Zambia Immunizations FHIR Implementation Guide
1.0.1 - ci-build Zambia flag

Zambia Immunizations FHIR Implementation Guide, published by Jembi Health Systems. This guide is not an authorized publication; it is the continuous build for version 1.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/jembi/Zambia-Immunizations/ and changes regularly. See the Directory of published versions

Resource Profile: SmartcareImmunizationPatient - Detailed Descriptions

Active as of 2024-09-30

Definitions for the smartcare-immunization-patient resource profile.

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

0. Patient
2. Patient.extension
Control2..?
4. Patient.extension:bornInZambia
Slice NamebornInZambia
Control1..1
TypeExtension(Patient born in Zambia?) (Extension Type: boolean)
6. Patient.extension:religion
Slice Namereligion
Definition

reason(s) why this should be supported.

Control0..1
TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
Must Supporttrue
8. Patient.extension:religion.value[x]
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
10. Patient.extension:religion.value[x].text
Control1..?
12. Patient.identifier:NUPIN
Slice NameNUPIN
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
14. Patient.identifier:NUPIN.system
Control1..?
Pattern Valuehttp://moh.gov.zm/fhir/immunizations/identifier/patient-nupin
16. Patient.identifier:NUPIN.value
Control1..?
InvariantsNUPIN-SmartcareID-1: Only letters, special characters (dash) and numbers are allowed. For example: 1001-XXGB0-12345-5, 5010-010-12345-5 ($this.matches('^[0-9A-Za-z]{1,4}-[0-9A-Za-z]{1,5}-[0-9]{1,5}-[0-9]{1}$'))
18. Patient.birthDate
20. Patient.birthDate.extension
SlicingThis element introduces a set of slices on Patient.birthDate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 22. Patient.birthDate.extension:birthTime
    Slice NamebirthTime
    Definition

    reason(s) why this should be supported.

    Control0..1
    TypeExtension(Patient Birth Time) (Extension Type: dateTime)
    Must Supporttrue
    24. Patient.birthDate.extension:IsEstimatedDOB
    Slice NameIsEstimatedDOB
    Definition

    reason(s) why this should be supported.

    Control0..1
    TypeExtension(Patient's Date of Birth Is Estimated?) (Extension Type: boolean)
    Must Supporttrue
    26. Patient.contact
    Definition

    reason(s) why this should be supported.

    Must Supporttrue
    28. Patient.contact.name
    30. Patient.contact.name.family
    Definition

    reason(s) why this should be supported.

    Must Supporttrue
    32. Patient.contact.name.given
    Definition

    reason(s) why this should be supported.

    Control0..1
    Must Supporttrue
    34. Patient.link:RelatedPerson
    Slice NameRelatedPerson
    36. Patient.link:RelatedPerson.other
    TypeReference(Related Person - Spouse Relation to Patient, Related Person - Guardian Relation to Patient Profile (Smartcare), Related Person - Mother Relation to Patient, Related Person - Father Relation to Patient, Related Person - Relative Relation to Patient, Related Person - Chief at Birth)

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

    0. Patient
    Definition

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

    ShortInformation about an individual or animal receiving health care services
    Control0..*
    Is Modifierfalse
    Must Supportfalse
    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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    2. Patient.implicitRules
    Definition

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

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its 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 its meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. Patient.contained
    Definition

    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

    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..*
    This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
    TypeResource
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesinline resources, anonymous resources, contained resources
    6. 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 managable, 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.

    Control20..*
    TypeExtension
    Is Modifierfalse
    Must Supportfalse
    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
    • 8. Patient.extension:sex
      Slice Namesex
      Definition

      This is an extension to capture that patient's administrative sex.

      ShortAdministrative Sex
      Control1..1
      TypeExtension(Administrative Sex) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      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())
      10. Patient.extension:bornInZambia
      Slice NamebornInZambia
      Definition

      This is an extension to capture whether the patient was born in Zambia.

      ShortPatient born in Zambia?
      Control1..1
      TypeExtension(Patient born in Zambia?) (Extension Type: boolean)
      Is Modifierfalse
      Must Supportfalse
      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())
      12. Patient.extension:religion
      Slice Namereligion
      Definition

      reason(s) why this should be supported.

      ShortThe patient's professed religious affiliations
      Control0..1
      TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      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())
      14. Patient.extension:religion.extension
      Definition

      An Extension


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

      ShortExtensionAdditional content defined by implementations
      Comments

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

      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Patient.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Patient.extension:religion.url
        Definition

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

        Shortidentifies the meaning of the extension
        Comments

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

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

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

        ShortValue of extension
        Control10..1
        This element is affected by the following invariants: ext-1
        BindingThe codes SHOULD be taken from For codes, see ReligiousAffiliation
        (preferred to http://terminology.hl7.org/ValueSet/v3-ReligiousAffiliation)
        TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, RatioRange, Coding, SampledData, id, positiveInt, Distance, Availability, integer64, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ExtendedContactDetail, ParameterDefinition, dateTime, code, string, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, CodeableReference, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Patient.extension:religion.value[x].text
        Definition

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

        ShortPlain text representation of the concept
        Comments

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

        Control10..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()))
        22. 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 managable, 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
        Must Supportfalse
        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
        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.identifier
        Definition

        An identifier for this patient.

