CH Core (R4)
7.0.0-ballot - ballot Switzerland flag

CH Core (R4), published by HL7 Switzerland. This guide is not an authorized publication; it is the continuous build for version 7.0.0-ballot 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: CH Core Patient - Detailed Descriptions

Active as of 2026-10-21

Definitions for the ch-core-patient resource profile

See the documentation on how to interpret the contents of this table

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: If one ore more human names are provided, at least one human name should have a family and a given name. (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
  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

    6. Patient.extension:placeOfBirth
    Slice NameplaceOfBirth
    Definition

    The registered place of birth of the patient.

    ShortPlace of birth of the patient
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Place of Birth according to eCH-0011) (Extension Type: Address(Address for Place of Birth))
    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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. Patient.extension:placeOfOrigin
    Slice NameplaceOfOrigin
    Definition

    The registered place of origin of the patient.

    ShortPlace of origin(s) of the 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
    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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    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.

    ShortInformation on nationality data (eCH: Staatsangehörigkeit/Nationalité) of the patient
    Control0..*
    This element is affected by the following invariants: ele-1
    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')))
    12. Patient.extension:religion
    Slice Namereligion
    Definition

    The patient's professed religious affiliations.

    ShortReligion of the patient
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Patient Religion) (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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    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:
    • value @ $this
    • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

      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 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 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..*
      TypeIdentifier(EPR-SPID Identifier)
      Is Modifierfalse
      Summarytrue
      Requirements

      Patients are almost always assigned specific numerical identifiers.

      Pattern Value
      {
        "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3"
      }
      <identifier>
        <system value="urn:oid:2.16.756.5.30.1.127.3.10.3"/>
      </identifier>
      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..*
      TypeIdentifier(AHVN13 / NAVS13 Identifier)
      Is Modifierfalse
      Summarytrue
      Requirements

      Patients are almost always assigned specific numerical identifiers.

      Pattern Value
      {
        "system" : "urn:oid:2.16.756.5.32"
      }
      <identifier>
        <system value="urn:oid:2.16.756.5.32"/>
      </identifier>
      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"
            }
          ]
        }
      }
      <identifier>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
            <code value="MR"/>
          </coding>
        </type>
      </identifier>
      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.

      ExampleGeneral: 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
      ExampleGeneral: 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..*
      TypeIdentifier(Insurance Card Number (Identifier))
      Is Modifierfalse
      Summarytrue
      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"
      }
      <identifier>
        <system value="urn:oid:2.16.756.5.30.1.123.100.1.1.1"/>
      </identifier>
      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 name associated with the individual.

      ShortA name associated with the patient
      Comments

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

      Control0..*
      TypeHumanName(Human Name)
      Is Modifierfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ch-core-hm-1: if officialName 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 originalName 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
      • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

        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

        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(CH Core ContactPoint eCH-0046 Email)
        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()))
        46. Patient.telecom:phone
        Slice Namephone
        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(CH Core ContactPoint eCH-0046 Phone)
        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()))
        48. Patient.telecom:internet
        Slice Nameinternet
        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(CH Core ContactPoint eCH-0046 Internet)
        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()))
        50. Patient.gender
        Definition

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

        Shortmale | female | other | unknown* (* see warning 'ch-pat-2')
        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] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

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

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

        An address for the individual.

        ShortAn address for the individual
        Comments

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

        Control0..*
        TypeAddress(CH Core Address)
        Is Modifierfalse
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        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-codedString' and (value.code = 'CH' or value.code = 'CHE')).empty() or 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|4.0.1
        (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())
        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
        • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

          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 the address of the 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|4.0.1
          (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship|4.0.1)

          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"
              }
            ]
          }
          <relationship>
            <coding>
              <system value="http://fhir.ch/ig/ch-core/CodeSystem/ech-11"/>
              <code value="contactData"/>
            </coding>
          </relationship>
          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

          Address for the contact person.

