Shared Health Specification and Guide Version 5.0


v5.0 of this specification has been superseded by v5.3. v5.3 is compatible but adds additional features for Quebec.

The version (Bundle.meta.tag:version) that is sent in the message will remain PrescribeIT5.0

 

Definitions for the profile-practitioner-tpr Profile.

1. Practitioner
Definition

A person who is directly or indirectly involved in the provisioning of healthcare.

Control0..*
Must Supporttrue
Comments

-

Max Length0
2. Practitioner.id
Definition

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

Control1..1
Typeid
Must Supporttrue
Comments

This value should be populated with the CPRID of the practitioner this resource describes. The CPRID of the practitioner is the business identifier used within the Provider Registry to uniquely identify a practitioner.

Max Length0
3. Practitioner.meta
Definition

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

Control1..1
TypeMeta
Must Supporttrue
Max Length0
4. Practitioner.meta.id
Definition

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

Control0..1
Typeid
Max Length0
5. Practitioner.meta.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
6. Practitioner.meta.versionId
Definition

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

Control0..1
Typeid
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.

Max Length0
7. Practitioner.meta.lastUpdated
Definition

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

Control0..1
Typeinstant
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.

Max Length0
8. Practitioner.meta.profile
Definition

A list of profiles StructureDefinitions that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Control0..*
Typeuri
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.

Max Length0
9. Practitioner.meta.security
Definition

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

Control0..*
BindingThe codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable Security Labels from the Healthcare Privacy and Security Classification System.
TypeCoding
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.

Max Length0
10. Practitioner.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.

Control1..*
Binding

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

TypeCoding
Must Supporttrue
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.

Max Length0
SlicingThis element introduces a set of slices on Practitioner.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
11. Practitioner.meta.tag:version
SliceNameversion
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.

Control1..1
BindingThe codes SHALL be taken from SharedSpecificationVersion (20210501)
TypeCoding
Must Supporttrue
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.

Max Length0
12. Practitioner.meta.tag:version.id
Definition

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

Control0..1
Typeid
Max Length0
13. Practitioner.meta.tag:version.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
14. Practitioner.meta.tag:version.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Must Supporttrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

Fixed value: https://fhir.infoway-inforoute.ca/CodeSystem/sharedspecificationversion

Max Length0
Fixed Valuehttps://fhir.infoway-inforoute.ca/CodeSystem/sharedspecificationversion
15. Practitioner.meta.tag:version.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Max Length0
16. Practitioner.meta.tag:version.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Max Length0
17. Practitioner.meta.tag:version.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Max Length0
18. Practitioner.meta.tag:version.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Max Length0
19. Practitioner.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.

Control0..1
Typeuri
Is Modifiertrue
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 as much as possible.

Max Length0
20. Practitioner.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language.
Typecode
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).

Max Length0
21. Practitioner.text
Definition

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

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Max Length0
22. Practitioner.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.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained 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.

Max Length0
23. Practitioner.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on Practitioner.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
24. Practitioner.extension:service
SliceNameservice
Definition

Identifies a electronic communication service offered by a service location or practitioner

Control0..*
TypeExtension(Entity Service) (Extension Type: Choice of: boolean, integer, decimal, base64Binary, instant, string, uri, date, dateTime, time, code, oid, id, unsignedInt, positiveInt, markdown, Annotation, Attachment, Identifier, CodeableConcept, Coding, Quantity, Range, Period, Ratio, SampledData, Signature, HumanName, Address, ContactPoint, Timing, Reference, Meta)
Must Supporttrue
Comments

Entity Service is used at this level, when the service registration process requires participation at both the Organization level and the Practitioner level. Both levels must be validated to confirm the outcome.

This is returned in the response when the service is determined to be active. It will be absent from the response when the service is no longer active.

Max Length0
25. Practitioner.modifierExtension
Definition

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

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
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.

Max Length0
26. Practitioner.identifier
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier(Shared Health Person Identifier)
Must Supporttrue
Requirements

Often, specific identities are assigned for the agent.

Comments

Two identifiers will be provided - the Provider Registry identifier, denoted by an Identifier.type code of 'PRN' and the provider license number, denoted by an Identifier.type.coding.code of 'LN'.

Conformance Rule: The Provider Registry identifier SHALL be sent if the practioner is the initiating practitioner for the tasks in a message. The Provider Registry identifier SHOULD be sent if known if the practitioner is being sent for other purposes (e.g. the prescriber of a prescription for which a renewal is being sought).