        ShortAn identifier for this patient
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..*
        TypeIdentifier
        Is Modifierfalse
        Must Supportfalse
        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 @ system
        • 26. Patient.identifier:NRC
          Slice NameNRC
          Definition

          reason(s) why this should be supported.


          An identifier for this patient.

          ShortAn identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..1*
          TypeIdentifier
          Is Modifierfalse
          Must Supporttrue
          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()))
          28. Patient.identifier:NRC.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|5.0.0
          (required to http://hl7.org/fhir/ValueSet/identifier-use|5.0.0)

          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()))
          30. Patient.identifier:NRC.system
          Definition

          Establishes the namespace for the value - that is, an absolute 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.

          Pattern Valuehttp://moh.gov.zm/fhir/immunizations/identifier/patient-nrc
          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          32. Patient.identifier:NRC.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 http://hl7.org/fhir/StructureDefinition/rendered-value). 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
          This element is affected by the following invariants: ident-1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Example<br/><b>General</b>:123456
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          NRC-SmartcareID-1: Only special characters (forward slash) and numbers are allowed. For example: 999999/99/9 ($this.matches('^[0-9]{1,6}/[0-9]{1,2}/[0-9]{1}$'))
          34. Patient.identifier:NUPIN
          Slice NameNUPIN
          Definition

          An identifier for this patient.

          ShortAn identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control10..1*
          TypeIdentifier
          Is Modifierfalse
          Must Supportfalse
          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()))
          36. Patient.identifier:NUPIN.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|5.0.0
          (required to http://hl7.org/fhir/ValueSet/identifier-use|5.0.0)

          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()))
          38. Patient.identifier:NUPIN.system
          Definition

          Establishes the namespace for the value - that is, an absolute 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.

          Pattern Valuehttp://moh.gov.zm/fhir/immunizations/identifier/patient-nupin
          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. Patient.identifier:NUPIN.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 http://hl7.org/fhir/StructureDefinition/rendered-value). 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
          This element is affected by the following invariants: ident-1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Example<br/><b>General</b>:123456
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          NUPIN-SmartcareID-1: Only letters, special characters (dash) and numbers are allowed. For example: 1001-XXGB0-12345-5, 5010-010-12345-5 ($this.matches('^[0-9A-Za-z]{1,4}-[0-9A-Za-z]{1,5}-[0-9]{1,5}-[0-9]{1}$'))
          42. 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
          Must Supportfalse
          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()))
          44. 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. Animal names may be communicated as given names, and optionally may include a family name.

          Control10..*
          TypeHumanName
          Is Modifierfalse
          Must Supportfalse
          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()))
          PatientName-Smartcare-1: If name.use is NOT nickname then name.family SHALL be present. (use.exists() and use != 'nickname' implies family.exists() and given.exists())
          PatientName-Smartcare-2: If name.use is nickname then name.text SHALL be present. (use.exists() and use = 'nickname' implies text.exists())
          46. Patient.name.use
          Definition

          Identifies the purpose for this name.

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

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

          Control10..1
          BindingThe codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|5.0.0
          (required to http://hl7.org/fhir/ValueSet/name-use|5.0.0)

          The use of a human name.

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

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

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

          Used to capture the patient's nickname.


          Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

          ShortText representation of the full name
          Comments

          Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

          A renderable, unencoded form.

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

          reason(s) why this should be supported.


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

          ShortFamily name (often called 'Surname')
          Comments

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

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Alternate Namessurname
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Patient.name.given
          Definition

          reason(s) why this should be supported.


          Given name.

          ShortGiven names (not always 'first'). Includes middle names
          Comments

          If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

          Control0..*
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Alternate Namesfirst name, middle name
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. Patient.telecom
          Definition

          reason(s) why this should be supported.


          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
          Must Supportfalse
          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
          • 56. Patient.telecom:email
            Slice Nameemail
            Definition

            reason(s) why this should be supported.


            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
            Must Supporttrue
            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()))
            58. Patient.telecom:email.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|5.0.0
            (required to http://hl7.org/fhir/ValueSet/contact-point-system|5.0.0)

            Telecommunications form for contact point.

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Pattern Valueemail
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. Patient.telecom:email.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
            This element is affected by the following invariants: cpt-2
            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()))
            62. Patient.telecom:email.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|5.0.0
            (required to http://hl7.org/fhir/ValueSet/contact-point-use|5.0.0)

            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()))
            64. Patient.telecom:phone
            Slice Namephone
            Definition

            reason(s) why this should be supported.


            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
            Must Supporttrue
            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()))
            66. Patient.telecom:phone.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|5.0.0
            (required to http://hl7.org/fhir/ValueSet/contact-point-system|5.0.0)

            Telecommunications form for contact point.