          ShortAddress for the contact person
          Control10..1
          TypeAddress(CH Core Postal Address)
          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()))
          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-codedString' and (value.code = 'CH' or value.code = 'CHE')).empty() or 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|4.0.1
          (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship|4.0.1)

          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"
              }
            ]
          }
          <relationship>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
              <code value="PRN"/>
            </coding>
          </relationship>
          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.contact:nameOfParent.gender
          Definition

          Sex of the parent as defined by eCH-0021 nameOfParent/sex (eCH-0044:sexType). The parent relationship stays gender-neutral (v3-RoleCode#PRN); the sex is conveyed here, not through the relationship code.


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

          ShortSex of the parent (eCH-0021: nameOfParent/sex)male | female | other | unknown
          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
          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()))
          86. 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()))
          88. 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())
          90. 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|4.0.1
          (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

          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()))
          92. 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()))
          94. 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())
          96. 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()))
          98. 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()))

          See the documentation on how to interpret the contents of this table

          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: If one ore more human names are provided, at least one human name should have a family and a given name. (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.extension
          SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

            4. Patient.extension:placeOfBirth
            Slice NameplaceOfBirth
            ShortPlace of birth of the 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 the 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.

            ShortInformation on nationality data (eCH: Staatsangehörigkeit/Nationalité) of the 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 the patient
            Control0..1
            TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
            12. Patient.identifier
            NoteThis is a business identifier, not a resource identifier (see discussion)
            SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ $this
            • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

              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 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 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"
              }
              <identifier>
                <system value="urn:oid:2.16.756.5.30.1.127.3.10.3"/>
              </identifier>
              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"
              }
              <identifier>
                <system value="urn:oid:2.16.756.5.32"/>
              </identifier>
              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"
                    }
                  ]
                }
              }
              <identifier>
                <type>
                  <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                    <code value="MR"/>
                  </coding>
                </type>
              </identifier>
              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"
              }
              <identifier>
                <system value="urn:oid:2.16.756.5.30.1.123.100.1.1.1"/>
              </identifier>
              26. Patient.name
              TypeHumanName(Human Name)
              28. Patient.telecom
              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
              • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                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 | unknown* (* see warning 'ch-pat-2')
                42. Patient.birthDate
                LOINC Code
                44. Patient.deceased[x]
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                46. Patient.address
                TypeAddress(CH Core Address)
                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)
                50. Patient.maritalStatus.extension:maritalDataSeparation
                Slice NamemaritalDataSeparation
                ShortMaritalData Separation
                Control0..1
                TypeExtension(Marital Data - Separation Type) (Extension Type: CodeableConcept)
                52. Patient.contact
                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
                • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                  54. Patient.contact:contact
                  Slice Namecontact
                  ShortContact data if it is not the address of the 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"
                      }
                    ]
                  }
                  <relationship>
                    <coding>
                      <system value="http://fhir.ch/ig/ch-core/CodeSystem/ech-11"/>
                      <code value="contactData"/>
                    </coding>
                  </relationship>
                  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"
                      }
                    ]
                  }
                  <relationship>
                    <coding>
                      <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
                      <code value="PRN"/>
                    </coding>
                  </relationship>
                  66. Patient.contact:nameOfParent.name
                  Control1..?
                  68. Patient.contact:nameOfParent.gender
                  Definition

                  Sex of the parent as defined by eCH-0021 nameOfParent/sex (eCH-0044:sexType). The parent relationship stays gender-neutral (v3-RoleCode#PRN); the sex is conveyed here, not through the relationship code.

                  ShortSex of the parent (eCH-0021: nameOfParent/sex)
                  70. Patient.communication

                  See the documentation on how to interpret the contents of this table

                  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: If one ore more human names are provided, at least one human name should have a family and a given name. (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|4.0.1)

                  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
                  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                    16. Patient.extension:placeOfBirth
                    Slice NameplaceOfBirth
                    Definition

                    The registered place of birth of the patient.

                    ShortPlace of birth of the patient
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Place of Birth according to eCH-0011) (Extension Type: Address(Address for Place of Birth))
                    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())
                    18. Patient.extension:placeOfOrigin
                    Slice NameplaceOfOrigin
                    Definition

                    The registered place of origin of the patient.

