                            56. Patient.telecom
                            Definition

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

                            ShortA contact detail for the individual
                            Comments

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

                            Control0..*
                            TypeContactPoint
                            Is Modifierfalse
                            Summarytrue
                            Requirements

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

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on Patient.telecom. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ system
                            • 58. Patient.telecom.id
                              Definition

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

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              60. Patient.telecom.extension
                              Definition

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

                              ShortAdditional content defined by implementations
                              Comments

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

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

                                Telecommunications form for contact point - what communications system is required to make use of the contact.

                                Shortphone | fax | email | pager | url | sms | other
                                Control1..1
                                This element is affected by the following invariants: cpt-2
                                BindingThe codes SHALL be taken from ContactPointSystem
                                (required to http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1)

                                Telecommunications form for contact point.

                                Typecode
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                64. Patient.telecom.value
                                Definition

                                The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

                                ShortThe actual contact point details
                                Comments

                                Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

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

                                Need to support legacy numbers that are not in a tightly controlled format.

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

                                Identifies the purpose for the contact point.

                                Shorthome | work | temp | old | mobile - purpose of this contact point
                                Comments

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

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

                                Use of contact point.

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

                                Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

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

                                Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

                                ShortSpecify preferred order of use (1 = highest)
                                Comments

                                Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

                                Control0..1
                                TypepositiveInt
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                70. Patient.telecom.period
                                Definition

                                Time period when the contact point was/is in use.

                                ShortTime period when the contact point was/is in use
                                Control0..1
                                TypePeriod
                                Is Modifierfalse
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                72. Patient.telecom:email
                                Slice Nameemail
                                Definition

                                Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.

                                ShortCH Core ContactPoint eCH-0046 Email
                                Comments

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

                                Control0..*
                                This element is affected by the following invariants: ele-1
                                TypeContactPoint(CH Core ContactPoint eCH-0046 Email)
                                Is Modifierfalse
                                Requirements

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

                                Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                74. Patient.telecom:phone
                                Slice Namephone
                                Definition

                                Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.

                                ShortCH Core ContactPoint eCH-0046 Phone
                                Comments

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

                                Control0..*
                                This element is affected by the following invariants: ele-1
                                TypeContactPoint(CH Core ContactPoint eCH-0046 Phone)
                                Is Modifierfalse
                                Requirements

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

                                Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                76. Patient.telecom:internet
                                Slice Nameinternet
                                Definition

                                Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.

                                ShortCH Core ContactPoint eCH-0046 Internet
                                Comments

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

                                Control0..*
                                This element is affected by the following invariants: ele-1
                                TypeContactPoint(CH Core ContactPoint eCH-0046 Internet)
                                Is Modifierfalse
                                Requirements

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

                                Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                78. Patient.gender
                                Definition

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

                                Shortmale | female | other
                                Comments

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

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

                                The gender of a person used for administrative purposes.

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

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

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

                                The date of birth for the individual.

                                ShortThe date of birth for the individual
                                Comments

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

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

                                Age of the individual drives many clinical processes.

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

                                Indicates if the individual is deceased or not.

                                ShortIndicates if the individual is deceased or not
                                Comments

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

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

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

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

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

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

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

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

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

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ch-addr-2: For a Swiss address, a canton abbreviation from the value set 'eCH-0007 Canton Abbreviation' must be used. (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').empty() or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH') = false) or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH').exists() and (state.empty() or state.memberOf('http://fhir.ch/ig/ch-core/ValueSet/ech-7-cantonabbreviation'))))
                                86. Patient.maritalStatus
                                Definition

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

                                ShortMarital (civil) status of a patient
                                Control0..1
                                BindingUnless not suitable, these codes SHALL be taken from ChCoreMaritalStatus
                                (extensible to http://fhir.ch/ig/ch-core/ValueSet/ch-core-maritalstatus)
                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Most, if not all systems capture it.

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

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

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                90. Patient.maritalStatus.extension
                                Definition

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

                                ShortAdditional content defined by implementations
                                Comments

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

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

                                  Extension for eCH-0011 - MaritalData - separation

                                  ShortMaritalData Separation
                                  Control0..1
                                  TypeExtension(Marital Data - Separation Type) (Extension Type: CodeableConcept)
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  94. Patient.maritalStatus.coding
                                  Definition

                                  A reference to a code defined by a terminology system.

                                  ShortCode defined by a terminology system
                                  Comments

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

                                  Control0..*
                                  TypeCoding
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

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

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

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

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

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

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

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

                                  ShortWhether patient is part of a multiple birth
                                  Comments

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

                                  Control0..1
                                  TypeChoice of: boolean, integer
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Requirements

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

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

                                  Image of the patient.

                                  ShortImage of the patient
                                  Comments

                                  Guidelines:

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

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

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

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

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

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

                                  Control0..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Need to track people you can contact about the patient.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                                  SlicingThis element introduces a set of slices on Patient.contact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ relationship
                                  • 104. Patient.contact.id
                                    Definition

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

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    106. Patient.contact.extension
                                    Definition

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

                                    ShortAdditional content defined by implementations
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    108. Patient.contact.modifierExtension
                                    Definition

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

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

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

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

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

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

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    110. 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 PatientContactRelationship
                                    (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

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

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

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

                                    A name associated with the contact person.