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Pattern Valuephone
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. Patient.telecom:phone.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
            This element is affected by the following invariants: cpt-2
            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()))
            70. Patient.telecom:phone.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|5.0.0
            (required to http://hl7.org/fhir/ValueSet/contact-point-use|5.0.0)

            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()))
            72. Patient.birthDate
            Definition

            The date of birth for the individual.

            ShortThe date of birth for the individual
            Comments

            Partial dates are allowed if the specific date of birth 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).

            Control10..1
            Typedate
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            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
            74. Patient.birthDate.extension
            Definition

            An Extension


            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, 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.birthDate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 76. Patient.birthDate.extension:birthTime
              Slice NamebirthTime
              Definition

              reason(s) why this should be supported.

              ShortTime of day of birth
              Control0..1
              TypeExtension(Patient Birth Time) (Extension Type: dateTime)
              Is Modifierfalse
              Must Supporttrue
              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())
              78. Patient.birthDate.extension:IsEstimatedDOB
              Slice NameIsEstimatedDOB
              Definition

              reason(s) why this should be supported.

              ShortPatient's Date of Birth Is Estimated?
              Control0..1
              TypeExtension(Patient's Date of Birth Is Estimated?) (Extension Type: boolean)
              Is Modifierfalse
              Must Supporttrue
              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.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
              Must Supportfalse
              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()))
              82. Patient.address
              Definition

              reason(s) why this should be supported.


              An address for the individual.

              ShortAn address for the individual
              Comments

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

              Control0..*
              TypeAddress
              Is Modifierfalse
              Must Supporttrue
              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()))
              84. Patient.address.use
              Definition

              The purpose of this address.

              Shorthome | work | temp | old | billing - purpose of this address
              Comments

              Applications can assume that an address is current unless it explicitly says that it is temporary or old.

              Control0..1
              BindingThe codes SHALL be taken from AddressUsehttp://hl7.org/fhir/ValueSet/address-use|5.0.0
              (required to http://hl7.org/fhir/ValueSet/address-use|5.0.0)

              The use of an address (home / work / etc.).

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

              Allows an appropriate address to be chosen from a list of many.

              Example<br/><b>General</b>:home
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              86. Patient.address.line
              Definition

              reason(s) why this should be supported.


              This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

              ShortStreet name, number, direction & P.O. Box etc.
              Control0..*
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Example<br/><b>General</b>:137 Nowhere Street
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              88. Patient.address.city
              Definition

              reason(s) why this should be supported.


              The name of the city, town, suburb, village or other community or delivery center.

              ShortName of city, town etc.
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Alternate NamesMunicpality
              Example<br/><b>General</b>:Erewhon
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              90. Patient.address.district
              Definition

              reason(s) why this should be supported.


              The name of the administrative area (county).

              ShortDistrict name (aka county)
              Comments

              District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Alternate NamesCounty
              Example<br/><b>General</b>:Madison
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              92. Patient.address.state
              Definition

              reason(s) why this should be supported.


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

              ShortSub-unit of country (abbreviations ok)
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Alternate NamesProvince, Territory
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              94. Patient.address.country
              Definition

              reason(s) why this should be supported.


              Country - a nation as commonly understood or generally accepted.

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

              ISO 3166 2- or 3- letter codes MAY be used in place of a human readable country name.

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

              reason(s) why this should be supported.


              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 MaritalStatusCodeshttp://hl7.org/fhir/ValueSet/marital-status
              (extensible to http://hl7.org/fhir/ValueSet/marital-status)

              The domestic partnership status of a person.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              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()))
              98. Patient.contact
              Definition

              reason(s) why this should be supported.


              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
              Must Supporttrue
              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())
              100. 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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A name associated with the contact person.

              ShortA name associated with the contact person
              Control0..1
              This element is affected by the following invariants: pat-1
              TypeHumanName
              Is Modifierfalse
              Must Supportfalse
              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()))
              104. Patient.contact.name.use
              Definition

              Identifies the purpose for this name.

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

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

              Control0..1
              BindingThe codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|5.0.0
              (required to http://hl7.org/fhir/ValueSet/name-use|5.0.0)

              The use of a human name.

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

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

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

              reason(s) why this should be supported.


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

              ShortFamily name (often called 'Surname')
              Comments

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

              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Alternate Namessurname
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              108. Patient.contact.name.given
              Definition

              reason(s) why this should be supported.


              Given name.

              ShortGiven names (not always 'first'). Includes middle names
              Comments

              If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

              Control0..1*
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Alternate Namesfirst name, middle name
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              110. Patient.managingOrganization
              Definition

              reason(s) why this should be supported.


              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 - Healthcare Service Provider Profile, Organization)
              Is Modifierfalse
              Must Supporttrue
              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()))
              112. Patient.link
              Definition

              reason(s) why this should be supported.


              Link to a Patient or RelatedPerson resource that concerns the same actual individual.

