Shared Health Specification and Guide Version 5.0


v5.2 of this specification has been superseded by v5.3.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-patient-903 Profile.

1. Patient
Definition

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

Control0..*
Must Supporttrue
Alternate NamesSubjectOfCare Client Resident
Max Length0
2. Patient.id
Definition

The logical id of the resource, as used in the URL for the resource.

Control1..1
Typeid
Must Supporttrue
Comments

Usage Note: This will usually be a GUID and is assigned by the sending application.

Max Length0
3. Patient.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.

Control0..1
TypeMeta
Max Length0
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.

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
5. Patient.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
6. Patient.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
7. 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.

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
8. Patient.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. 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
9. 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. 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
10. Patient.identifier
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier(Shared Health Person Identifier)
Must Supporttrue
Requirements

Patients are almost always assigned specific numerical identifiers.

Comments

Conformance Rule: This will be the OID representing the jurisdictional health number.

Usage Note: If both a federal and provincial health number are available, provide the provincial health number.

Conformance Rule: If the jurisdictional identifier is available, it must be sent.

Max Length0
11. Patient.identifier.id
Definition

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

Control0..1
Typeid
Max Length0
12. Patient.identifier.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on Patient.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
13. Patient.identifier.extension:phn-version
SliceNamephn-version
Definition

Indicates the version number associated with a provincial health numner

Control0..1
TypeExtension(Patient PHN version) (Extension Type: string)
Must Supporttrue
Max Length0
14. Patient.identifier.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
15. Patient.identifier.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 SharedIdentifierType (20190415); 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
16. Patient.identifier.type.id
Definition

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

Control0..1
Typeid
Max Length0
17. Patient.identifier.type.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
18. Patient.identifier.type.coding
Definition

A reference to a code defined by a terminology system.

Control1..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
19. Patient.identifier.type.coding.id
Definition

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

Control0..1
Typeid
Max Length0
20. Patient.identifier.type.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
21. Patient.identifier.type.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

Fixed value: http://hl7.org/fhir/v2/0203

Max Length0
Fixed Valuehttp://hl7.org/fhir/v2/0203
22. Patient.identifier.type.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
23. Patient.identifier.type.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

Fixed value: JHN

Max Length0
Fixed ValueJHN
24. Patient.identifier.type.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
25. Patient.identifier.type.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
26. Patient.identifier.type.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
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

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

Max Length0
27. Patient.identifier.system
Definition

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

Control1..1
BindingThe codes SHALL be taken from SharedPatientJurisdictionalHealthIdentifierType
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.

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

Control1..1
Typestring
Must Supporttrue
Comments

Conformance Rule: This is the human readable Patient Identifier from the sending system

Max Length0
Example
General:123456
???:123456
29. Patient.identifier.period
Definition

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

Control0..1
TypePeriod
Max Length0
30. Patient.identifier.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
31. Patient.active
Definition

Whether this patient record is in active use.

Control0..1
Typeboolean
Is Modifiertrue
Requirements

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

Comments

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

Max Length0
Default Valuetrue
32. Patient.name
Definition

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

Control1..3
TypeHumanName(Shared Health HumanName)
Must Supporttrue
Requirements

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

Comments

This data type is used to support both Practitioner names and Patient names. These name values are used for SAML validation (Practitioner) and eFax generation, and possibly patient matching algorithms.

Conformance Rule: For the purpose of presentation, the data elements will be organized as Prefix + Given1 + Given2 + Family + Suffix.

Max Length0
SlicingThis element introduces a set of slices on Patient.name. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ use
33. Patient.name:legalName
SliceNamelegalName
Definition

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

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

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

Comments

This data type is used to support both Practitioner names and Patient names. These name values are used for SAML validation (Practitioner) and eFax generation, and possibly patient matching algorithms.

Conformance Rule: For the purpose of presentation, the data elements will be organized as Prefix + Given1 + Given2 + Family + Suffix.

Max Length0
34. Patient.name:legalName.id
Definition

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

Control0..1
Typeid
Max Length0
35. Patient.name:legalName.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
36. Patient.name:legalName.use
Definition

Identifies the purpose for this name.

Control1..1
BindingThe codes SHALL be taken from SharedNameUse (20190415)
Typecode
Is Modifiertrue
Must Supporttrue
Requirements

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

Comments

Fixed value: official

Max Length0
Fixed Valueofficial
37. Patient.name:legalName.text
Definition

A full text representation of the name.

Control0..1
Typestring
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and structured parts.

Max Length0
38. Patient.name:legalName.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.

Control1..1
Typestring
Must Supporttrue
Alternate Namessurname
Comments

Conformance rule: Family is not to include professional designations

Max Length0
39. Patient.name:legalName.given
Definition

Given name.

Control1..2
Typestring
Must Supporttrue
Alternate Namesfirst name, middle name
Comments

Conformance Rule: Given name(s) is not to include profession designations

Max Length0
40. Patient.name:legalName.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.

Control0..1
Typestring
Must Supporttrue
Comments

Conformance Rule: Prefix or Suffix must be used for Practitioner to represent the appropriate professional designation.

Max Length0
41. Patient.name:legalName.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.

Control0..1
Typestring
Must Supporttrue
Comments

Conformance Rule: Prefix or Suffix must be used for Practitioner to represent the appropriate professional designation.

Max Length0
42. Patient.name:legalName.period
Definition

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

Control0..1
TypePeriod
Requirements

Allows names to be placed in historical context.

Max Length0
43. Patient.telecom
Definition

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

Control0..*
TypeContactPoint
Requirements

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

Comments

A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address may 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).