When transmitting the provider license number (always mandatory), the Identifier.type shall have a coding from the 'http://hl7.org/fhir/v2/0203' system of 'LN'. For the specific license type expressed as a urn (e.g. urn:oid:1.2.3.4). In a future version of this specification, we may be migrating from OIDs to more readable URL’s. You can plan for this in your design.

Conformance Rule: The second identifier provided will be the licence ID of the Prescriber. The assigning authority OID will be determined based on the licencing body; a list of which is found within the Vendor Implementation guide.

Max Length0
SlicingThis element introduces a set of slices on Practitioner.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
27. Practitioner.identifier:registry
SliceNameregistry
Definition

An identifier that applies to this person in this role.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
TypeIdentifier
Must Supporttrue
Requirements

Often, specific identities are assigned for the agent.

Comments

This is the same id as found on Practitioner.id, but expressed as a business identifier - it will remain the same as the Practitioner resource is stored on different systems.

In the context of Pharmacist Adapt (p170) and Pharmacist Prescribe (p190), no value will exist as pharmacists are not registered.

Max Length0
28. Practitioner.identifier:registry.id
Definition

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

Control0..1
Typeid
Max Length0
29. Practitioner.identifier:registry.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
30. Practitioner.identifier:registry.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known .
Typecode
Is Modifiertrue
Requirements

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

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Max Length0
31. Practitioner.identifier:registry.type
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control1..1
BindingThe codes SHALL be taken from IdentifierType (20210501); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Code)
Must Supporttrue
Requirements

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

Comments

-

Max Length0
Pattern Value<valueCodeableConcept xmlns="http://hl7.org/fhir">
  <coding>
    <system value="http://hl7.org/fhir/v2/0203"/>
    <code value="PRN"/>
  </coding>
</valueCodeableConcept>
32. Practitioner.identifier:registry.system
Definition

Establishes the namespace in which set of possible id values is unique.

Control1..1
Typeuri
Must Supporttrue
Requirements

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

Comments

Fixed value: http://sharedhealth.exchange/fhir/NamingSystem/registry-id-practitioner

Max Length0
Fixed Valuehttp://sharedhealth.exchange/fhir/NamingSystem/registry-id-practitioner
Example
General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
33. Practitioner.identifier:registry.value
Definition

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

Control1..1
Typestring
Must Supporttrue
Comments

Conformance Rule: This SHALL match the practitioner.id value.

Max Length0
Example
General:123456
34. Practitioner.identifier:registry.period
Definition

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

Control0..1
TypePeriod
Max Length0
35. Practitioner.identifier:registry.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
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.

Max Length0
36. Practitioner.identifier:license
SliceNamelicense
Definition

An identifier that applies to this person in this role.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..10
TypeIdentifier
Must Supporttrue
Requirements

Often, specific identities are assigned for the agent.

Comments

Conformance Rule: Only a single licence number can be submitted. For Prescriber's with multiple licence numbers, the licence number must be the one that the Prescriber is acting under the authority of when Prescribing.

In the context of Pharmacist Adapt (p170) and Pharmacist Prescribe (p190), populate with Pharmacist licensing body and license number

Max Length0
37. Practitioner.identifier:license.id
Definition

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

Control0..1
Typeid
Max Length0
38. Practitioner.identifier:license.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
39. Practitioner.identifier:license.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known .
Typecode
Is Modifiertrue
Requirements

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

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Max Length0
40. Practitioner.identifier:license.type
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control1..1
BindingThe codes SHALL be taken from IdentifierType (20210501); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Code Required and Text Required)
Must Supporttrue
Requirements

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

Comments

-

Max Length0
Pattern Value<valueCodeableConcept xmlns="http://hl7.org/fhir">
  <coding>
    <system value="http://hl7.org/fhir/v2/0203"/>
    <code value="LN"/>
  </coding>
</valueCodeableConcept>
41. Practitioner.identifier:license.system
Definition

Establishes the namespace in which set of possible id values is unique.

Control1..1
BindingThe codes SHALL be taken from SharedPractitionerIdentifierType
Typeuri
Must Supporttrue
Requirements

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

Comments

The jurisdictional licensing body (e.g. College of Physicians and Surgeons) that issued the practitioner’s license, chosen from terminology binding (this will be an OID expressed as a URI).

Max Length0
Example
General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
42. Practitioner.identifier:license.value
Definition

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

Control1..1
Typestring
Must Supporttrue
Comments

This is the Practitioner license number

Max Length0
Example
General:123456
43. Practitioner.identifier:license.period
Definition

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

Control0..1
TypePeriod
Max Length0
44. Practitioner.identifier:license.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
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.

Max Length0
45. Practitioner.active
Definition

Whether this practitioner's record is in active use.

