CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
3.0.0 - Release 3 - draft United States of America flag

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v3.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: CrossMeasurePatient - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 2

Definitions for the cross-measure-patient resource profile.

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

0. Patient
Definition

-


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

Short icon Changed:(NHSN-MS) A patient who is the subject of the measure report. This resource is required for all NHSN dQMs and must be referenced in all Individual MeasureReport resources for these measures.Information about an individual or animal receiving health care services
Comments

-

Control icon Changed:10..*
Is Modifier false
Must Support icon Changed:true
Complies with Profile This profile complies with the profile
Summary false
Alternate Names SubjectOfCare Client Resident
Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
patient-full-name: name.given and name.family are present in at least one name. (name.where(family.exists() and given.exists()).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.

Short icon Changed:(NHSN-MS) The logical id of the Patient resourceLogical id of this artifact
Comments

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

Control 10..1
Type idstring
Is Modifier false
Must Support icon Added:true
Summary true
4. 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.

Short A set of rules under which this content was created
Comments

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

Control 0..1
Type uri
Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value This primitive element may be present, or absent, or replaced by an extension
Summary true
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Patient.extension:race
Slice Name race
Definition

Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the CDC Race and Ethnicity Code Set Version 1.0 which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Native Hawaiian or Other Pacific Islander
  • White.
Short (QI-Core)(USCDI) US Core Race Extension
Control 0..1
This element is affected by the following invariants: ele-1
Type Extension(US Core Race Extension) (Complex Extension)
Is Modifier false
Must Support false
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Patient.extension:ethnicity
Slice Name ethnicity
Definition

Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The ethnicity codes used to represent these concepts are based upon the CDC ethnicity and Ethnicity Code Set Version 1.0 which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity. The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.

Short (QI-Core)(USCDI) US Core ethnicity Extension
Control 0..1
This element is affected by the following invariants: ele-1
Type Extension(US Core Ethnicity Extension) (Complex Extension)
Is Modifier false
Must Support false
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. Patient.extension:tribalAffiliation
Slice Name tribalAffiliation
Definition

A tribe or band with which a person associates whether or not they are an enrolled member.

Short (QI-Core)(USCDI) Tribal Affiliation Extension
Control 0..*
This element is affected by the following invariants: ele-1
Type Extension(US Core Tribal Affiliation Extension) (Complex Extension)
Is Modifier false
Must Support false
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
12. Patient.extension:birthsex
Slice Name birthsex
Definition

A code classifying the person's sex assigned at birth as specified by the Office of the National Coordinator for Health IT (ONC).

Short (NHSN-MS) US Core Birth Sex Extension
Comments

The codes required are intended to present birth sex (i.e., the sex recorded on the patient's birth certificate) and not gender identity or reassigned sex.

Control 0..1
This element is affected by the following invariants: ele-1
Type Extension(US Core Birth Sex Extension) (Extension Type: code)
Is Modifier false
Must Support true
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
14. Patient.extension:sex
Slice Name sex
Definition

The US Core Sex Extension is used to reflect the documentation of a person's sex. It aligns with the C-CDA Sex Observation (LOINC 46098-0).

Short (NHSN-MS) US Core Sex Extension
Control 0..1
This element is affected by the following invariants: ele-1
Type Extension(US Core Sex Extension) (Extension Type: code)
Is Modifier false
Must Support true
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
16. Patient.extension:genderIdentity
Slice Name genderIdentity
Definition

An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else.

Short (QI-Core)(USCDI) The individual's gender identity
Comments

This represents an individual's identity, ascertained by asking them what that identity is.

Control 0..*
This element is affected by the following invariants: ele-1
Type Extension(US Core Gender Identity Extension) (Extension Type: CodeableConcept)
Is Modifier false
Must Support false
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
18. Patient.modifierExtension
Definition

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

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

Short Extensions 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.

Control 0..*
Type Extension
Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary false
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 Names extensions, user content
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
20. Patient.identifier
Definition

An identifier for this patient.

Short icon Changed:(NHSN-MS)(USCDI) An identifier for this patientAn identifier for this patient
Note This is a business identifier, not a resource identifier (see discussion)
Control 10..*
Type Identifier
Is Modifier false
Must Support true
Summary true
Requirements

Patients are almost always assigned specific numerical identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing This element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
  • 22. Patient.identifier.use
    Definition

    The purpose of this identifier.

    Short icon Changed:(NHSN-MS) The purpose of this identifier usual | official | temp | secondary | old (If known)usual | official | temp | secondary | old (If known)
    Comments

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

    Control 0..1
    Binding The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

    Identifies the purpose for this identifier, if known .

    Type code
    Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

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

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

    Short icon Changed:(NHSN-MS) Description of identifierDescription 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.

    Control 0..1
    Binding Unless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1
    (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.

    Type CodeableConcept
    Is Modifier false
    Must Support true
    Summary true
    Requirements

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

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

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

    Short icon Changed:(NHSN-MS)(USCDI) The namespace for the identifier valueThe namespace for the identifier value
    Comments

    Identifier.system is always case sensitive.

    Control 10..1
    Type uri
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

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

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

    Short icon Changed:(NHSN-MS)(USCDI) The value that is unique within the system.The value that is unique
    Comments

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

    Control 10..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Example General: 123456
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. Patient.identifier.period
    Definition

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

    Short icon Changed:(NHSN-MS) Time period when id is/was valid for useTime period when id is/was valid for use
    Control 0..1
    Type Period
    Is Modifier false
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. Patient.identifier:medicalRecordNumber
    Slice Name medicalRecordNumber
    Definition

    An identifier for this patient.

    Short (NHSN-MS) Medical Record Number (MRN) identifier for the patientAn identifier for this patient
    Note This is a business identifier, not a resource identifier (see discussion)
    Control 10..*
    Type Identifier
    Is Modifier false
    Must Support true
    Summary true
    Requirements

    Patients are almost always assigned specific numerical identifiers.

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. Patient.identifier:medicalRecordNumber.use
    Definition

    The purpose of this identifier.

    Short (NHSN-MS) The purpose of this identifier usual | official | temp | secondary | old (If known)usual | official | temp | secondary | old (If known)
    Comments

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

    Control 0..1
    Binding The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

    Identifies the purpose for this identifier, if known .

    Type code
    Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    36. Patient.identifier:medicalRecordNumber.type
    Definition

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

    Short (NHSN-MS) Medical Record Number (MRN) identifier for the patientDescription 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.

    Control 10..1
    Binding Unless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1
    (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.

    Type CodeableConcept
    Is Modifier false
    Must Support true
    Summary true
    Requirements

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

    Pattern Value {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code" : "MR"
      }]
    }
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    nhsn-single-mrn-warning: Patient SHOULD NOT include more than one identifier with type MR from http://terminology.hl7.org/CodeSystem/v2-0203. (identifier.where(type.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v2-0203' and code = 'MR').exists()).count() <= 1)
    38. Patient.identifier:medicalRecordNumber.system
    Definition

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

    Short (NHSN-MS)(USCDI) The namespace for the identifier valueThe namespace for the identifier value
    Comments

    Identifier.system is always case sensitive.