              ShortLink to a Patient or RelatedPerson resource that concerns the same actual individual
              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'
              Must Supporttrue
              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()))
              SlicingThis element introduces a set of slices on Patient.link. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • profile @ other.resolve()
              • type @ other.type
              • 114. 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 managable, 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())
                116. Patient.link.other
                Definition

                Link to a Patient or RelatedPerson resource that concerns the same actual individual.

                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
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                118. 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|5.0.0
                (required to http://hl7.org/fhir/ValueSet/link-type|5.0.0)

                The type of link between this patient resource and another Patient resource, or Patient/RelatedPerson when using the seealso code

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

                Link to a Patient or RelatedPerson resource that concerns the same actual individual.

                ShortLink to a Patient or RelatedPerson resource that concerns the same actual individual
                Comments

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

                Control0..1*
                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'
                Must Supporttrue
                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()))
                122. Patient.link:RelatedPerson.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 managable, 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())
                124. Patient.link:RelatedPerson.other
                Definition

                Link to a Patient or RelatedPerson resource that concerns the same actual individual.

                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(Related Person - Spouse Relation to Patient, Related Person - Guardian Relation to Patient Profile (Smartcare), Related Person - Mother Relation to Patient, Related Person - Father Relation to Patient, Related Person - Relative Relation to Patient, Related Person - Chief at Birth, Patient, RelatedPerson)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                126. Patient.link:RelatedPerson.other.reference
                Definition

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

                ShortLiteral reference, Relative, internal or absolute URL
                Comments

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

                Control0..1
                This element is affected by the following invariants: ref-2, ref-1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                128. Patient.link:RelatedPerson.other.type
                Definition

                The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                ShortType the reference refers to (e.g. "Patient") - must be a resource in resources
                Comments

                This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

                Control10..1
                BindingUnless not suitable, these codes SHALL be taken from ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types
                (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                Aa resource (or, for logical models, the URI of the logical model).

                Typeuri
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Pattern ValueRelatedPerson
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                130. Patient.link:RelatedPerson.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|5.0.0
                (required to http://hl7.org/fhir/ValueSet/link-type|5.0.0)

                The type of link between this patient resource and another Patient resource, or Patient/RelatedPerson when using the seealso code

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

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

                0. Patient
                Definition

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

                ShortInformation about an individual or animal receiving health care services
                Control0..*
                Is Modifierfalse
                Must Supportfalse
                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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                dom-6: A resource should have narrative for robust management (text.`div`.exists())
                2. Patient.id
                Definition

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

                ShortLogical id of this artifact
                Comments

                Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

                Control0..1
                Typeid
                Is Modifierfalse
                Must Supportfalse
                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
                Must Supportfalse
                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 its 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 its meaning or interpretation
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                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 SHALL be taken from AllLanguages
                (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

                IETF language tag for a human language

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                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 a 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
                This element is affected by the following invariants: dom-6
                TypeNarrative
                Is Modifierfalse
                Must Supportfalse
                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, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

                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..*
                This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
                TypeResource
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Alternate Namesinline resources, anonymous resources, contained resources
                14. Patient.extension
                Definition

                An Extension

                ShortExtension
                Control2..*
                TypeExtension
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 16. Patient.extension:sex
                  Slice Namesex
                  Definition

                  This is an extension to capture that patient's administrative sex.

                  ShortAdministrative Sex
                  Control1..1
                  TypeExtension(Administrative Sex) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Must Supportfalse
                  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:bornInZambia
                  Slice NamebornInZambia
                  Definition

                  This is an extension to capture whether the patient was born in Zambia.

                  ShortPatient born in Zambia?
                  Control1..1
                  TypeExtension(Patient born in Zambia?) (Extension Type: boolean)
                  Is Modifierfalse
                  Must Supportfalse
                  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:religion
                  Slice Namereligion
                  Definition

                  reason(s) why this should be supported.

                  ShortThe patient's professed religious affiliations
                  Control0..1
                  TypeExtension(Patient Religion) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Must Supporttrue
                  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())
                  22. Patient.extension:religion.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
                  This element is affected by the following invariants: ele-1
                  Typeid
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  24. Patient.extension:religion.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..0
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Patient.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 26. Patient.extension:religion.url
                    Definition

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

                    Shortidentifies the meaning of the extension
                    Comments

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

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

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

                    ShortValue of extension
                    Control1..1
                    This element is affected by the following invariants: ext-1
                    BindingThe codes SHOULD be taken from ReligiousAffiliation
                    (preferred to http://terminology.hl7.org/ValueSet/v3-ReligiousAffiliation)
                    TypeCodeableConcept
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    30. Patient.extension:religion.value[x].id
                    Definition

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

                    ShortUnique id for inter-element referencing
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    Typeid
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    32. Patient.extension:religion.value[x].extension
                    Definition

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

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

                      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()))
                      36. Patient.extension:religion.value[x].text
                      Definition

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

                      ShortPlain text representation of the concept
                      Comments

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

                      Control1..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()))
                      38. 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 managable, 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
                      Must Supportfalse
                      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
                      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())
                      40. Patient.identifier
                      Definition

                      An identifier for this patient.