Max Length0
44. Patient.gender
Definition

Administrative Gender - the gender that the patient 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 for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.

Comments

The gender may 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 M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, 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, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error.

Max Length0
45. Patient.birthDate
Definition

The date of birth for the individual.

Control1..1
Typedate
Must Supporttrue
Requirements

Age of the individual drives many clinical processes.

Comments

Usage Note: It is expected that the real date of birth is known by the prescriber and pharmacy and that the full date of birth must be submitted.

Max Length0
LOINC Code21112-8
46. Patient.deceased[x]
Definition

Indicates if the individual is deceased or not.

Control0..1
TypeChoice of: boolean, dateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifiertrue
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.

Comments

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

Max Length0
47. Patient.address
Definition

Addresses for the individual.

Control0..*
TypeAddress
Requirements

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

Comments

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

Max Length0
48. Patient.maritalStatus
Definition

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

Control0..1
BindingThe codes SHALL be taken from Marital Status Codes The domestic partnership status of a person.
TypeCodeableConcept
Requirements

Most, if not all systems capture it.

Max Length0
49. Patient.multipleBirth[x]
Definition

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

Control0..1
TypeChoice of: boolean, integer
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

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

Comments

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

Max Length0
50. Patient.photo
Definition

Image of the patient.

Control0..*
TypeAttachment
Requirements

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

Max Length0
51. Patient.contact
Definition

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

Control0..*
TypeBackboneElement
Requirements

Need to track people you can contact about 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.

Max Length0
InvariantsDefined on this element
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())
52. Patient.contact.id
Definition

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

Control0..1
Typeid
Max Length0
53. Patient.contact.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
54. 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 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
55. Patient.contact.relationship
Definition

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

Control0..*
BindingThe codes SHALL be taken from PatientContactRelationship; other codes may be used where these codes are not suitable The nature of the relationship between a patient and a contact person for that patient.
TypeCodeableConcept
Requirements

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

Max Length0
56. Patient.contact.name
Definition

A name associated with the contact person.

Control0..1
TypeHumanName
Requirements

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

Max Length0
57. Patient.contact.telecom
Definition

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

Control0..*
TypeContactPoint
Requirements

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

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.

Max Length0
58. Patient.contact.address
Definition

Address for the contact person.

Control0..1
TypeAddress
Requirements

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

Max Length0
59. Patient.contact.gender
Definition

Administrative Gender - the gender that the contact 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
60. Patient.contact.organization
Definition

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

Control0..1 This element is affected by the following invariants: pat-1
TypeReference(Organization)
Requirements

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

Max Length0
61. Patient.contact.period
Definition

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

Control0..1
TypePeriod
Max Length0
62. Patient.animal
Definition

This patient is known to be an animal.

Control0..1
TypeBackboneElement
Is Modifiertrue
Requirements

Many clinical systems are extended to care for animal patients as well as human.

Comments

The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

Max Length0
63. Patient.animal.id
Definition

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

Control0..1
Typeid
Max Length0
64. Patient.animal.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
65. Patient.animal.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
66. Patient.animal.species
Definition

Identifies the high level taxonomic categorization of the kind of animal.

Control1..1
BindingFor example codes, see AnimalSpecies The species of an animal.
TypeCodeableConcept
Requirements

Need to know what kind of animal.

Comments

If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).

Max Length0
67. Patient.animal.breed
Definition

Identifies the detailed categorization of the kind of animal.

Control0..1
BindingFor example codes, see AnimalBreeds The breed of an animal.
TypeCodeableConcept
Requirements

May need to know the specific kind within the species.

Comments

Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.

Max Length0
68. Patient.animal.genderStatus
Definition

Indicates the current state of the animal's reproductive organs.

Control0..1
BindingFor example codes, see GenderStatus The state of the animal's reproductive organs.
TypeCodeableConcept
Requirements

Gender status can affect housing and animal behavior.

Max Length0
69. Patient.communication
Definition

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

Control0..*
TypeBackboneElement
Requirements

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

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.

Max Length0
70. Patient.communication.id
Definition

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

Control0..1
Typeid
Max Length0
71. Patient.communication.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
72. 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 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
73. 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.

Control1..1
BindingThe codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language.
TypeCodeableConcept
Requirements

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

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.

Max Length0
74. Patient.communication.preferred
Definition

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

Control0..1
Typeboolean
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.

Comments

This language is specifically identified for communicating healthcare information.

Max Length0
75. Patient.careProvider
Definition

Patient's nominated care provider.

Control0..*
TypeReference(Organization | Practitioner)
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles. This is not to be used to record Care Teams, these should be recorded on either the CarePlan or EpisodeOfCare resources.

Max Length0
76. Patient.managingOrganization
Definition

Organization that is the custodian of the patient record.

Control0..1
TypeReference(Organization)
Requirements

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

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).

Max Length0
77. Patient.link
Definition

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

Control0..*
TypeBackboneElement
Is Modifiertrue
Requirements

There are multiple usecases: * Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers.

Comments

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

Max Length0
78. Patient.link.id
Definition

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

Control0..1
Typeid
Max Length0
79. Patient.link.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
80. 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 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
81. Patient.link.other
Definition

The other patient resource that the link refers to.

Control1..1
TypeReference(Patient)
Is Modifiertrue
Max Length0
82. Patient.link.type
Definition

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

Control1..1
BindingThe codes SHALL be taken from LinkType The type of link between this patient resource and another patient resource.
Typecode
Is Modifiertrue
Max Length0