    Control 10..1
    Type uri
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

    Example General: http://www.acme.com/identifiers/patient
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    40. Patient.identifier:medicalRecordNumber.value
    Definition

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

    Short (NHSN-MS)(USCDI) The value that is unique within the system.The value that is unique
    Comments

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

    Control 10..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Example General: 123456
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    42. Patient.identifier:medicalRecordNumber.period
    Definition

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

    Short (NHSN-MS) Time period when id is/was valid for useTime period when id is/was valid for use
    Control 0..1
    Type Period
    Is Modifier false
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. 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.

    Short Whether 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.

    Control 0..1
    Type boolean
    Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension
    Summary true
    Requirements

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

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

    A name associated with the individual.

    Short icon Changed:(NHSN-MS)(USCDI) A name associated with the patientA 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.

    Control 10..*
    Type HumanName
    Is Modifier false
    Must Support true
    Summary true
    Requirements

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

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. ((family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists())
    48. Patient.name.use
    Definition

    Identifies the purpose for this name.

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) usual | official | temp | nickname | anonymous | old | maidenusual | 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.

    Control 0..1
    Binding The codes SHALL be taken from NameUsehttp://hl7.org/fhir/ValueSet/name-use|4.0.1
    (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

    The use of a human name.

    Type code
    Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. Patient.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.

    Short icon Changed:(NHSN-MS) A full text representation of the nameText 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.

    Control 0..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

    A renderable, unencoded form.

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

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

    Short icon Changed:(NHSN-MS)(USCDI) Family name (often called 'Surname')Family name (often called 'Surname')
    Comments

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

    Control 0..1
    This element is affected by the following invariants: us-core-6
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Alternate Names surname
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    54. Patient.name.given
    Definition

    Given name.

    Short icon Changed:(NHSN-MS)(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the nameGiven 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.

    Control 0..*
    This element is affected by the following invariants: us-core-6
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Alternate Names first name, middle name
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    56. 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.

    Short icon Changed:(NHSN-MS) Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the nameParts that come before the name
    Control 0..*
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    58. 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.

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the nameParts that come after the name
    Control 0..*
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    60. Patient.name.period
    Definition

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

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Time period when name was/is in useTime period when name was/is in use
    Control 0..1
    Type Period
    Is Modifier false
    Must Support true
    Summary true
    Requirements

    Allows names to be placed in historical context.

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

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

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) A contact detail for the individualA 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).

    Control 0..*
    Type ContactPoint
    Is Modifier false
    Must Support true
    Summary true
    Requirements

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

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    64. Patient.telecom.extension:telecom-preferred
    Slice Name telecom-preferred
    Definition

    Flag denoting whether parent item is preferred - e.g., a preferred address or telephone number.

    Short Preferred
    Control 0..1
    Type Extension(Preferred) (Extension Type: boolean)
    Is Modifier false
    Must Support false
    Summary false
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    66. Patient.telecom.system
    Definition

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

    Short icon Changed:(NHSN-MS)(USCDI) The type of contact point phone | fax | email | pager | url | sms | otherphone | fax | email | pager | url | sms | other
    Control 10..1
    This element is affected by the following invariants: cpt-2
    Binding The codes SHALL be taken from ContactPointSystemhttp://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
    (required to http://hl7.org/fhir/ValueSet/contact-point-system)

    Telecommunications form for contact point.

    Type code
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    68. Patient.telecom.value
    Definition

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

    Short icon Changed:(NHSN-MS)(USCDI) The actual contact point detailsThe 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.

    Control 10..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

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

    Identifies the purpose for the contact point.

    Short icon Changed:(NHSN-MS)(USCDI) home | work | temp | old | mobile - purpose of this contact pointhome | 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.

    Control 0..1
    Binding The codes SHALL be taken from ContactPointUsehttp://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
    (required to http://hl7.org/fhir/ValueSet/contact-point-use)
    Type code
    Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

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

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

    Short icon Changed:(NHSN-MS) Specify preferred order of use (1 = highest)Specify 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.

    Control 0..1
    Type positiveInt
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    74. Patient.telecom.period
    Definition

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

    Short icon Changed:(NHSN-MS) Time period when the contact point was/is in useTime period when the contact point was/is in use
    Control 0..1
    Type Period
    Is Modifier false
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    76. Patient.gender
    Definition

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

    Short icon Changed:(NHSN-MS)(USCDI)(USCDI) The administrative gender of the patient male | female | other | unknownmale | 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.

    Control 10..1
    Binding The codes SHALL be taken from AdministrativeGenderhttp://hl7.org/fhir/ValueSet/administrative-gender|4.0.1
    (required to http://hl7.org/fhir/ValueSet/administrative-gender)
    Type code
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

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

    The date of birth for the individual.

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) The date of birth for the individualThe date of birth for the individual
    Comments

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

    Control 10..1
    Type date
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

    Age of the individual drives many clinical processes.

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    LOINC Code 21112-8
    80. Patient.deceased[x]
    Definition

    Indicates if the individual is deceased or not.

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Indicates if the individual is deceased or notIndicates if the individual is deceased or not
    Comments

    The "Cause of death" for a patient is typically captured as an Observation.


    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.

    Control 0..1
    Type Choice of: boolean, dateTime
    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
    Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Must Support Types No must-support rules about the choice of types/profiles
    Summary true
    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.

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

    An address for the individual.

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) An address for the individualAn address for the individual
    Comments

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

    Control 0..*
    Type Address
    Is Modifier false
    Must Support true
    Summary true
    Requirements

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

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    84. Patient.address.extension:address-preferred
    Slice Name address-preferred
    Definition

    Flag denoting whether parent item is preferred - e.g., a preferred address or telephone number.

    Short Preferred
    Comments

    Make general extension.

    Control 0..1
    Type Extension(Preferred) (Extension Type: boolean)
    Is Modifier false
    Must Support false
    Summary false
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    86. Patient.address.use
    Definition

    The purpose of this address.

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) home | work | temp | old | billing - purpose of this addresshome | 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.

    Control 0..1
    Binding The codes SHALL be taken from AddressUsehttp://hl7.org/fhir/ValueSet/address-use|4.0.1
    (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

    The use of an address.

    Type code
    Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

    Example General: home
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    88. 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.

    Short icon Changed:(NHSN-MS) postal | physical | bothpostal | 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).


    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).

    Control 0..1
    Binding The codes SHALL be taken from AddressTypehttp://hl7.org/fhir/ValueSet/address-type|4.0.1
    (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1)

    The type of an address (physical / postal).

    Type code
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Example General: both
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    90. 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.

    Short icon Changed:(NHSN-MS)(USCDI) Text representation of the addressText 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.

    Control 0..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

    A renderable, unencoded form.