                      ShortAn identifier for this patient
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control1..*
                      TypeIdentifier
                      Is Modifierfalse
                      Must Supportfalse
                      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 @ system
                      • 42. Patient.identifier:NRC
                        Slice NameNRC
                        Definition

                        reason(s) why this should be supported.

                        ShortAn identifier for this patient
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control0..1
                        TypeIdentifier
                        Is Modifierfalse
                        Must Supporttrue
                        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()))
                        44. Patient.identifier:NRC.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
                        This element is affected by the following invariants: ele-1
                        Typeid
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        46. Patient.identifier:NRC.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 managable, 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
                        • 48. Patient.identifier:NRC.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|5.0.0)

                          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()))
                          50. Patient.identifier:NRC.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 IdentifierTypeCodes
                          (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summarytrue
                          Requirements

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

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

                          Establishes the namespace for the value - that is, an absolute 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.

                          Pattern Valuehttp://moh.gov.zm/fhir/immunizations/identifier/patient-nrc
                          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          54. Patient.identifier:NRC.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 http://hl7.org/fhir/StructureDefinition/rendered-value). 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
                          This element is affected by the following invariants: ident-1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Example<br/><b>General</b>:123456
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          NRC-SmartcareID-1: Only special characters (forward slash) and numbers are allowed. For example: 999999/99/9 ($this.matches('^[0-9]{1,6}/[0-9]{1,2}/[0-9]{1}$'))
                          56. Patient.identifier:NRC.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()))
                          58. Patient.identifier:NRC.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()))
                          60. Patient.identifier:NUPIN
                          Slice NameNUPIN
                          Definition

                          An identifier for this patient.

                          ShortAn identifier for this patient
                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control1..1
                          TypeIdentifier
                          Is Modifierfalse
                          Must Supportfalse
                          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()))
                          62. Patient.identifier:NUPIN.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
                          This element is affected by the following invariants: ele-1
                          Typeid
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          64. Patient.identifier:NUPIN.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 managable, 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
                          • 66. Patient.identifier:NUPIN.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|5.0.0)

                            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()))
                            68. Patient.identifier:NUPIN.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 IdentifierTypeCodes
                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

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

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

                            Establishes the namespace for the value - that is, an absolute 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.

                            Pattern Valuehttp://moh.gov.zm/fhir/immunizations/identifier/patient-nupin
                            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            72. Patient.identifier:NUPIN.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 http://hl7.org/fhir/StructureDefinition/rendered-value). 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
                            This element is affected by the following invariants: ident-1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Example<br/><b>General</b>:123456
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            NUPIN-SmartcareID-1: Only letters, special characters (dash) and numbers are allowed. For example: 1001-XXGB0-12345-5, 5010-010-12345-5 ($this.matches('^[0-9A-Za-z]{1,4}-[0-9A-Za-z]{1,5}-[0-9]{1,5}-[0-9]{1}$'))
                            74. Patient.identifier:NUPIN.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()))
                            76. Patient.identifier:NUPIN.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()))
                            78. 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
                            Must Supportfalse
                            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()))
                            80. 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. Animal names may be communicated as given names, and optionally may include a family name.

                            Control1..*
                            TypeHumanName
                            Is Modifierfalse
                            Must Supportfalse
                            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()))
                            PatientName-Smartcare-1: If name.use is NOT nickname then name.family SHALL be present. (use.exists() and use != 'nickname' implies family.exists() and given.exists())
                            PatientName-Smartcare-2: If name.use is nickname then name.text SHALL be present. (use.exists() and use = 'nickname' implies text.exists())
                            82. Patient.name.id
                            Definition

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

                            ShortUnique id for inter-element referencing
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            Typeid
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            84. Patient.name.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 managable, 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.name.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 86. Patient.name.use
                              Definition

                              Identifies the purpose for this name.

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

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

                              Control1..1
                              BindingThe codes SHALL be taken from NameUse
                              (required to http://hl7.org/fhir/ValueSet/name-use|5.0.0)

                              The use of a human name.

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

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

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

                              Used to capture the patient's nickname.

                              ShortText representation of the full name
                              Comments

                              Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

                              A renderable, unencoded form.

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

                              reason(s) why this should be supported.

                              ShortFamily name (often called 'Surname')
                              Comments

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

                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Alternate Namessurname
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              92. Patient.name.given
                              Definition

                              reason(s) why this should be supported.

                              ShortGiven names (not always 'first'). Includes middle names
                              Comments

                              If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

                              Control0..*
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Alternate Namesfirst name, middle name
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              94. Patient.name.prefix
                              Definition

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

                              ShortParts that come before the name
                              Control0..*
                              Typestring
                              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()))
                              96. Patient.name.suffix
                              Definition

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

                              ShortParts that come after the name
                              Control0..*
                              Typestring
                              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()))
                              98. Patient.name.period
                              Definition

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

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

                              Allows names to be placed in historical context.

