Shared Health Specification and Guide Version 5.0

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

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

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.

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.

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

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.

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.

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.

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.

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

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.

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

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.

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

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.

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.

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

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.

• value @ system

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.

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.

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

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.

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.

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

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

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

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.

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.

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).

Need to refer to a particular code in the system.

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

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

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

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.

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.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

The base language in which the resource is written.

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).

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.

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

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.

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.

An Extension

• value @ url

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

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.

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.

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.

A technical identifier - identifies some entity uniquely and unambiguously.

Often, specific identities are assigned for the agent.

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.

• pattern @ type

An identifier that applies to this person in this role.

Often, specific identities are assigned for the agent.

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.

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

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.

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.

The purpose of this identifier.

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

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.

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

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

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

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.

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

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

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

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

Organization that issued/manages the identifier.

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.

An identifier that applies to this person in this role.

Often, specific identities are assigned for the agent.

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.

In the context of TPR Cache, PrescribeIT® searches for the most recent role based on either create date or update date, and returns that role and the associated specialty in the TPR Query Response.

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

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.

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.

The purpose of this identifier.

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

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.

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

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

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

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.

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).

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

This is the Practitioner license number

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

Organization that issued/manages the identifier.

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.

Whether this practitioner's record is in active use.

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

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.

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

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.

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.

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.

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

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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.

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.

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).

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

Needed to address the person correctly.

The date of birth for the practitioner.

Needed for identification.

Image of the person.

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

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

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

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

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.

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.

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.

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.

A reference from one resource to another.

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

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.

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.

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

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

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.

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.

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

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.

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

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.

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.

A reference to a code defined by a terminology system.

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

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

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.

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.

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

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

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

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.

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.

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).

Need to refer to a particular code in the system.

This is the code as defined within the binding.

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

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

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

An Extension

• value @ url

An expression of the original string in an alternate language.

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.

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

An Extension

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

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 #.

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

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

An Extension

• value @ url

The language in which the string is expressed.

The actual value

The actual value

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

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.

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.

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.

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.

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

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

At the present time, the Provider Registry Query Response will return the prescriber specialty as text only, in both English and French. Coding will not be returned.

Although multiple specialties are supported, the Provider Registry Query Response will return only the most recent specialty associated with that practitioner/organization, multiple specialties will not be returned at the present time.

Note: multiple specialties can be provided when the EMR/PMS are providing the practitioner information as part of the messages they are creating and sending.

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

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.

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.

A reference to a code defined by a terminology system.

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

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.

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

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.

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.

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

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

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

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.

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.

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).

Need to refer to a particular code in the system.

This is the code as defined within the binding.

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

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

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

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.

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.

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.

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.

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'

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

An Extension

• value @ url

An expression of the original string in an alternate language.

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.

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

An Extension

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

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 #.

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

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

An Extension

• value @ url

The language in which the string is expressed.

The actual value

The actual value

Business Identifiers that are specific to a role/location.

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

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

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.

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

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

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

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

Qualifications obtained by training and certification.

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

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.

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.

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.

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.

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

Often, specific identities are assigned for the qualification.

Coded representation of the qualification.

Period during which the qualification is valid.

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

Organization that regulates and issues the qualification.

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

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

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.