    Example General: 137 Nowhere Street, Erewhon 9132
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    92. Patient.address.line
    Definition

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

    Short icon Changed:(NHSN-MS)(USCDI) Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address labelStreet name, number, direction & P.O. Box etc.
    Control 0..*
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Example General: 137 Nowhere Street
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    94. Patient.address.city
    Definition

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

    Short icon Changed:(NHSN-MS)(USCDI) Name of city, town etc.Name of city, town etc.
    Control 0..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Alternate Names Municpality
    Example General: Erewhon
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    96. Patient.address.district
    Definition

    The name of the administrative area (county).

    Short icon Changed:(NHSN-MS) District name (aka county)District 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.

    Control 0..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Alternate Names County
    Example General: Madison
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    98. Patient.address.state
    Definition

    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).

    Short icon Changed:(NHSN-MS)(USCDI) Sub-unit of countrySub-unit of country (abbreviations ok)
    Control 0..1
    Binding Unless not suitable, these codes SHALL be taken from For codes, see UspsTwoLetterAlphabeticCodes (6.1.0)
    (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state|6.1.0)

    Two Letter USPS alphabetic codes.

    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Alternate Names Province, Territory
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    100. Patient.address.postalCode
    Definition

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

    Short icon Changed:(NHSN-MS)(USCDI) US Zip CodesPostal code for area
    Control 0..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Alternate Names Zip, Zip Code
    Example General: 9132
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    102. Patient.address.country
    Definition

    Country - a nation as commonly understood or generally accepted.

    Short icon Changed:(NHSN-MS) (USCDI) Country (e.g. can be ISO 3166 2 or 3 letter code)Country (e.g. can be ISO 3166 2 or 3 letter code)
    Comments

    ISO 3166 3 letter codes can be used in place of a human readable country name.

    Control 0..1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    104. Patient.address.period
    Definition

    Time period when address was/is in use.

    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Time period when address was/is in useTime period when address was/is in use
    Control 0..1
    Type Period
    Is Modifier false
    Must Support true
    Summary true
    Requirements

    Allows addresses to be placed in historical context.

    Example General: { "start" : "2010-03-23", "end" : "2010-07-01" }
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    106. Patient.communication
    Definition

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

    Short icon Changed:(QI-Core)(USCDI) A language which may be used to communicate with the patient about his or her healthA 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.

    Control 0..*
    Type BackboneElement
    Is Modifier false
    Must Support icon Changed:false
    Summary false
    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.

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

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

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

    Short Extensions 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.

    Control 0..*
    Type Extension
    Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summary true
    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 Names extensions, user content, modifiers
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    110. Patient.communication.language
    Definition

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

    Short icon Changed:(USCDI) The language which can be used to communicate with the patient about his or her healthThe 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.

    Control 1..1
    Binding Unless not suitable, these codes SHALL be taken from The codes SHOULD be taken from LanguageCodesWithLanguageAndOptionallyARegionModifier (6.1.0)http://hl7.org/fhir/ValueSet/languages|4.0.1
    (extensible to http://hl7.org/fhir/us/core/ValueSet/simple-language|6.1.0)
    Type CodeableConcept
    Is Modifier false
    Must Support true
    Summary false
    Requirements

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

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

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

    Short icon Changed:(NHSN-MS) Link to another patient resource that concerns the same actual personLink to another patient resource that concerns the same actual person
    Comments

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

    Control 0..*
    Type BackboneElement
    Is Modifier true 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 Support true
    Summary true
    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.
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

    Short Extensions 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.

    Control 0..*
    Type Extension
    Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summary true
    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 Names extensions, user content, modifiers
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    116. Patient.link.other
    Definition

    The other patient resource that the link refers to.

    Short icon Changed:(NHSN-MS) The other patient or related person resource that the link refers toThe 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.

    Control 1..1
    Type Reference(QICore Patient, Patient, RelatedPerson)bundled
    Is Modifier false
    Must Support icon Added:true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    118. Patient.link.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.

    Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral 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.

    Control 10..1
    This element is affected by the following invariants: ref-1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support icon Added:true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    120. Patient.link.type
    Definition

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

    Short icon Changed:(NHSN-MS) The type of link between this patient resource and another patient resource replaced-by | replaces | refer | seealsoreplaced-by | replaces | refer | seealso
    Control 1..1
    Binding The codes SHALL be taken from LinkTypehttp://hl7.org/fhir/ValueSet/link-type|4.0.1
    (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

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

    Type code
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support icon Added:true
    Summary true
    Invariants ele-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 foundhere