Control0..1
Typeboolean
Requirements

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

Comments

Default is true. If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.

Max Length0
Default Valuetrue
46. Practitioner.name
Definition

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

Control1..1
TypeHumanName(Shared Health HumanName)
Must Supporttrue
Requirements

The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.

Comments

Usage Note: The last name provided within this segment is validated against the name in the SAML token. It is also used to populate faxes during the “fail to fax” scenario.

Max Length0
47. Practitioner.telecom
Definition

This segment provide methods of contacting the practitioner. Only numbers that have authorized to be disclosed by the practitioner should be included. For example, most practitioners do not authorize the disclosure of their cell phone number to pharmacies.

Control0..*
TypeContactPoint(Shared Health ContactPoint)
Must Supporttrue
Requirements

Need to know how to reach a practitioner independent to any roles the practitioner may have.

Comments

-

Max Length0
InvariantsDefined on this element
cpt-2: A system is required if a value is provided. (: value.empty() or system.exists())
48. Practitioner.address
Definition

Address(es) of the practitioner that are not role specific (typically home address). Work addresses are not typically entered in this property as they are usually role dependent.

Control0..*
TypeAddress
Requirements

The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.

Comments

The PractitionerRole does not have an address value on it, as it is expected that the location property be used for this purpose (which has an address).

Max Length0
49. Practitioner.gender
Definition

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

Control0..1
BindingThe codes SHALL be taken from AdministrativeGender The gender of a person used for administrative purposes.
Typecode
Requirements

Needed to address the person correctly.

Max Length0
50. Practitioner.birthDate
Definition

The date of birth for the practitioner.

Control0..1
Typedate
Requirements

Needed for identification.

Max Length0
51. Practitioner.photo
Definition

Image of the person.

Control0..*
TypeAttachment
Requirements

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

Max Length0
52. Practitioner.practitionerRole
Definition

The list of roles/organizations that the practitioner is associated with.

Control0..*
TypeBackboneElement
Must Supporttrue
Comments

The address to be used for this PractitionerRole is in the referenced location (removing duplication across all the services provided at the location).

Max Length0
InvariantsDefined on this element
practitionerRole-1: Must have at least one of organization and role (: organization.exists() or role.exists())
53. Practitioner.practitionerRole.id
Definition

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

Control0..1
Typeid
Max Length0
54. Practitioner.practitionerRole.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
55. Practitioner.practitionerRole.modifierExtension
Definition

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

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

Max Length0
56. Practitioner.practitionerRole.organization
Definition

A reference from one resource to another.

Control0..1 This element is affected by the following invariants: practitionerRole-1
TypeReference(Shared Health Reference)(Shared Health Organization - Provider Registry)
Must Supporttrue
Max Length0
57. Practitioner.practitionerRole.organization.id
Definition

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

Control0..1
Typeid
Max Length0
58. Practitioner.practitionerRole.organization.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
59. Practitioner.practitionerRole.organization.reference
Definition

This is a reference to the resource within the current bundle that represents the organization the practitioner is working for.

Control1..1 This element is affected by the following invariants: ref-1
Typestring
Must Supporttrue
Comments

-

Max Length0
60. Practitioner.practitionerRole.organization.display
Definition

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

Control0..1
Typestring
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.

Max Length0
61. Practitioner.practitionerRole.role
Definition

In the context of EMR messages: The prescribers role that is associated to the prescribers license number in the context the clinical event this message is related to.

In the context of PMS messages: The prescribers role that is associated to the prescribers license number in the context the event this message is related to.

In the context of PR Query Responses: The prescribers role that is associated to the prescribers license number. The prescriber can only have 1 role per license number.

Control0..1 This element is affected by the following invariants: practitionerRole-1
BindingThe codes SHALL be taken from SharedPractitionerRole (20190415)
TypeCodeableConcept(Shared Health CodeableConcept Code)
Must Supporttrue
Requirements

Need to know what authority the practitioner has - what can they do?

Comments

In the context of EMR messages: Conformance Rule: EMR vendors must populate this segment with the associated prescribers role that is related to the license number that is being submitted in the message. The role that is stored and submitted must match the prescribers registered role within the PrescribeIT Provider Registry.

In the context of PMS messages: Conformance Rule: PMS vendors should populate this segment with the associated prescribers role that is related to the license number that is being submitted in the message.

In the context of Query Response, the prescriber role as associated to the license number will be returned.

Max Length0
62. Practitioner.practitionerRole.role.id
Definition

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

Control0..1
Typeid
Max Length0
63. Practitioner.practitionerRole.role.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
64. Practitioner.practitionerRole.role.coding
Definition

A reference to a code defined by a terminology system.

