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        CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
        2.0.0 - Release 2 US

        This page is part of the NHSN Digital Quality Measures (dQM) Content Package Implementation Guide (v2.0.0: Release) based on FHIR (HL7? FHIR? Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

        Resource Profile: CrossMeasurePatient - Detailed Descriptions

        Page standards status: Trial-use Maturity Level: 2

        Definitions for the cross-measure-patient resource profile.

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

        0. Patient
        Definition

        -


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

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

        -

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

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

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

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

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

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

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

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

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

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

        • American Indian or Alaska Native
        • Asian
        • Black or African American
        • Native Hawaiian or Other Pacific Islander
        • White.
        Short (NHSN-MS) US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
        Control 0..1
        This element is affected by the following invariants: ele-1
        Type Extension(US Core Race Extension) (Complex Extension)
        Is Modifier false
        Must Support true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        8. Patient.extension:ethnicity
        Slice Name ethnicity
        Definition

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

        Short (NHSN-MS) US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
        Control 0..1
        This element is affected by the following invariants: ele-1
        Type Extension(US Core Ethnicity Extension) (Complex Extension)
        Is Modifier false
        Must Support true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        10. Patient.extension:tribalAffiliation
        Slice Name tribalAffiliation
        Definition

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

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

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

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

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

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

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

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

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

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

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

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

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

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

        Short Extensions that cannot be ignored
        Comments

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

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summary false
        Requirements

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

        Alternate Names extensions, user content
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. Patient.identifier
        Definition

        An identifier for this patient.

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

        Patients are almost always assigned specific numerical identifiers.

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

        The purpose of this identifier.

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

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

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

        Identifies the purpose for this identifier, if known .

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

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

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

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

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

        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

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

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

        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary true
        Requirements

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

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

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

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

        Identifier.system is always case sensitive.

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

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

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

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

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

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

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

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

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

        Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

        It is often used to filter patient lists to exclude inactive patients

        Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

        Short Whether this patient's record is in active use
        Comments

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

        Control 0..1
        Type boolean
        Is Modifier true because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Requirements

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

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

        A name associated with the individual.

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

        A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

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

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

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

        Identifies the purpose for this name.

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

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

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

        The use of a human name.

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

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

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

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

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

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

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

        A renderable, unencoded form.

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

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

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

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

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

        Given name.

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

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

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

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

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

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

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

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

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

        Allows names to be placed in historical context.

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

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

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

        A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

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

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

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

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

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

        Telecommunications form for contact point.

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

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

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

        Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

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

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

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

        Identifies the purpose for the contact point.

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

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

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

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

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

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

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

        Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

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

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

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

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

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

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

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

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

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

        The date of birth for the individual.

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

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

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

        Age of the individual drives many clinical processes.

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

        Indicates if the individual is deceased or not.

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

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


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

        Control 0..1
        Type Choice of: boolean, dateTime
        [x] Note SeeChoice of Data Typesfor further information about how to use [x]
        Is Modifier true because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Must Support Types No must-support rules about the choice of types/profiles
        Summary true
        Requirements

        The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

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

        An address for the individual.

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

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

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

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

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

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

        Short Preferred
        Comments

        Make general extension.

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

        The purpose of this address.

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

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

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

        The use of an address.

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

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

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

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

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

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


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

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

        The type of an address (physical / postal).

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

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

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

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

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

        A renderable, unencoded form.

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

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

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

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

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

        The name of the administrative area (county).

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

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

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

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

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

        Two Letter USPS alphabetic codes.

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

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

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

        Country - a nation as commonly understood or generally accepted.

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

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

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

        Time period when address was/is in use.

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

        Allows addresses to be placed in historical context.

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

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

        Short icon Changed:(NHSN-MS) A contact party (e.g. guardian, partner, friend) for the patientA contact party (e.g. guardian, partner, friend) for the patient
        Comments

        Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

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

        Need to track people you can contact about the patient.