    0. Patient
    Short icon Added:(NHSN-MS) A patient who is the subject of the measure report. This resource is required for all NHSN dQMs and must be referenced in all Individual MeasureReport resources for these measures.
    Control icon Added:1..?
    Must Support icon Added:true
    Complies with Profile This profile complies with the profile
    Invariants icon Added:patient-full-name: name.given and name.family are present in at least one name. (name.where(family.exists() and given.exists()).exists())
    2. Patient.id
    Short icon Added:(NHSN-MS) The logical id of the Patient resource
    Control 1..?
    Must Support icon Added:true
    4. Patient.meta
    6. Patient.meta.extension:link-received-date-extension
    Slice Name link-received-date-extension
    Control 0..1
    Type Extension(Received Date) (Extension Type: dateTime)
    icon Added: 8. Patient.extension:birthsex
    Slice Name birthsex
    Short (NHSN-MS) US Core Birth Sex Extension
    Must Support true
    icon Added: 10. Patient.extension:sex
    Slice Name sex
    Short (NHSN-MS) US Core Sex Extension
    Must Support true
    icon Added: 12. Patient.identifier
    Short (NHSN-MS)(USCDI) An identifier for this patient
    Note This is a business identifier, not a resource identifier (see discussion)
    Slicing This element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ type
    • 14. Patient.identifier.use
      Short (NHSN-MS) The purpose of this identifier usual | official | temp | secondary | old (If known)
      Must Support true
      16. Patient.identifier.type
      Short (NHSN-MS) Description of identifier
      Must Support true
      18. Patient.identifier.system
      Short (NHSN-MS)(USCDI) The namespace for the identifier value
      20. Patient.identifier.value
      Short (NHSN-MS)(USCDI) The value that is unique within the system.
      22. Patient.identifier.period
      Short (NHSN-MS) Time period when id is/was valid for use
      Must Support true
      24. Patient.identifier:medicalRecordNumber
      Slice Name medicalRecordNumber
      Short (NHSN-MS) Medical Record Number (MRN) identifier for the patient
      Note This is a business identifier, not a resource identifier (see discussion)
      Control 1..*
      Must Support true
      26. Patient.identifier:medicalRecordNumber.type
      Short (NHSN-MS) Medical Record Number (MRN) identifier for the patient
      Control 1..?
      Pattern Value {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
          "code" : "MR"
        }]
      }
      Invariants nhsn-single-mrn-warning: Patient SHOULD NOT include more than one identifier with type MR from http://terminology.hl7.org/CodeSystem/v2-0203. (identifier.where(type.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v2-0203' and code = 'MR').exists()).count() <= 1)
      icon Added: 28. Patient.name
      Short (NHSN-MS)(USCDI) A name associated with the patient
      30. Patient.name.use
      Short (NHSN-MS)(QI-Core)(USCDI) usual | official | temp | nickname | anonymous | old | maiden
      Must Support true
      32. Patient.name.text
      Short (NHSN-MS) A full text representation of the name
      Must Support true
      34. Patient.name.family
      Short (NHSN-MS)(USCDI) Family name (often called 'Surname')
      36. Patient.name.given
      Short (NHSN-MS)(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
      38. Patient.name.prefix
      Short (NHSN-MS) Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
      Must Support true
      40. Patient.name.suffix
      Short (NHSN-MS)(QI-Core)(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
      Must Support true
      42. Patient.name.period
      Short (NHSN-MS)(QI-Core)(USCDI) Time period when name was/is in use
      Must Support true
      icon Added: 44. Patient.telecom
      Short (NHSN-MS)(QI-Core)(USCDI) A contact detail for the individual
      Must Support true
      46. Patient.telecom.system
      Short (NHSN-MS)(USCDI) The type of contact point phone | fax | email | pager | url | sms | other
      48. Patient.telecom.value
      Short (NHSN-MS)(USCDI) The actual contact point details
      50. Patient.telecom.use
      Short (NHSN-MS)(USCDI) home | work | temp | old | mobile - purpose of this contact point
      52. Patient.telecom.rank
      Short (NHSN-MS) Specify preferred order of use (1 = highest)
      Must Support true
      54. Patient.telecom.period
      Short (NHSN-MS) Time period when the contact point was/is in use
      Must Support true
      icon Added: 56. Patient.gender
      Short (NHSN-MS)(USCDI)(USCDI) The administrative gender of the patient male | female | other | unknown
      58. Patient.birthDate
      Short icon Added:(NHSN-MS)(QI-Core)(USCDI) The date of birth for the individual
      Control 1..?
      LOINC Code
      60. Patient.deceased[x]
      Short icon Added:(NHSN-MS)(QI-Core)(USCDI) Indicates if the individual is deceased or not
      [x] Note SeeChoice of Data Typesfor further information about how to use [x]
      Must Support true
      icon Added: 62. Patient.address
      Short (NHSN-MS)(QI-Core)(USCDI) An address for the individual
      64. Patient.address.use
      Short (NHSN-MS)(QI-Core)(USCDI) home | work | temp | old | billing - purpose of this address
      Must Support true
      66. Patient.address.type
      Short (NHSN-MS) postal | physical | both
      Must Support true
      68. Patient.address.text
      Short (NHSN-MS)(USCDI) Text representation of the address
      Must Support true
      70. Patient.address.line
      Short (NHSN-MS)(USCDI) Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label
      72. Patient.address.city
      Short (NHSN-MS)(USCDI) Name of city, town etc.
      74. Patient.address.district
      Short (NHSN-MS) District name (aka county)
      Must Support true
      76. Patient.address.state
      Short (NHSN-MS)(USCDI) Sub-unit of country
      78. Patient.address.postalCode
      Short (NHSN-MS)(USCDI) US Zip Codes
      80. Patient.address.country
      Short (NHSN-MS) (USCDI) Country (e.g. can be ISO 3166 2 or 3 letter code)
      Must Support true
      82. Patient.address.period
      Short (NHSN-MS)(QI-Core)(USCDI) Time period when address was/is in use
      Must Support true
      84. Patient.link
      Short icon Added:(NHSN-MS) Link to another patient resource that concerns the same actual person
      Must Support true
      icon Added: 86. Patient.link.other
      Short (NHSN-MS) The other patient or related person resource that the link refers to
      Type Reference(QICore Patient)bundled
      Must Support true
      88. Patient.link.other.reference
      Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
      Control 1..?
      Must Support true
      icon Added: 90. Patient.link.type
      Short (NHSN-MS) The type of link between this patient resource and another patient resource replaced-by | replaces | refer | seealso
      Must Support true
      icon Removed:--. Patient.link.other.reference
      Control 1..?
      icon Removed:--. Patient.extension:race
      Slice Name race
      Short US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
      icon Removed:--. Patient.extension:ethnicity
      Slice Name ethnicity
      Short US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
      icon Removed:--. Patient.identifier.use
      Must Support true
      icon Removed:--. Patient.identifier.type
      Must Support true
      icon Removed:--. Patient.identifier.period
      Must Support true
      icon Removed:--. Patient.name.use
      Must Support true
      icon Removed:--. Patient.name.text
      Must Support true
      icon Removed:--. Patient.name.prefix
      Must Support true
      icon Removed:--. Patient.name.suffix
      Must Support true
      icon Removed:--. Patient.name.period
      Must Support true
      icon Removed:--. Patient.telecom.rank
      Must Support true
      icon Removed:--. Patient.telecom.period
      Must Support true
      icon Removed:--. Patient.address.use
      Must Support true
      icon Removed:--. Patient.address.type
      Must Support true
      icon Removed:--. Patient.address.text
      Must Support true
      icon Removed:--. Patient.address.district
      Must Support true
      icon Removed:--. Patient.address.country
      Must Support true
      icon Removed:--. Patient.contact
      Must Support true
      icon Removed:--. Patient.communication.preferred
      Must Support true

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

      0. Patient
      Definition

      icon Changed:

      -

      Short icon Changed:(NHSN-MS) A patient who is the subject of the measure report. This resource is required for all NHSN dQMs and must be referenced in all Individual MeasureReport resources for these measures.
      Comments

      icon Added:

      -

      Control icon Changed:1..*
      Is Modifier false
      Must Support icon Changed:true
      Complies with Profile This profile complies with the profile
      Summary false
      Alternate Names SubjectOfCare Client Resident
      Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      patient-full-name: name.given and name.family are present in at least one name. (name.where(family.exists() and given.exists()).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.

      Short icon Changed:(NHSN-MS) The logical id of the Patient resource
      Comments

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

      Control 1..1
      Type id
      Is Modifier false
      Must Support icon Added:true
      Summary true
      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.

      Short Metadata about the resource
      Control 0..1
      Type Meta
      Is Modifier false
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. Patient.meta.id
      Definition

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

      Short Unique id for inter-element referencing
      Control 0..1
      Type string
      Is Modifier false
      XML Format In the XML format, this property is represented as an attribute.
      Summary false
      8. Patient.meta.extension
      Definition

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

      Short Additional 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.

      Control 0..*
      Type Extension
      Is Modifier false
      Summary false
      Alternate Names extensions, user content
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      Slicing This element introduces a set of slices on Patient.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 10. Patient.meta.extension:link-received-date-extension
        Slice Name link-received-date-extension
        Definition

        This extension stores the date and time a Resource was received by the processing system (e.g., NHSNLink).