Control1..*
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

-

Max Length0
65. Practitioner.practitionerRole.role.coding.id
Definition

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

Control0..1
Typeid
Max Length0
66. Practitioner.practitionerRole.role.coding.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
67. Practitioner.practitionerRole.role.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Must Supporttrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

This is the URI that represents the coding system as defined within the binding.

Max Length0
68. Practitioner.practitionerRole.role.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Max Length0
69. Practitioner.practitionerRole.role.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

This is the code as defined within the binding.

Max Length0
70. Practitioner.practitionerRole.role.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Must Supporttrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Max Length0
71. Practitioner.practitionerRole.role.coding.display.id
Definition

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

Control0..1
Typeid
72. Practitioner.practitionerRole.role.coding.display.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Practitioner.practitionerRole.role.coding.display.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
73. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation
SliceNameroleTranslation
Definition

An expression of the original string in an alternate language.

Control0..1
TypeExtension(translation) (Extension Type: string)
Must Supporttrue
Comments

string-translation elements should not have string-translation extensions (i.e. all translations should be expressed as siblings, not as a translation hierarchy) to simplify processing.

Max Length0
74. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.id
Definition

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

Control0..1
Typeid
75. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.extension
Definition

An Extension

Control0..0
TypeExtension
Max Length0
76. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.url
Definition

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

Control1..1
Typeuri
Must Supporttrue
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition should be version specific. This will ideally be the URI for the Resource Profile defining the extension, with the code for the extension after a #.

Max Length0
Fixed Valuehttp://hl7.org/fhir/StructureDefinition/iso21090-ST-translation
77. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control1..1
Typestring
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Max Length0
78. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.value[x].id
Definition

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

Control0..1
Typeid
79. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.value[x].extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Practitioner.practitionerRole.role.coding.display.extension.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
80. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.value[x].extension:roleTranslationLanguage
SliceNameroleTranslationLanguage
Definition

The language in which the string is expressed.

Control1..1
TypeExtension(language) (Extension Type: code)
Must Supporttrue
Max Length0
81. Practitioner.practitionerRole.role.coding.display.extension:roleTranslation.value[x].value
Definition

The actual value

Control0..1
Typestring
Max Length1048576
82. Practitioner.practitionerRole.role.coding.display.value
Definition

The actual value

Control0..1
Typestring
Max Length1048576
83. Practitioner.practitionerRole.role.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Max Length0
84. Practitioner.practitionerRole.role.text
Definition

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

Control0..1
Typestring
Requirements

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

Comments

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

Max Length0
85. Practitioner.practitionerRole.specialty
Definition

The area(s) of medicine that a prescriber specializes in (i.e. Cardiology, Pediatrics, Oncology etc.)

Control0..*
BindingFor example codes, see PractitionerSpecialty Specific specialty associated with the agency
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
Must Supporttrue
Comments

In the context of PR Query Response, at the present time, the prescriber specialty as recorded will be returned as text only in both English and French. Coding will not be returned.

Conformance Rule: Vendors must populate this segment with the associated prescribers specialties. If a prescriber does not have a specialty the same value that is sent as the role can be sent as the specialty value.

Max Length0
86. Practitioner.practitionerRole.specialty.id
Definition

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

Control0..1
Typeid
Max Length0
87. Practitioner.practitionerRole.specialty.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
88. Practitioner.practitionerRole.specialty.coding
Definition

A reference to a code defined by a terminology system.

Control0..1
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

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

Max Length0
89. Practitioner.practitionerRole.specialty.coding.id
Definition

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

Control0..1
Typeid
Max Length0
90. Practitioner.practitionerRole.specialty.coding.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
91. Practitioner.practitionerRole.specialty.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Must Supporttrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

This is the URI that represents the coding system as defined within the binding.

Max Length0
92. Practitioner.practitionerRole.specialty.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Max Length0
93. Practitioner.practitionerRole.specialty.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

This is the code as defined within the binding.

Max Length0
94. Practitioner.practitionerRole.specialty.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Max Length0
95. Practitioner.practitionerRole.specialty.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Max Length0
96. Practitioner.practitionerRole.specialty.text
Definition

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

Control1..1
Typestring
Must Supporttrue
Requirements

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

Comments

If a free text description of the practitioner’s specialty is available, it must be provided here. If no free text description is available, the value from practitionerRole(practitionerSpecialty).role.coding.display must be provided here.