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

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

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

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

                                    ShortA contact detail for the person
                                    Comments

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

                                    Control0..*
                                    TypeContactPoint
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

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

                                    Address for the contact person.

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

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

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

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

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

                                    The gender of a person used for administrative purposes.

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

                                    Needed to address the person correctly.

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

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

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

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

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

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

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

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

                                    ShortContact data if it is not address of patient
                                    Comments

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

                                    Control0..1
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Need to track people you can contact about the patient.

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

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

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    128. Patient.contact:contact.extension
                                    Definition

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

                                    ShortAdditional content defined by implementations
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    130. Patient.contact:contact.modifierExtension
                                    Definition

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

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

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

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

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

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

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

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

                                    ShortThe kind of relationship
                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationship
                                    (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

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

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://fhir.ch/ig/ch-core/CodeSystem/ech-11",
                                        "code" : "contactData"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    134. Patient.contact:contact.name
                                    Definition

                                    A name associated with the contact person.

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

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

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

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

                                    ShortA contact detail for the person
                                    Comments

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

                                    Control0..0
                                    TypeContactPoint
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

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

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

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

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

                                    Control1..1
                                    This element is affected by the following invariants: ele-1
                                    TypeAddress(CH Core Postal Address)
                                    Is Modifierfalse
                                    Requirements

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

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ch-addr-2: For a Swiss address, a canton abbreviation from the value set 'eCH-0007 Canton Abbreviation' must be used. (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').empty() or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH') = false) or (country.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-SC-coding').value.code.startsWith('CH').exists() and (state.empty() or state.memberOf('http://fhir.ch/ig/ch-core/ValueSet/ech-7-cantonabbreviation'))))
                                    140. Patient.contact:contact.gender
                                    Definition

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

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

                                    The gender of a person used for administrative purposes.

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

                                    Needed to address the person correctly.

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

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

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

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

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

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

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

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

                                    ShortName of parent
                                    Comments

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

                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Need to track people you can contact about the patient.

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

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

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    150. Patient.contact:nameOfParent.extension
                                    Definition

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

                                    ShortAdditional content defined by implementations
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    152. Patient.contact:nameOfParent.modifierExtension
                                    Definition

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

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

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

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

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

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

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

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

                                    ShortThe kind of relationship
                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationship
                                    (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

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

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                                        "code" : "PRN"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    156. Patient.contact:nameOfParent.name
                                    Definition

                                    A name associated with the contact person.

                                    ShortA name associated with the contact person
                                    Control1..1
                                    TypeHumanName
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

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

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

                                    ShortA contact detail for the person
                                    Comments

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

                                    Control0..*
                                    TypeContactPoint
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

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

                                    Address for the contact person.

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

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

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

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

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

                                    The gender of a person used for administrative purposes.

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

                                    Needed to address the person correctly.

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

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

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

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

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

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

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

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

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

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

                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

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

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    SlicingThis element introduces a set of slices on Patient.communication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ preferred
                                    • 170. Patient.communication.id
                                      Definition

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      172. Patient.communication.extension
                                      Definition

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

                                      ShortAdditional content defined by implementations
                                      Comments

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

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      174. Patient.communication.modifierExtension
                                      Definition

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

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

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

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

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

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

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

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

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

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

                                      Control1..1
                                      BindingThe codes SHOULD be taken from CommonLanguages
                                      (preferred to http://hl7.org/fhir/ValueSet/languages)

                                      A human language.

                                      Additional BindingsPurpose
                                      AllLanguagesMax Binding
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

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

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

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

                                      ShortLanguage preference indicator
                                      Comments

                                      This language is specifically identified for communicating healthcare information.

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

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

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

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

                                      ShortLanguage of correspondence
                                      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..1
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

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

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

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      184. Patient.communication:languageOfCorrespondence.extension
                                      Definition

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

                                      ShortAdditional content defined by implementations
                                      Comments

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

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      186. Patient.communication:languageOfCorrespondence.modifierExtension
                                      Definition

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

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

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

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

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

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

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

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

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

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

                                      Control1..1
                                      BindingThe codes SHOULD be taken from CommonLanguages
                                      (preferred to http://hl7.org/fhir/ValueSet/languages)

                                      A human language.

                                      Additional BindingsPurpose
                                      AllLanguagesMax Binding
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

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

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

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

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

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

                                      Patient's nominated care provider.

                                      ShortPatient's nominated primary care provider
                                      Comments

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

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

                                      Control0..*
                                      TypeReference(Organization, Practitioner, PractitionerRole)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate NamescareProvider
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      194. Patient.managingOrganization
                                      Definition

                                      Organization that is the custodian of the patient record.

                                      ShortOrganization that is the custodian of the patient record
                                      Comments

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

                                      Control0..1
                                      TypeReference(Organization)
                                      Is Modifierfalse
                                      Summarytrue
                                      Requirements

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

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

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

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

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

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

                                      There are multiple use cases:

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

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      200. Patient.link.extension
                                      Definition

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

                                      ShortAdditional content defined by implementations
                                      Comments

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

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      202. Patient.link.modifierExtension
                                      Definition

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

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

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

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

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

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

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

                                      The other patient resource that the link refers to.

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

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

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

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

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

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

                                      Typecode
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))