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

                              reason(s) why this should be supported.

                              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
                              Must Supportfalse
                              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
                              • 102. Patient.telecom:email
                                Slice Nameemail
                                Definition

                                reason(s) why this should be supported.

                                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
                                Must Supporttrue
                                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()))
                                104. Patient.telecom:email.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
                                This element is affected by the following invariants: ele-1
                                Typeid
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                106. Patient.telecom:email.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 managable, 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
                                • 108. Patient.telecom:email.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|5.0.0)

                                  Telecommunications form for contact point.

                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Pattern Valueemail
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  110. Patient.telecom:email.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
                                  This element is affected by the following invariants: cpt-2
                                  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()))
                                  112. Patient.telecom:email.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|5.0.0)

                                  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()))
                                  114. Patient.telecom:email.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.

                                  Ranks need not be unique. E.g. it's possible to have multiple contacts with rank=1. If the ranks have different systems or uses, this would be interpreted to mean "X is my most preferred phone number, Y is my most preferred email address" or "X is my preferred home email and Y is my preferred work email". If the system and use for equally-ranked contacts are the same, then the level of preference is equivalent for both repetitions.

                                  Ranks need not be sequential and not all repetitions must have a rank. For example, it's possible to have 4 contacts with ranks of 2, 5 and two with no rank specified. That would be interpreted to mean the first is preferred over the second and no preference stated for the remaining contacts.

                                  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()))
                                  116. Patient.telecom:email.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()))
                                  118. Patient.telecom:phone
                                  Slice Namephone
                                  Definition

                                  reason(s) why this should be supported.

                                  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
                                  Must Supporttrue
                                  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()))
                                  120. Patient.telecom:phone.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
                                  This element is affected by the following invariants: ele-1
                                  Typeid
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  122. Patient.telecom:phone.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 managable, 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
                                  • 124. Patient.telecom:phone.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|5.0.0)

                                    Telecommunications form for contact point.

                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Pattern Valuephone
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    126. Patient.telecom:phone.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
                                    This element is affected by the following invariants: cpt-2
                                    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()))
                                    128. Patient.telecom:phone.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|5.0.0)

                                    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()))
                                    130. Patient.telecom:phone.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.

                                    Ranks need not be unique. E.g. it's possible to have multiple contacts with rank=1. If the ranks have different systems or uses, this would be interpreted to mean "X is my most preferred phone number, Y is my most preferred email address" or "X is my preferred home email and Y is my preferred work email". If the system and use for equally-ranked contacts are the same, then the level of preference is equivalent for both repetitions.

                                    Ranks need not be sequential and not all repetitions must have a rank. For example, it's possible to have 4 contacts with ranks of 2, 5 and two with no rank specified. That would be interpreted to mean the first is preferred over the second and no preference stated for the remaining contacts.

                                    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()))
                                    132. Patient.telecom:phone.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()))
                                    134. Patient.gender
                                    Definition

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

                                    Shortmale | female | other | unknown
                                    Comments

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

                                    Control0..1
                                    BindingThe codes SHALL be taken from AdministrativeGender
                                    (required to http://hl7.org/fhir/ValueSet/administrative-gender|5.0.0)

                                    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
                                    Must Supportfalse
                                    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()))
                                    136. Patient.birthDate
                                    Definition

                                    The date of birth for the individual.

                                    ShortThe date of birth for the individual
                                    Comments

                                    Partial dates are allowed if the specific date of birth 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).

                                    Control1..1
                                    Typedate
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supportfalse
                                    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
                                    138. Patient.birthDate.id
                                    Definition

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

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

                                    An Extension

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

                                      reason(s) why this should be supported.

                                      ShortTime of day of birth
                                      Control0..1
                                      TypeExtension(Patient Birth Time) (Extension Type: dateTime)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      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())
                                      144. Patient.birthDate.extension:IsEstimatedDOB
                                      Slice NameIsEstimatedDOB
                                      Definition

                                      reason(s) why this should be supported.

                                      ShortPatient's Date of Birth Is Estimated?
                                      Control0..1
                                      TypeExtension(Patient's Date of Birth Is Estimated?) (Extension Type: boolean)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      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())
                                      146. Patient.birthDate.value
                                      Definition

                                      The actual value

                                      ShortPrimitive value for date
                                      Control0..1
                                      Typedate
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      148. 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
                                      Must Supportfalse
                                      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()))
                                      150. Patient.address
                                      Definition

                                      reason(s) why this should be supported.

                                      ShortAn address for the individual
                                      Comments

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

                                      Control0..*
                                      TypeAddress
                                      Is Modifierfalse
                                      Must Supporttrue
                                      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()))
                                      152. Patient.address.id
                                      Definition

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      Typeid
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      154. Patient.address.extension
                                      Definition

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

                                      ShortAdditional content defined by implementations
                                      Comments

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

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

                                        The purpose of this address.