In the context of Pharmacist Adapt (p170) and Pharmacist Prescribe (p190), populate with 'Pharmacist'

Max Length2500
97. Practitioner.practitionerRole.specialty.text.id
Definition

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

Control0..1
Typeid
98. Practitioner.practitionerRole.specialty.text.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Practitioner.practitionerRole.specialty.text.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
99. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation
SliceNamespecialtyTranslation
Definition

An expression of the original string in an alternate language.

Control0..1
TypeExtension(translation) (Extension Type: string)
Must Supporttrue
Comments

string-translation elements should not have string-translation extensions (i.e. all translations should be expressed as siblings, not as a translation hierarchy) to simplify processing.

Max Length0
100. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.id
Definition

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

Control0..1
Typeid
101. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.extension
Definition

An Extension

Control0..0
TypeExtension
Max Length0
102. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.url
Definition

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

Control1..1
Typeuri
Must Supporttrue
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition should be version specific. This will ideally be the URI for the Resource Profile defining the extension, with the code for the extension after a #.

Max Length0
Fixed Valuehttp://hl7.org/fhir/StructureDefinition/iso21090-ST-translation
103. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control1..1
Typestring
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Max Length0
104. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.value[x].id
Definition

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

Control0..1
Typeid
105. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.value[x].extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Practitioner.practitionerRole.specialty.text.extension.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
106. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.value[x].extension:specialtyTranslationLanguage
SliceNamespecialtyTranslationLanguage
Definition

The language in which the string is expressed.

Control1..1
TypeExtension(language) (Extension Type: code)
Must Supporttrue
Max Length0
107. Practitioner.practitionerRole.specialty.text.extension:specialtyTranslation.value[x].value
Definition

The actual value

Control0..1
Typestring
Max Length1048576
108. Practitioner.practitionerRole.specialty.text.value
Definition

The actual value

Control0..1
Typestring
Max Length1048576
109. Practitioner.practitionerRole.identifier
Definition

Business Identifiers that are specific to a role/location.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Requirements

Some business identifiers are specific to a location and should be able to be associated.

Max Length0
110. Practitioner.practitionerRole.telecom
Definition

Contact details that are specific to the role/location/service.

Control0..*
TypeContactPoint
Requirements

Often practitioners have a dedicated line for each location (or service) that they work at, and need to be able to define separate contact details for each of these.

Max Length0
111. Practitioner.practitionerRole.period
Definition

The period during which the person is authorized to act as a practitioner in these role(s) for the organization.

Control0..1
TypePeriod
Requirements

Even after the agencies is revoked, the fact that it existed must still be recorded.

Max Length0
112. Practitioner.practitionerRole.location
Definition

The location(s) at which this practitioner provides care.

Control0..*
TypeReference(Location)
Max Length0
113. Practitioner.practitionerRole.healthcareService
Definition

The list of healthcare services that this worker provides for this role's Organization/Location(s).

Control0..*
TypeReference(HealthcareService)
Max Length0
114. Practitioner.qualification
Definition

Qualifications obtained by training and certification.

Control0..*
TypeBackboneElement
Max Length0
115. Practitioner.qualification.id
Definition

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

Control0..1
Typeid
Max Length0
116. Practitioner.qualification.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
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.

Max Length0
117. Practitioner.qualification.modifierExtension
Definition

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

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

Max Length0
118. Practitioner.qualification.identifier
Definition

An identifier that applies to this person's qualification in this role.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Requirements

Often, specific identities are assigned for the qualification.

Max Length0
119. Practitioner.qualification.code
Definition

Coded representation of the qualification.

Control1..1
BindingFor example codes, see ANZSCO -- Australian and New Zealand Standard Classification of Occupations, 2013, Version 1.2 Specific qualification the practitioner has to provide a service
TypeCodeableConcept
Max Length0
120. Practitioner.qualification.period
Definition

Period during which the qualification is valid.

Control0..1
TypePeriod
Requirements

Qualifications are often for a limited period of time, and can be revoked.

Max Length0
121. Practitioner.qualification.issuer
Definition

Organization that regulates and issues the qualification.

Control0..1
TypeReference(Organization)
Max Length0
122. Practitioner.communication
Definition

This will convey the language of the User who is sending the request.

Control1..*
BindingThe codes SHALL be taken from SharedCommunicationLanguage (20170626)
TypeCodeableConcept(Shared Health CodeableConcept Code Required with Text Optional)
Must Supporttrue
Requirements

Knowing which language a practitioner speaks can help in facilitating communication with patients.

Comments

Conformance Rule: Text is optionally supported and if communication is French, can be set to French.

In the context of PR Practitioner or Organization Search, this represents the Practitioner's spoken languages (e.g. en-CA for English and fr-CA for French. If both languages are present it means that Practitioner is bilingual.

Max Length0