        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
        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())
        96. Patient.contact.modifierExtension
        Definition

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

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

        Short Extensions that cannot be ignored even if unrecognized
        Comments

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

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summary true
        Requirements

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

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

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

        Short icon Changed:(NHSN-MS) The kind of relationshipThe kind of relationship
        Control 0..*
        Binding Unless not suitable, these codes SHALL be taken from PatientContactRelationshiphttp://hl7.org/fhir/ValueSet/patient-contactrelationship|4.0.1
        (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

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

        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary false
        Requirements

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

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

        A name associated with the contact person.

        Short icon Changed:(NHSN-MS) A name associated with the contact personA name associated with the contact person
        Control 0..1
        Type HumanName
        Is Modifier false
        Must Support true
        Summary false
        Requirements

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

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

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

        Short icon Changed:(NHSN-MS) A contact detail for the contact personA contact detail for the person
        Comments

        Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

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

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

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

        Address for the contact person.

        Short icon Changed:(NHSN-MS) Address for the contact personAddress for the contact person
        Control 0..1
        Type Address
        Is Modifier false
        Must Support true
        Summary false
        Requirements

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

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

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

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

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

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

        If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

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

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

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

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

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

        Short Extensions that cannot be ignored even if unrecognized
        Comments

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

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summary true
        Requirements

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

        Alternate Names extensions, user content, modifiers
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        112. Patient.communication.language
        Definition

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

        Short icon Changed:(NHSN-MS)(USCDI) The language which can be used to communicate with the patient about his or her healthThe language which can be used to communicate with the patient about his or her health
        Comments

        The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

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

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

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

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

        Short icon Changed:(NHSN-MS)(USCDI) Language preference indicatorLanguage preference indicator
        Comments

        This language is specifically identified for communicating healthcare information.

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

        People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

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

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

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

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

        Control 0..*
        Type BackboneElement
        Is Modifier true because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
        Must Support true
        Summary true
        Requirements

        There are multiple use cases:

        • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
        • Distribution of patient information across multiple servers.
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        118. Patient.link.modifierExtension
        Definition

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

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

        Short Extensions that cannot be ignored even if unrecognized
        Comments

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

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summary true
        Requirements

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

        Alternate Names extensions, user content, modifiers
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        120. Patient.link.other
        Definition

        The other patient resource that the link refers to.