                                        Shorthome | work | temp | old | billing - purpose of this address
                                        Comments

                                        Applications can assume that an address is current unless it explicitly says that it is temporary or old.

                                        Control0..1
                                        BindingThe codes SHALL be taken from AddressUse
                                        (required to http://hl7.org/fhir/ValueSet/address-use|5.0.0)

                                        The use of an address (home / work / etc.).

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

                                        Allows an appropriate address to be chosen from a list of many.

                                        Example<br/><b>General</b>:home
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        158. Patient.address.type
                                        Definition

                                        Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

                                        Shortpostal | physical | both
                                        Comments

                                        The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

                                        Control0..1
                                        BindingThe codes SHALL be taken from AddressType
                                        (required to http://hl7.org/fhir/ValueSet/address-type|5.0.0)

                                        The type of an address (physical / postal).

                                        Typecode
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Example<br/><b>General</b>:both
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        160. Patient.address.text
                                        Definition

                                        Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

                                        ShortText representation of the address
                                        Comments

                                        Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

                                        A renderable, unencoded form.

                                        Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        162. Patient.address.line
                                        Definition

                                        reason(s) why this should be supported.

                                        ShortStreet name, number, direction & P.O. Box etc.
                                        Control0..*
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Example<br/><b>General</b>:137 Nowhere Street
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        164. Patient.address.city
                                        Definition

                                        reason(s) why this should be supported.

                                        ShortName of city, town etc.
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Alternate NamesMunicpality
                                        Example<br/><b>General</b>:Erewhon
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        166. Patient.address.district
                                        Definition

                                        reason(s) why this should be supported.

                                        ShortDistrict name (aka county)
                                        Comments

                                        District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Alternate NamesCounty
                                        Example<br/><b>General</b>:Madison
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        168. Patient.address.state
                                        Definition

                                        reason(s) why this should be supported.

                                        ShortSub-unit of country (abbreviations ok)
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Alternate NamesProvince, Territory
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        170. Patient.address.postalCode
                                        Definition

                                        A postal code designating a region defined by the postal service.

                                        ShortPostal code for area
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Alternate NamesZip
                                        Example<br/><b>General</b>:9132
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        172. Patient.address.country
                                        Definition

                                        reason(s) why this should be supported.

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

                                        ISO 3166 2- or 3- letter codes MAY be used in place of a human readable country name.

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

                                        Time period when address was/is in use.

                                        ShortTime period when address was/is in use
                                        Control0..1
                                        TypePeriod
                                        Is Modifierfalse
                                        Summarytrue
                                        Requirements

                                        Allows addresses to be placed in historical context.

                                        Example<br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        176. Patient.maritalStatus
                                        Definition

                                        reason(s) why this should be supported.

                                        ShortMarital (civil) status of a patient
                                        Control0..1
                                        BindingUnless not suitable, these codes SHALL be taken from MaritalStatusCodes
                                        (extensible to http://hl7.org/fhir/ValueSet/marital-status)

                                        The domestic partnership status of a person.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        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()))
                                        178. 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
                                        Must Supportfalse
                                        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()))
                                        180. 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
                                        Must Supportfalse
                                        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()))
                                        182. Patient.contact
                                        Definition

                                        reason(s) why this should be supported.

                                        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
                                        Must Supporttrue
                                        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())
                                        184. 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
                                        This element is affected by the following invariants: ele-1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        186. 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 managable, 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())
                                        188. 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 managable, 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())
                                        190. Patient.contact.relationship
                                        Definition

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

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

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

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supportfalse
                                        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()))
                                        192. Patient.contact.name
                                        Definition

                                        A name associated with the contact person.

                                        ShortA name associated with the contact person
                                        Control0..1
                                        This element is affected by the following invariants: pat-1
                                        TypeHumanName
                                        Is Modifierfalse
                                        Must Supportfalse
                                        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()))
                                        194. Patient.contact.name.id
                                        Definition

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

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        This element is affected by the following invariants: ele-1
                                        Typeid
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        196. Patient.contact.name.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

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

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

                                          Identifies the purpose for this name.

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

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

                                          Control0..1
                                          BindingThe codes SHALL be taken from NameUse
                                          (required to http://hl7.org/fhir/ValueSet/name-use|5.0.0)

                                          The use of a human name.

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

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

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

                                          Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

                                          ShortText representation of the full name
                                          Comments

                                          Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

                                          A renderable, unencoded form.

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

                                          reason(s) why this should be supported.

                                          ShortFamily name (often called 'Surname')
                                          Comments

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

                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Alternate Namessurname
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          204. Patient.contact.name.given
                                          Definition

                                          reason(s) why this should be supported.

                                          ShortGiven names (not always 'first'). Includes middle names
                                          Comments

                                          If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.