        Short Received Date
        Control 0..1
        Type Extension(Received Date) (Extension Type: dateTime)
        Is Modifier false
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        12. Patient.meta.versionId
        Definition

        The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

        Short Version specific identifier
        Comments

        The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

        Control 0..1
        Type id
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. Patient.meta.lastUpdated
        Definition

        When the resource last changed - e.g. when the version changed.

        Short When the resource version last changed
        Comments

        This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

        Control 0..1
        Type instant
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Patient.meta.source
        Definition

        A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

        Short Identifies where the resource comes from
        Comments

        In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

        This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

        Control 0..1
        Type uri
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. Patient.meta.profile
        Definition

        A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

        Short Profiles this resource claims to conform to
        Comments

        It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

        Control 0..*
        Type canonical(StructureDefinition)
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Patient.meta.security
        Definition

        Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

        Short Security Labels applied to this resource
        Comments

        The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

        Control 0..*
        Binding Unless not suitable, these codes SHALL be taken from All Security Labels
        (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

        Security Labels from the Healthcare Privacy and Security Classification System.

        Type Coding
        Is Modifier false
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Patient.meta.tag
        Definition

        Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

        Short Tags applied to this resource
        Comments

        The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

        Control 0..*
        Binding For example codes, see CommonTags
        (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

        Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

        Type Coding
        Is Modifier false
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. 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.

        Short A set of rules under which this content was created
        Comments

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

        Control 0..1
        Type uri
        Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Patient.language
        Definition

        The base language in which the resource is written.

        Short Language 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).

        Control 0..1
        Binding The codes SHOULD be taken from CommonLanguages
        (preferred to http://hl7.org/fhir/ValueSet/languages)

        A human language.

        Additional Bindings Purpose
        AllLanguages Max Binding
        Type code
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. 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.

        Short Text summary of the resource, for human interpretation
        Comments

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

        Control 0..1
        Type Narrative
        Is Modifier false
        Summary false
        Alternate Names narrative, html, xhtml, display
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Patient.contained
        Definition

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

        Short Contained, 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.

        Control 0..*
        Type Resource
        Is Modifier false
        Summary false
        Alternate Names inline resources, anonymous resources, contained resources
        32. Patient.extension
        Definition

        An Extension

        Short Extension
        Control 0..*
        Type Extension
        Is Modifier false
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        Slicing This element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 34. Patient.extension:race
          Slice Name race
          Definition

          Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the CDC Race and Ethnicity Code Set Version 1.0 which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:

          • American Indian or Alaska Native
          • Asian
          • Black or African American
          • Native Hawaiian or Other Pacific Islander
          • White.
          Short (QI-Core)(USCDI) US Core Race Extension
          Control 0..1
          This element is affected by the following invariants: ele-1
          Type Extension(US Core Race Extension) (Complex Extension)
          Is Modifier false
          Must Support false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          36. Patient.extension:ethnicity
          Slice Name ethnicity
          Definition

          Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The ethnicity codes used to represent these concepts are based upon the CDC ethnicity and Ethnicity Code Set Version 1.0 which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity. The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.

          Short (QI-Core)(USCDI) US Core ethnicity Extension
          Control 0..1
          This element is affected by the following invariants: ele-1
          Type Extension(US Core Ethnicity Extension) (Complex Extension)
          Is Modifier false
          Must Support false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          38. Patient.extension:tribalAffiliation
          Slice Name tribalAffiliation
          Definition

          A tribe or band with which a person associates whether or not they are an enrolled member.

          Short (QI-Core)(USCDI) Tribal Affiliation Extension
          Control 0..*
          This element is affected by the following invariants: ele-1
          Type Extension(US Core Tribal Affiliation Extension) (Complex Extension)
          Is Modifier false
          Must Support false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          40. Patient.extension:birthsex
          Slice Name birthsex
          Definition

          A code classifying the person's sex assigned at birth as specified by the Office of the National Coordinator for Health IT (ONC).

          Short (NHSN-MS) US Core Birth Sex Extension
          Comments

          The codes required are intended to present birth sex (i.e., the sex recorded on the patient's birth certificate) and not gender identity or reassigned sex.

          Control 0..1
          This element is affected by the following invariants: ele-1
          Type Extension(US Core Birth Sex Extension) (Extension Type: code)
          Is Modifier false
          Must Support true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          42. Patient.extension:sex
          Slice Name sex
          Definition

          The US Core Sex Extension is used to reflect the documentation of a person's sex. It aligns with the C-CDA Sex Observation (LOINC 46098-0).

          Short (NHSN-MS) US Core Sex Extension
          Control 0..1
          This element is affected by the following invariants: ele-1
          Type Extension(US Core Sex Extension) (Extension Type: code)
          Is Modifier false
          Must Support true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          44. Patient.extension:genderIdentity
          Slice Name genderIdentity
          Definition

          An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else.

          Short (QI-Core)(USCDI) The individual's gender identity
          Comments

          This represents an individual's identity, ascertained by asking them what that identity is.

          Control 0..*
          This element is affected by the following invariants: ele-1
          Type Extension(US Core Gender Identity Extension) (Extension Type: CodeableConcept)
          Is Modifier false
          Must Support false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          46. Patient.modifierExtension
          Definition

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

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

          Short Extensions 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.

          Control 0..*
          Type Extension
          Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summary false
          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 Names extensions, user content
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          48. Patient.identifier
          Definition

          An identifier for this patient.

          Short icon Changed:(NHSN-MS)(USCDI) An identifier for this patient
          Note This is a business identifier, not a resource identifier (see discussion)
          Control 1..*
          Type Identifier
          Is Modifier false
          Must Support true
          Summary true
          Requirements

          Patients are almost always assigned specific numerical identifiers.

          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          Slicing This element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • pattern @ type
          • 50. Patient.identifier.id
            Definition

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

            Short Unique id for inter-element referencing
            Control 0..1
            Type string
            Is Modifier false
            XML Format In the XML format, this property is represented as an attribute.
            Summary false
            52. Patient.identifier.extension
            Definition

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

            Short Additional 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.

            Control 0..*
            Type Extension
            Is Modifier false
            Summary false
            Alternate Names extensions, user content
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            Slicing This 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
            • 54. Patient.identifier.use
              Definition

              The purpose of this identifier.

              Short icon Changed:(NHSN-MS) The purpose of this identifier usual | official | temp | secondary | old (If known)
              Comments

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

              Control 0..1
              Binding The codes SHALL be taken from IdentifierUse
              (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

              Identifies the purpose for this identifier, if known .

              Type code
              Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Must Support true
              Summary true
              Requirements

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

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

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

              Short icon Changed:(NHSN-MS) Description 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.

              Control 0..1
              Binding Unless not suitable, these codes SHALL be taken from Identifier Type Codes
              (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary true
              Requirements

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

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

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

              Short icon Changed:(NHSN-MS)(USCDI) The namespace for the identifier value
              Comments

              Identifier.system is always case sensitive.