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

        Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

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

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

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

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

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

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

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

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

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

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

        0. Patient
        Short icon Added:(NHSN-MS) A patient who is the subject of the measure report. This resource is required for all NHSN dQMs and must be referenced in all Individual MeasureReport resources for these measures.
        Control icon Added:1..?
        Must Support icon Added:true
        Complies with Profile This profile complies with the profile
        Invariants icon Added:patient-full-name: name.given and name.family are present in at least one name. (name.where(family.exists() and given.exists()).exists())
        2. Patient.id
        Short icon Added:(NHSN-MS) The logical id of the Patient resource
        Control 1..?
        Must Support icon Added:true
        4. Patient.meta
        6. Patient.meta.extension:link-received-date-extension
        Slice Name link-received-date-extension
        Control 0..1
        Type Extension(Received Date) (Extension Type: dateTime)
        8. Patient.extension:race
        Slice Name race
        Short icon Changed:(NHSN-MS) US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
        Must Support icon Added:true
        10. Patient.extension:ethnicity
        Slice Name ethnicity
        Short icon Changed:(NHSN-MS) US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
        Must Support icon Added:true
        icon Added: 12. Patient.extension:tribalAffiliation
        Slice Name tribalAffiliation
        Short (NHSN-MS) US Core Tribal Affiliation Extension
        Must Support true
        icon Added: 14. Patient.extension:birthsex
        Slice Name birthsex
        Short (NHSN-MS) US Core Birth Sex Extension
        Must Support true
        icon Added: 16. Patient.extension:sex
        Slice Name sex
        Short (NHSN-MS) US Core Sex Extension
        Must Support true
        icon Added: 18. Patient.identifier
        Short (NHSN-MS)(USCDI) An identifier for this patient
        Note This is a business identifier, not a resource identifier (see discussion)
        20. Patient.identifier.use
        Short (NHSN-MS) The purpose of this identifier usual | official | temp | secondary | old (If known)
        Must Support true
        22. Patient.identifier.type
        Short (NHSN-MS) Description of identifier
        Must Support true
        24. Patient.identifier.system
        Short (NHSN-MS)(USCDI) The namespace for the identifier value
        26. Patient.identifier.value
        Short (NHSN-MS)(USCDI) The value that is unique within the system.
        28. Patient.identifier.period
        Short (NHSN-MS) Time period when id is/was valid for use
        Must Support true
        icon Added: 30. Patient.name
        Short (NHSN-MS)(USCDI) A name associated with the patient
        32. Patient.name.use
        Short (NHSN-MS)(QI-Core)(USCDI) usual | official | temp | nickname | anonymous | old | maiden
        Must Support true
        34. Patient.name.text
        Short (NHSN-MS) A full text representation of the name
        Must Support true
        36. Patient.name.family
        Short (NHSN-MS)(USCDI) Family name (often called 'Surname')
        38. Patient.name.given
        Short (NHSN-MS)(USCDI) Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
        40. Patient.name.prefix
        Short (NHSN-MS) Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
        Must Support true
        42. Patient.name.suffix
        Short (NHSN-MS)(QI-Core)(USCDI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
        Must Support true
        44. Patient.name.period
        Short (NHSN-MS)(QI-Core)(USCDI) Time period when name was/is in use
        Must Support true
        icon Added: 46. Patient.telecom
        Short (NHSN-MS)(QI-Core)(USCDI) A contact detail for the individual
        Must Support true
        48. Patient.telecom.system
        Short (NHSN-MS)(USCDI) The type of contact point phone | fax | email | pager | url | sms | other
        50. Patient.telecom.value
        Short (NHSN-MS)(USCDI) The actual contact point details
        52. Patient.telecom.use
        Short (NHSN-MS)(USCDI) home | work | temp | old | mobile - purpose of this contact point
        54. Patient.telecom.rank
        Short (NHSN-MS) Specify preferred order of use (1 = highest)
        Must Support true
        56. Patient.telecom.period
        Short (NHSN-MS) Time period when the contact point was/is in use
        Must Support true
        icon Added: 58. Patient.gender