                    ShortPlace of origin(s) of the 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
                    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())
                    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.

                    ShortInformation on nationality data (eCH: Staatsangehörigkeit/Nationalité) of the patient
                    Control0..*
                    This element is affected by the following invariants: ele-1
                    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 the patient
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Patient Religion) (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())
                    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:
                    • value @ $this
                    • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                      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 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 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)
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Patients are almost always assigned specific numerical identifiers.

                      Pattern Value
                      {
                        "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3"
                      }
                      <identifier>
                        <system value="urn:oid:2.16.756.5.30.1.127.3.10.3"/>
                      </identifier>
                      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..*
                      TypeIdentifier(AHVN13 / NAVS13 Identifier)
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Patients are almost always assigned specific numerical identifiers.

                      Pattern Value
                      {
                        "system" : "urn:oid:2.16.756.5.32"
                      }
                      <identifier>
                        <system value="urn:oid:2.16.756.5.32"/>
                      </identifier>
                      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"
                            }
                          ]
                        }
                      }
                      <identifier>
                        <type>
                          <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                            <code value="MR"/>
                          </coding>
                        </type>
                      </identifier>
                      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|4.0.1)

                        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.

                        ExampleGeneral: 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
                        ExampleGeneral: 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..*
                        TypeIdentifier(Insurance Card Number (Identifier))
                        Is Modifierfalse
                        Summarytrue
                        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"
                        }
                        <identifier>
                          <system value="urn:oid:2.16.756.5.30.1.123.100.1.1.1"/>
                        </identifier>
                        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 name associated with the individual.

                        ShortA name associated with the patient
                        Comments

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

                        Control0..*
                        TypeHumanName(Human Name)
                        Is Modifierfalse
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ch-core-hm-1: if officialName 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 originalName 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
                        • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                          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

                            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(CH Core ContactPoint eCH-0046 Email)
                            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()))
                            74. Patient.telecom:phone
                            Slice Namephone
                            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(CH Core ContactPoint eCH-0046 Phone)
                            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()))
                            76. Patient.telecom:internet
                            Slice Nameinternet
                            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(CH Core ContactPoint eCH-0046 Internet)
                            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()))
                            78. Patient.gender
                            Definition

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

                            Shortmale | female | other | unknown* (* see warning 'ch-pat-2')
                            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] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

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

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

                            An address for the individual.

                            ShortAn address for the individual
                            Comments

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

                            Control0..*
                            TypeAddress(CH Core Address)
                            Is Modifierfalse
                            Summarytrue
                            Requirements

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

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            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-codedString' and (value.code = 'CH' or value.code = 'CHE')).empty() or 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] NoteSeeChoice of Data Typesfor 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
                              • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                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|4.0.1)

                                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 the address of 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())
                                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|4.0.1)

                                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"
                                    }
                                  ]
                                }
                                <relationship>
                                  <coding>
                                    <system value="http://fhir.ch/ig/ch-core/CodeSystem/ech-11"/>
                                    <code value="contactData"/>
                                  </coding>
                                </relationship>
                                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

                                Address for the contact person.

                                ShortAddress for the contact person
                                Control1..1
                                TypeAddress(CH Core Postal Address)
                                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()))
                                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-codedString' and (value.code = 'CH' or value.code = 'CHE')).empty() or 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|4.0.1)

                                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"
                                    }
                                  ]
                                }
                                <relationship>
                                  <coding>
                                    <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
                                    <code value="PRN"/>
                                  </coding>
                                </relationship>
                                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

                                Sex of the parent as defined by eCH-0021 nameOfParent/sex (eCH-0044:sexType). The parent relationship stays gender-neutral (v3-RoleCode#PRN); the sex is conveyed here, not through the relationship code.

                                ShortSex of the parent (eCH-0021: nameOfParent/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
                                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()))
                                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|4.0.1)

                                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.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()))
                                182. 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()))
                                184. 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()))
                                186. 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
                                188. 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())
                                190. 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())
                                192. 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()))
                                194. 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()))