              Control 1..1
              Type uri
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Must Support true
              Summary true
              Requirements

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

              Example General: http://www.acme.com/identifiers/patient
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              60. Patient.identifier.value
              Definition

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

              Short icon Changed:(NHSN-MS)(USCDI) The value that is unique within the system.
              Comments

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

              Control 1..1
              Type string
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Must Support true
              Summary true
              Example General: 123456
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              62. Patient.identifier.period
              Definition

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

              Short icon Changed:(NHSN-MS) Time period when id is/was valid for use
              Control 0..1
              Type Period
              Is Modifier false
              Must Support true
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. Patient.identifier.assigner
              Definition

              Organization that issued/manages the identifier.

              Short Organization 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.

              Control 0..1
              Type Reference(Organization)
              Is Modifier false
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. Patient.identifier:medicalRecordNumber
              Slice Name medicalRecordNumber
              Definition

              An identifier for this patient.

              Short (NHSN-MS) Medical Record Number (MRN) identifier for the patient
              Note This is a business identifier, not a resource identifier (see discussion)
              Control 1..*
              Type Identifier
              Is Modifier false
              Must Support true
              Summary true
              Requirements

              Patients are almost always assigned specific numerical identifiers.

              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. Patient.identifier:medicalRecordNumber.id
              Definition

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

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              70. Patient.identifier:medicalRecordNumber.extension
              Definition

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

              Short Additional 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.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              Slicing This 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
              • 72. Patient.identifier:medicalRecordNumber.use
                Definition

                The purpose of this identifier.

                Short (NHSN-MS) The purpose of this identifier usual | official | temp | secondary | old (If known)
                Comments

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

                Control 0..1
                Binding The codes SHALL be taken from IdentifierUse
                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                Identifies the purpose for this identifier, if known .

                Type code
                Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary true
                Requirements

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

                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                74. Patient.identifier:medicalRecordNumber.type
                Definition

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

                Short (NHSN-MS) Medical Record Number (MRN) identifier for the patient
                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.

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

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

                Type CodeableConcept
                Is Modifier false
                Must Support true
                Summary true
                Requirements

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

                Pattern Value {
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                    "code" : "MR"
                  }]
                }
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                nhsn-single-mrn-warning: Patient SHOULD NOT include more than one identifier with type MR from http://terminology.hl7.org/CodeSystem/v2-0203. (identifier.where(type.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v2-0203' and code = 'MR').exists()).count() <= 1)
                76. Patient.identifier:medicalRecordNumber.system
                Definition

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

                Short (NHSN-MS)(USCDI) The namespace for the identifier value
                Comments

                Identifier.system is always case sensitive.

                Control 1..1
                Type uri
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary true
                Requirements

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

                Example General: http://www.acme.com/identifiers/patient
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                78. Patient.identifier:medicalRecordNumber.value
                Definition

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

                Short (NHSN-MS)(USCDI) The value that is unique within the system.
                Comments

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

                Control 1..1
                Type string
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary true
                Example General: 123456
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                80. Patient.identifier:medicalRecordNumber.period
                Definition

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

                Short (NHSN-MS) Time period when id is/was valid for use
                Control 0..1
                Type Period
                Is Modifier false
                Must Support true
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                82. Patient.identifier:medicalRecordNumber.assigner
                Definition

                Organization that issued/manages the identifier.

                Short Organization 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.

                Control 0..1
                Type Reference(Organization)
                Is Modifier false
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                84. 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.

                Short Whether 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.

                Control 0..1
                Type boolean
                Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Requirements

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

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

                A name associated with the individual.

                Short icon Changed:(NHSN-MS)(USCDI) A 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.

                Control 1..*
                Type HumanName
                Is Modifier false
                Must Support true
                Summary true
                Requirements

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

                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. ((family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists())
                88. 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.

                Short Unique id for inter-element referencing
                Control 0..1
                Type string
                Is Modifier false
                XML Format In the XML format, this property is represented as an attribute.
                Summary false
                90. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                Short Additional 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.

                Control 0..*
                Type Extension
                Is Modifier false
                Summary false
                Alternate Names extensions, user content
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                Slicing This 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
                • 92. Patient.name.use
                  Definition

                  Identifies the purpose for this name.

                  Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) usual | 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.

                  Control 0..1
                  Binding The codes SHALL be taken from NameUse
                  (required to http://hl7.org/fhir/ValueSet/name-use|4.0.1)

                  The use of a human name.

                  Type code
                  Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Requirements

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

                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  94. Patient.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.

                  Short icon Changed:(NHSN-MS) A full text representation of the 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.

                  Control 0..1
                  Type string
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Requirements

                  A renderable, unencoded form.

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

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

                  Short icon Changed:(NHSN-MS)(USCDI) Family name (often called 'Surname')
                  Comments

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

                  Control 0..1
                  This element is affected by the following invariants: us-core-6
                  Type string
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Alternate Names surname
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  98. Patient.name.given
                  Definition

                  Given name.

                  Short icon Changed:(NHSN-MS)(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
                  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.

                  Control 0..*
                  This element is affected by the following invariants: us-core-6
                  Type string
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Alternate Names first name, middle name
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  100. 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.

                  Short icon Changed:(NHSN-MS) Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
                  Control 0..*
                  Type string
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  102. 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.

                  Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
                  Control 0..*
                  Type string
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  104. Patient.name.period
                  Definition

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

                  Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Time period when name was/is in use
                  Control 0..1
                  Type Period
                  Is Modifier false
                  Must Support true
                  Summary true
                  Requirements

                  Allows names to be placed in historical context.

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

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

                  Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) A 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).

                  Control 0..*
                  Type ContactPoint
                  Is Modifier false
                  Must Support true
                  Summary true
                  Requirements

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

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

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

                  Short Unique id for inter-element referencing
                  Control 0..1
                  Type string
                  Is Modifier false
                  XML Format In the XML format, this property is represented as an attribute.
                  Summary false
                  110. Patient.telecom.extension
                  Definition

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

                  Short Additional 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.

                  Control 0..*
                  Type Extension
                  Is Modifier false
                  Summary false
                  Alternate Names extensions, user content
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  Slicing This 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
                  • 112. Patient.telecom.extension:telecom-preferred
                    Slice Name telecom-preferred
                    Definition

                    Flag denoting whether parent item is preferred - e.g., a preferred address or telephone number.

                    Short Preferred
                    Control 0..1
                    Type Extension(Preferred) (Extension Type: boolean)
                    Is Modifier false
                    Must Support false
                    Summary false
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    114. Patient.telecom.system
                    Definition

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

                    Short icon Changed:(NHSN-MS)(USCDI) The type of contact point phone | fax | email | pager | url | sms | other
                    Control 1..1
                    This element is affected by the following invariants: cpt-2
                    Binding The codes SHALL be taken from ContactPointSystem
                    (required to http://hl7.org/fhir/ValueSet/contact-point-system)

                    Telecommunications form for contact point.