        Short (NHSN-MS)(USCDI)(USCDI) The administrative gender of the patient male | female | other | unknown
        60. Patient.birthDate
        Short icon Added:(NHSN-MS)(QI-Core)(USCDI) The date of birth for the individual
        Control 1..?
        LOINC Code
        62. Patient.deceased[x]
        Short icon Added:(NHSN-MS)(QI-Core)(USCDI) Indicates if the individual is deceased or not
        [x] Note SeeChoice of Data Typesfor further information about how to use [x]
        Must Support true
        icon Added: 64. Patient.address
        Short (NHSN-MS)(QI-Core)(USCDI) An address for the individual
        66. Patient.address.use
        Short (NHSN-MS)(QI-Core)(USCDI) home | work | temp | old | billing - purpose of this address
        Must Support true
        68. Patient.address.type
        Short (NHSN-MS) postal | physical | both
        Must Support true
        70. Patient.address.text
        Short (NHSN-MS)(USCDI) Text representation of the address
        Must Support true
        72. Patient.address.line
        Short (NHSN-MS)(USCDI) Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label
        74. Patient.address.city
        Short (NHSN-MS)(USCDI) Name of city, town etc.
        76. Patient.address.district
        Short (NHSN-MS) District name (aka county)
        Must Support true
        78. Patient.address.state
        Short (NHSN-MS)(USCDI) Sub-unit of country
        80. Patient.address.postalCode
        Short (NHSN-MS)(USCDI) US Zip Codes
        82. Patient.address.country
        Short (NHSN-MS) (USCDI) Country (e.g. can be ISO 3166 2 or 3 letter code)
        Must Support true
        84. Patient.address.period
        Short (NHSN-MS)(QI-Core)(USCDI) Time period when address was/is in use
        Must Support true
        86. Patient.contact
        Short icon Added:(NHSN-MS) A contact party (e.g. guardian, partner, friend) for the patient
        Must Support true
        88. Patient.contact.relationship
        Short icon Added:(NHSN-MS) The kind of relationship
        Must Support true
        90. Patient.contact.name
        Short icon Added:(NHSN-MS) A name associated with the contact person
        Must Support true
        icon Added: 92. Patient.contact.telecom
        Short (NHSN-MS) A contact detail for the contact person
        Must Support true
        94. Patient.contact.address
        Short icon Added:(NHSN-MS) Address for the contact person
        Must Support true
        96. Patient.contact.period
        Short icon Added:(NHSN-MS) The period during which this contact person or organization is valid to be contacted relating to this patient
        Must Support true
        icon Added: 98. Patient.communication
        Short (NHSN-MS)(QI-Core)(USCDI) A language which may be used to communicate with the patient about his or her health
        Must Support true
        100. Patient.communication.language
        Short (NHSN-MS)(USCDI) The language which can be used to communicate with the patient about his or her health
        102. Patient.communication.preferred
        Short (NHSN-MS)(USCDI) Language preference indicator
        Must Support true
        104. Patient.link
        Short icon Added:(NHSN-MS) Link to another patient resource that concerns the same actual person
        Must Support true
        icon Added: 106. Patient.link.other
        Short (NHSN-MS) The other patient or related person resource that the link refers to
        Type Reference(QICore Patient)bundled
        Must Support true
        108. Patient.link.other.reference
        Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
        Control 1..?
        Must Support true
        icon Added: 110. Patient.link.type
        Short (NHSN-MS) The type of link between this patient resource and another patient resource replaced-by | replaces | refer | seealso
        Must Support true
        icon Removed:--. Patient.link.other.reference
        Control 1..?
        icon Removed:--. Patient.identifier.use
        Must Support true
        icon Removed:--. Patient.identifier.type
        Must Support true
        icon Removed:--. Patient.identifier.period
        Must Support true
        icon Removed:--. Patient.name.use
        Must Support true
        icon Removed:--. Patient.name.text
        Must Support true
        icon Removed:--. Patient.name.prefix
        Must Support true
        icon Removed:--. Patient.name.suffix
        Must Support true
        icon Removed:--. Patient.name.period
        Must Support true
        icon Removed:--. Patient.telecom.rank
        Must Support true
        icon Removed:--. Patient.telecom.period
        Must Support true
        icon Removed:--. Patient.address.use
        Must Support true
        icon Removed:--. Patient.address.type
        Must Support true
        icon Removed:--. Patient.address.text
        Must Support true
        icon Removed:--. Patient.address.district
        Must Support true
        icon Removed:--. Patient.address.country
        Must Support true
        icon Removed:--. Patient.communication.preferred
        Must Support true