                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Alternate Namesfirst name, middle name
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          206. Patient.contact.name.prefix
                                          Definition

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

                                          ShortParts that come before the name
                                          Control0..*
                                          Typestring
                                          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()))
                                          208. Patient.contact.name.suffix
                                          Definition

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

                                          ShortParts that come after the name
                                          Control0..*
                                          Typestring
                                          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()))
                                          210. Patient.contact.name.period
                                          Definition

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

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

                                          Allows names to be placed in historical context.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          212. 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..*
                                          This element is affected by the following invariants: pat-1
                                          TypeContactPoint
                                          Is Modifierfalse
                                          Must Supportfalse
                                          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()))
                                          214. Patient.contact.address
                                          Definition

                                          Address for the contact person.

                                          ShortAddress for the contact person
                                          Control0..1
                                          This element is affected by the following invariants: pat-1
                                          TypeAddress
                                          Is Modifierfalse
                                          Must Supportfalse
                                          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()))
                                          216. 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|5.0.0)

                                          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
                                          Must Supportfalse
                                          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()))
                                          218. 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
                                          Must Supportfalse
                                          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()))
                                          220. 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
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          222. 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
                                          Must Supportfalse
                                          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()))
                                          224. 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
                                          This element is affected by the following invariants: ele-1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          226. 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 managable, 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())
                                          228. 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 managable, 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())
                                          230. 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-AU" for Australian 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 SHALL be taken from AllLanguages
                                          (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

                                          IETF language tag for a human language

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supportfalse
                                          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()))
                                          232. 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
                                          Must Supportfalse
                                          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()))
                                          234. 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
                                          Must Supportfalse
                                          Summaryfalse
                                          Alternate NamescareProvider
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          236. Patient.managingOrganization
                                          Definition

                                          reason(s) why this should be supported.

                                          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 - Healthcare Service Provider Profile)
                                          Is Modifierfalse
                                          Must Supporttrue
                                          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()))
                                          238. Patient.link
                                          Definition

                                          reason(s) why this should be supported.

                                          ShortLink to a Patient or RelatedPerson resource that concerns the same actual individual
                                          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'
                                          Must Supporttrue
                                          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()))
                                          SlicingThis element introduces a set of slices on Patient.link. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • profile @ other.resolve()
                                          • type @ other.type
                                          • 240. 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
                                            This element is affected by the following invariants: ele-1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            242. 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 managable, 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())
                                            244. 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 managable, 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())
                                            246. Patient.link.other
                                            Definition

                                            Link to a Patient or RelatedPerson resource that concerns the same actual individual.

                                            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
                                            Must Supportfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            248. 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|5.0.0)

                                            The type of link between this patient resource and another Patient resource, or Patient/RelatedPerson when using the seealso code

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

                                            Link to a Patient or RelatedPerson resource that concerns the same actual individual.

                                            ShortLink to a Patient or RelatedPerson resource that concerns the same actual individual
                                            Comments

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

                                            Control0..1
                                            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'
                                            Must Supporttrue
                                            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()))
                                            252. Patient.link:RelatedPerson.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
                                            This element is affected by the following invariants: ele-1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            254. Patient.link:RelatedPerson.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 managable, 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())
                                            256. Patient.link:RelatedPerson.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 managable, 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())
                                            258. Patient.link:RelatedPerson.other
                                            Definition

                                            Link to a Patient or RelatedPerson resource that concerns the same actual individual.

                                            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(Related Person - Spouse Relation to Patient, Related Person - Guardian Relation to Patient Profile (Smartcare), Related Person - Mother Relation to Patient, Related Person - Father Relation to Patient, Related Person - Relative Relation to Patient, Related Person - Chief at Birth)
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            260. Patient.link:RelatedPerson.other.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
                                            This element is affected by the following invariants: ele-1
                                            Typeid
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            262. Patient.link:RelatedPerson.other.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 managable, 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.link.other.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 264. Patient.link:RelatedPerson.other.reference
                                              Definition

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

                                              ShortLiteral reference, Relative, internal or absolute URL
                                              Comments

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

                                              Control0..1
                                              This element is affected by the following invariants: ref-2, ref-1
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              266. Patient.link:RelatedPerson.other.type
                                              Definition

                                              The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                              The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                              ShortType the reference refers to (e.g. "Patient") - must be a resource in resources
                                              Comments

                                              This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

                                              Control1..1
                                              BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                              (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                              Aa resource (or, for logical models, the URI of the logical model).

                                              Typeuri
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Pattern ValueRelatedPerson
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              268. Patient.link:RelatedPerson.other.identifier
                                              Definition

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

                                              ShortLogical reference, when literal reference is not known
                                              Comments

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

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

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

                                              Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                              This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                              Control0..1
                                              This element is affected by the following invariants: ref-2
                                              TypeIdentifier
                                              Is Modifierfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              270. Patient.link:RelatedPerson.other.display
                                              Definition

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

                                              ShortText alternative for the resource
                                              Comments

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

                                              Control0..1
                                              This element is affected by the following invariants: ref-2
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              272. Patient.link:RelatedPerson.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|5.0.0)

                                              The type of link between this patient resource and another Patient resource, or Patient/RelatedPerson when using the seealso code

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