                    Type code
                    Is Modifier false
                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                    Must Support true
                    Summary true
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    116. Patient.telecom.value
                    Definition

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

                    Short icon Changed:(NHSN-MS)(USCDI) The 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.

                    Control 1..1
                    Type string
                    Is Modifier false
                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                    Must Support true
                    Summary true
                    Requirements

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

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

                    Identifies the purpose for the contact point.

                    Short icon Changed:(NHSN-MS)(USCDI) home | 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.

                    Control 0..1
                    Binding The codes SHALL be taken from ContactPointUse
                    (required to http://hl7.org/fhir/ValueSet/contact-point-use)
                    Type code
                    Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one
                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                    Must Support true
                    Summary true
                    Requirements

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

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

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

                    Short icon Changed:(NHSN-MS) Specify 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.

                    Control 0..1
                    Type positiveInt
                    Is Modifier false
                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                    Must Support true
                    Summary true
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    122. Patient.telecom.period
                    Definition

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

                    Short icon Changed:(NHSN-MS) Time period when the contact point was/is in use
                    Control 0..1
                    Type Period
                    Is Modifier false
                    Must Support true
                    Summary true
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    124. Patient.gender
                    Definition

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

                    Short icon Changed:(NHSN-MS)(USCDI)(USCDI) The administrative gender of the patient male | 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.

                    Control 1..1
                    Binding The codes SHALL be taken from AdministrativeGender
                    (required to http://hl7.org/fhir/ValueSet/administrative-gender)
                    Type code
                    Is Modifier false
                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                    Must Support true
                    Summary true
                    Requirements

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

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

                    The date of birth for the individual.

                    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) The date of birth for the individual
                    Comments

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

                    Control 1..1
                    Type date
                    Is Modifier false
                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                    Must Support true
                    Summary true
                    Requirements

                    Age of the individual drives many clinical processes.

                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    LOINC Code 21112-8
                    128. Patient.deceased[x]
                    Definition

                    Indicates if the individual is deceased or not.

                    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Indicates if the individual is deceased or not
                    Comments

                    icon Changed:

                    The "Cause of death" for a patient is typically captured as an Observation.

                    Control 0..1
                    Type Choice of: boolean, dateTime
                    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension
                    Must Support true
                    Must Support Types No must-support rules about the choice of types/profiles
                    Summary true
                    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.

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

                    An address for the individual.

                    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) An address for the individual
                    Comments

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

                    Control 0..*
                    Type Address
                    Is Modifier false
                    Must Support true
                    Summary true
                    Requirements

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

                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    132. 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.

                    Short Unique id for inter-element referencing
                    Control 0..1
                    Type string
                    Is Modifier false
                    XML Format In the XML format, this property is represented as an attribute.
                    Summary false
                    134. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    Short Additional 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.

                    Control 0..*
                    Type Extension
                    Is Modifier false
                    Summary false
                    Alternate Names extensions, user content
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    Slicing This 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
                    • 136. Patient.address.extension:address-preferred
                      Slice Name address-preferred
                      Definition

                      Flag denoting whether parent item is preferred - e.g., a preferred address or telephone number.

                      Short Preferred
                      Comments

                      Make general extension.

                      Control 0..1
                      Type Extension(Preferred) (Extension Type: boolean)
                      Is Modifier false
                      Must Support false
                      Summary false
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      138. Patient.address.use
                      Definition

                      The purpose of this address.

                      Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) home | 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.

                      Control 0..1
                      Binding The codes SHALL be taken from AddressUse
                      (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

                      The use of an address.

                      Type code
                      Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Requirements

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

                      Example General: home
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      140. 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.

                      Short icon Changed:(NHSN-MS) postal | 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).

                      Control 0..1
                      Binding The codes SHALL be taken from AddressType
                      (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1)

                      The type of an address (physical / postal).

                      Type code
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Example General: both
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      142. 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.

                      Short icon Changed:(NHSN-MS)(USCDI) Text 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.

                      Control 0..1
                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Requirements

                      A renderable, unencoded form.

                      Example General: 137 Nowhere Street, Erewhon 9132
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      144. Patient.address.line
                      Definition

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

                      Short icon Changed:(NHSN-MS)(USCDI) Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label
                      Control 0..*
                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Example General: 137 Nowhere Street
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      146. Patient.address.city
                      Definition

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

                      Short icon Changed:(NHSN-MS)(USCDI) Name of city, town etc.
                      Control 0..1
                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Alternate Names Municpality
                      Example General: Erewhon
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      148. Patient.address.district
                      Definition

                      The name of the administrative area (county).

                      Short icon Changed:(NHSN-MS) District 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.

                      Control 0..1
                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Alternate Names County
                      Example General: Madison
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      150. Patient.address.state
                      Definition

                      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).

                      Short icon Changed:(NHSN-MS)(USCDI) Sub-unit of country
                      Control 0..1
                      Binding Unless not suitable, these codes SHALL be taken from UspsTwoLetterAlphabeticCodes (6.1.0)
                      (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state|6.1.0)

                      Two Letter USPS alphabetic codes.

                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Alternate Names Province, Territory
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      152. Patient.address.postalCode
                      Definition

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

                      Short icon Changed:(NHSN-MS)(USCDI) US Zip Codes
                      Control 0..1
                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Alternate Names Zip, Zip Code
                      Example General: 9132
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      154. Patient.address.country
                      Definition

                      Country - a nation as commonly understood or generally accepted.

                      Short icon Changed:(NHSN-MS) (USCDI) Country (e.g. can be ISO 3166 2 or 3 letter code)
                      Comments

                      ISO 3166 3 letter codes can be used in place of a human readable country name.

                      Control 0..1
                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support true
                      Summary true
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      156. Patient.address.period
                      Definition

                      Time period when address was/is in use.

                      Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Time period when address was/is in use
                      Control 0..1
                      Type Period
                      Is Modifier false
                      Must Support true
                      Summary true
                      Requirements

                      Allows addresses to be placed in historical context.

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

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

                      Short Marital (civil) status of a patient
                      Control 0..1
                      Binding Unless not suitable, these codes SHALL be taken from Marital Status Codes
                      (extensible to http://hl7.org/fhir/ValueSet/marital-status)

                      The domestic partnership status of a person.

                      Type CodeableConcept
                      Is Modifier false
                      Summary false
                      Requirements

                      Most, if not all systems capture it.

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

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

                      Short Whether 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).

                      Control 0..1
                      Type Choice of: boolean, integer
                      [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Summary false
                      Requirements

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

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

                      Image of the patient.

                      Short Image of the patient
                      Comments

                      Guidelines:

                      • Use id photos, not clinical photos.
                      • Limit dimensions to thumbnail.
                      • Keep byte count low to ease resource updates.
                      Control 0..*
                      Type Attachment
                      Is Modifier false
                      Summary false
                      Requirements

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

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

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

                      Short A 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.

                      Control 0..*
                      Type BackboneElement
                      Is Modifier false
                      Must Support icon Removed:true
                      Summary false
                      Requirements

                      Need to track people you can contact about the patient.