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

        0. Patient
        Definition

        icon Changed:

        -

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

        icon Added:

        -

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

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

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

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

        Control 1..1
        Type id
        Is Modifier false
        Must Support icon Added:true
        Summary true
        4. Patient.meta
        Definition

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

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

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

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

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

        Short Additional content defined by implementations
        Comments

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

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

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

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

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

          Short Version specific identifier
          Comments

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

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

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

          Short When the resource version last changed
          Comments

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

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

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

          Short Identifies where the resource comes from
          Comments

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

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

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

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

          Short Profiles this resource claims to conform to
          Comments

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

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

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

          Short Security Labels applied to this resource
          Comments

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

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

          Security Labels from the Healthcare Privacy and Security Classification System.

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

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

          Short Tags applied to this resource
          Comments

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

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

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

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

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

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

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

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

          The base language in which the resource is written.

          Short Language of the resource content
          Comments

          Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

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

          A human language.

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

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

          Short Text summary of the resource, for human interpretation
          Comments

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

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

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

          Short Contained, inline Resources
          Comments

          This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

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

          An Extension

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

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

            • American Indian or Alaska Native
            • Asian
            • Black or African American
            • Native Hawaiian or Other Pacific Islander
            • White.
            Short (NHSN-MS) US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
            Control 0..1
            This element is affected by the following invariants: ele-1
            Type Extension(US Core Race Extension) (Complex Extension)
            Is Modifier false
            Must Support true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            36. Patient.extension:ethnicity
            Slice Name ethnicity
            Definition

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

            Short (NHSN-MS) US Core Race Extension (If present, must include at least one of the required codes. Preferably this would include at least a code in the ombCategory slice.)
            Control 0..1
            This element is affected by the following invariants: ele-1
            Type Extension(US Core Ethnicity Extension) (Complex Extension)
            Is Modifier false
            Must Support true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            38. Patient.extension:tribalAffiliation
            Slice Name tribalAffiliation
            Definition

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

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

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

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

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

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

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

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

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

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

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

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

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

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

            Short Extensions that cannot be ignored
            Comments

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

            Control 0..*
            Type Extension
            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            Summary false
            Requirements

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

            Alternate Names extensions, user content
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            48. Patient.identifier
            Definition

            An identifier for this patient.

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

            Patients are almost always assigned specific numerical identifiers.

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

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

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

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

            Short Additional content defined by implementations
            Comments

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

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

              The purpose of this identifier.

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

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

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

              Identifies the purpose for this identifier, if known .

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

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

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

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

              Short icon Changed:(NHSN-MS) Description of identifier
              Comments

              This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

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

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

              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary true
              Requirements

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

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

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

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

              Identifier.system is always case sensitive.

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

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

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

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

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

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

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

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

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

              Organization that issued/manages the identifier.

              Short Organization that issued id (may be just text)
              Comments

              The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

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

              Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

              It is often used to filter patient lists to exclude inactive patients

              Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

              Short Whether this patient's record is in active use
              Comments

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

              Control 0..1
              Type boolean
              Is Modifier true because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary true
              Requirements

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

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

              A name associated with the individual.

              Short icon Changed:(NHSN-MS)(USCDI) A name associated with the patient
              Comments

              A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

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

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

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

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

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

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

              Short Additional content defined by implementations
              Comments

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

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

                Identifies the purpose for this name.

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

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

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

                The use of a human name.

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

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

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

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

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

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

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

                A renderable, unencoded form.

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

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

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

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

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

                Given name.

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

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

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

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

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

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

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

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

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

                Allows names to be placed in historical context.

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

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

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

                A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

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

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

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

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

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

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

                Short Additional content defined by implementations
                Comments

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

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

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

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

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

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

                  Telecommunications form for contact point.

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

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

                  Short icon Changed:(NHSN-MS)(USCDI) The actual contact point details
                  Comments

                  Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

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

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

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

                  Identifies the purpose for the contact point.

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

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

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

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

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

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

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

                  Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

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

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

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

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

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

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

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

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

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

                  The date of birth for the individual.

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

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

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

                  Age of the individual drives many clinical processes.

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

                  Indicates if the individual is deceased or not.

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

                  icon Changed:

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

                  Control 0..1
                  Type Choice of: boolean, dateTime
                  [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifier true because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Must Support Types No must-support rules about the choice of types/profiles
                  Summary true
                  Requirements

                  The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

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

                  An address for the individual.

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

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

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

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

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

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

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

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

                  Short Additional content defined by implementations
                  Comments

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

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

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

                    Short Preferred
                    Comments

                    Make general extension.

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

                    The purpose of this address.

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

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

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

                    The use of an address.

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

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

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

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

                    Short icon Changed:(NHSN-MS) postal | physical | both
                    Comments

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

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

                    The type of an address (physical / postal).

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

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

                    Short icon Changed:(NHSN-MS)(USCDI) Text representation of the address
                    Comments

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

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

                    A renderable, unencoded form.

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

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

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

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

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

                    The name of the administrative area (county).

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

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

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

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

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

                    Two Letter USPS alphabetic codes.

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

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

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

                    Country - a nation as commonly understood or generally accepted.

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

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

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

                    Time period when address was/is in use.

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

                    Allows addresses to be placed in historical context.

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

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

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

                    The domestic partnership status of a person.

                    Type CodeableConcept
                    Is Modifier false
                    Summary false
                    Requirements

                    Most, if not all systems capture it.

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

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

                    Short Whether patient is part of a multiple birth
                    Comments

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

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

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

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

                    Image of the patient.

                    Short Image of the patient
                    Comments

                    Guidelines:

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

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

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

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

                    Short icon Changed:(NHSN-MS) A contact party (e.g. guardian, partner, friend) for the patient
                    Comments

                    Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

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

                    Need to track people you can contact about the patient.

                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                    148. Patient.contact.id
                    Definition

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

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

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

                    Short Additional content defined by implementations
                    Comments

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

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

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

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

                    Short Extensions that cannot be ignored even if unrecognized
                    Comments

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

                    Control 0..*
                    Type Extension
                    Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summary true
                    Requirements

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

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

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

                    Short icon Changed:(NHSN-MS) The kind of relationship
                    Control 0..*
                    Binding Unless not suitable, these codes SHALL be taken from PatientContactRelationship
                    (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

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

                    Type CodeableConcept
                    Is Modifier false
                    Must Support true
                    Summary false
                    Requirements

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

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

                    A name associated with the contact person.

                    Short icon Changed:(NHSN-MS) A name associated with the contact person
                    Control 0..1
                    Type HumanName
                    Is Modifier false
                    Must Support true
                    Summary false
                    Requirements

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

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

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

                    Short icon Changed:(NHSN-MS) A contact detail for the contact person
                    Comments

                    Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

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

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

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

                    Address for the contact person.

                    Short icon Changed:(NHSN-MS) Address for the contact person
                    Control 0..1
                    Type Address
                    Is Modifier false
                    Must Support true
                    Summary false
                    Requirements

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

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

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

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

                    The gender of a person used for administrative purposes.

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

                    Needed to address the person correctly.

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

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

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

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

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

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

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

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

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

                    If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

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

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

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

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

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

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

                    Short Additional content defined by implementations
                    Comments

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

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

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

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

                    Short Extensions that cannot be ignored even if unrecognized
                    Comments

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

                    Control 0..*
                    Type Extension
                    Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summary true
                    Requirements

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

                    Alternate Names extensions, user content, modifiers
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    176. Patient.communication.language
                    Definition

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

                    Short icon Changed:(NHSN-MS)(USCDI) The language which can be used to communicate with the patient about his or her health
                    Comments

                    The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

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

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

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

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

                    Short icon Changed:(NHSN-MS)(USCDI) Language preference indicator
                    Comments

                    This language is specifically identified for communicating healthcare information.

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

                    People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

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

                    Patient's nominated care provider.

                    Short Patient's nominated primary care provider
                    Comments

                    This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

                    Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

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

                    Organization that is the custodian of the patient record.

                    Short Organization that is the custodian of the patient record
                    Comments

                    There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

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

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

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

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

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

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

                    Control 0..*
                    Type BackboneElement
                    Is Modifier true because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
                    Must Support true
                    Summary true
                    Requirements

                    There are multiple use cases:

                    • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
                    • Distribution of patient information across multiple servers.
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    186. Patient.link.id
                    Definition

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

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

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

                    Short Additional content defined by implementations
                    Comments

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

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

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

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

                    Short Extensions that cannot be ignored even if unrecognized
                    Comments

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

                    Control 0..*
                    Type Extension
                    Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summary true
                    Requirements

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

                    Alternate Names extensions, user content, modifiers
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    192. Patient.link.other
                    Definition

                    The other patient resource that the link refers to.

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

                    Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

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

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

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

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

                    Short Additional content defined by implementations
                    Comments

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

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

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

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

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

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

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

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

                      Short Type the reference refers to (e.g. "Patient")
                      Comments

                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

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

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

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

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

                      Short Logical reference, when literal reference is not known
                      Comments

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

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

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

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

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

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

                      Short Text alternative for the resource
                      Comments

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

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

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

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

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

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

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