                      Invariants ele-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())
                      166. 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.

                      Short Unique id for inter-element referencing
                      Control 0..1
                      Type string
                      Is Modifier false
                      XML Format In the XML format, this property is represented as an attribute.
                      Summary false
                      168. Patient.contact.extension
                      Definition

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

                      Short Additional 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.

                      Control 0..*
                      Type Extension
                      Is Modifier false
                      Summary false
                      Alternate Names extensions, user content
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      170. Patient.contact.modifierExtension
                      Definition

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

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

                      Short Extensions 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.

                      Control 0..*
                      Type Extension
                      Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summary true
                      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 Names extensions, user content, modifiers
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      172. Patient.contact.relationship
                      Definition

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

                      Short The kind of relationship
                      Control 0..*
                      Binding Unless 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.

                      Type CodeableConcept
                      Is Modifier false
                      Must Support icon Removed:true
                      Summary false
                      Requirements

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

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

                      A name associated with the contact person.

                      Short A name associated with the contact person
                      Control 0..1
                      Type HumanName
                      Is Modifier false
                      Must Support icon Removed:true
                      Summary false
                      Requirements

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

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

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

                      Short A 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.

                      Control 0..*
                      Type ContactPoint
                      Is Modifier false
                      Summary false
                      Requirements

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

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

                      Address for the contact person.

                      Short Address for the contact person
                      Control 0..1
                      Type Address
                      Is Modifier false
                      Must Support icon Removed:true
                      Summary false
                      Requirements

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

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

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

                      Short male | female | other | unknown
                      Control 0..1
                      Binding The codes SHALL be taken from AdministrativeGender
                      (required to http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1)

                      The gender of a person used for administrative purposes.

                      Type code
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Summary false
                      Requirements

                      Needed to address the person correctly.

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

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

                      Short Organization that is associated with the contact
                      Control 0..1
                      This element is affected by the following invariants: pat-1
                      Type Reference(Organization)
                      Is Modifier false
                      Summary false
                      Requirements

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

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

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

                      Short The period during which this contact person or organization is valid to be contacted relating to this patient
                      Control 0..1
                      Type Period
                      Is Modifier false
                      Must Support icon Removed:true
                      Summary false
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      186. Patient.communication
                      Definition

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

                      Short icon Changed:(QI-Core)(USCDI) A 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.

                      Control 0..*
                      Type BackboneElement
                      Is Modifier false
                      Must Support icon Changed:false
                      Summary false
                      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.

                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      188. 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.

                      Short Unique id for inter-element referencing
                      Control 0..1
                      Type string
                      Is Modifier false
                      XML Format In the XML format, this property is represented as an attribute.
                      Summary false
                      190. Patient.communication.extension
                      Definition

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

                      Short Additional 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.

                      Control 0..*
                      Type Extension
                      Is Modifier false
                      Summary false
                      Alternate Names extensions, user content
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      192. Patient.communication.modifierExtension
                      Definition

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

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

                      Short Extensions 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.

                      Control 0..*
                      Type Extension
                      Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summary true
                      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 Names extensions, user content, modifiers
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      194. Patient.communication.language
                      Definition

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

                      Short icon Changed:(USCDI) The 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.

                      Control 1..1
                      Binding Unless not suitable, these codes SHALL be taken from LanguageCodesWithLanguageAndOptionallyARegionModifier (6.1.0)
                      (extensible to http://hl7.org/fhir/us/core/ValueSet/simple-language|6.1.0)
                      Type CodeableConcept
                      Is Modifier false
                      Must Support true
                      Summary false
                      Requirements

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

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

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

                      Short Language preference indicator
                      Comments

                      This language is specifically identified for communicating healthcare information.

                      Control 0..1
                      Type boolean
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Must Support icon Removed:true
                      Summary false
                      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.

                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      198. Patient.generalPractitioner
                      Definition

                      Patient's nominated care provider.

                      Short Patient'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.

                      Control 0..*
                      Type Reference(Organization, Practitioner, PractitionerRole)
                      Is Modifier false
                      Summary false
                      Alternate Names careProvider
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      200. Patient.managingOrganization
                      Definition

                      Organization that is the custodian of the patient record.

                      Short Organization 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).

                      Control 0..1
                      Type Reference(Organization)
                      Is Modifier false
                      Summary true
                      Requirements

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

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

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

                      Short icon Changed:(NHSN-MS) Link to another patient resource that concerns the same actual person
                      Comments

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

                      Control 0..*
                      Type BackboneElement
                      Is Modifier true 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 Support true
                      Summary true
                      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.
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      204. 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.

                      Short Unique id for inter-element referencing
                      Control 0..1
                      Type string
                      Is Modifier false
                      XML Format In the XML format, this property is represented as an attribute.
                      Summary false
                      206. Patient.link.extension
                      Definition

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

                      Short Additional 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.

                      Control 0..*
                      Type Extension
                      Is Modifier false
                      Summary false
                      Alternate Names extensions, user content
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      208. Patient.link.modifierExtension
                      Definition

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

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

                      Short Extensions 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.

                      Control 0..*
                      Type Extension
                      Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summary true
                      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 Names extensions, user content, modifiers
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      210. Patient.link.other
                      Definition

                      The other patient resource that the link refers to.

                      Short icon Changed:(NHSN-MS) The 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.

                      Control 1..1
                      Type Reference(QICore Patient)bundled
                      Is Modifier false
                      Must Support icon Added:true
                      Summary true
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      212. Patient.link.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.

                      Short Unique id for inter-element referencing
                      Control 0..1
                      Type string
                      Is Modifier false
                      XML Format In the XML format, this property is represented as an attribute.
                      Summary false
                      214. Patient.link.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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      Short Additional 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.

                      Control 0..*
                      Type Extension
                      Is Modifier false
                      Summary false
                      Alternate Names extensions, user content
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      Slicing This 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
                      • 216. Patient.link.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.

                        Short icon Changed:(NHSN-MS) Literal 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.

                        Control 1..1
                        This element is affected by the following invariants: ref-1
                        Type string
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Must Support icon Added:true
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        218. Patient.link.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).

                        Short Type the reference refers to (e.g. "Patient")
                        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 RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                        Control 0..1
                        Binding Unless not suitable, these codes SHALL be taken from ResourceType
                        (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

                        Type uri
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        220. Patient.link.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.

                        Short Logical 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).

                        Note This is a business identifier, not a resource identifier (see discussion)
                        Control 0..1
                        Type Identifier
                        Is Modifier false
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        222. Patient.link.other.display
                        Definition

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

                        Short Text 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.

                        Control 0..1
                        Type string
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        224. Patient.link.type
                        Definition

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

                        Short icon Changed:(NHSN-MS) The type of link between this patient resource and another patient resource replaced-by | replaces | refer | seealso
                        Control 1..1
                        Binding The codes SHALL be taken from LinkType
                        (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

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

                        Type code
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Must Support icon Added:true
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))