Patient Profile¶

Canonical	`../StructureDefinition/nexus-emr-core-patient`
Status	draft · 1.26.0
Base	Patient (constraint)
Source	FSH · JSON

Generic Nexus EMR core profile for patient demographic and administrative information, based on CA Core+. Designed to support a broad range of integration needs.

Elements / Details

Every element this profile touches, with its full definition. Element names in the tables link here.

`Patient`¶

Short	Nexus EMR Patient Core
Definition	Represents patient demographic and administrative information, capturing key details like identifiers, name, gender, birth date, and contact information using standard Nexus EMR references. Uses instance-specific identifiers for tracking patients across systems.
Cardinality	`0..*`
Invariants	`dom-2`, `dom-3`, `dom-4`, `dom-5`, `dom-6`, `patient-name-family-or-given`, `patient-indigenous-identity-absence-exclusive`, `patient-indigenous-identity-instances-clean`, `patient-racialized-group-absence-exclusive`, `patient-racialized-group-instances-clean`, `patient-indian-registration-number-format`
Also called	SubjectOfCare Client Resident

`Patient.id`¶

Short	Logical id of this artifact
Definition	The logical id of the resource, used to reference this Patient resource in transactions and other operations. Assigned by the server and should not be changed by clients.
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.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String
Must Support	yes

`Patient.meta`¶

Short	Metadata about the resource
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.
Cardinality	`0..1`
Type	Meta
Invariants	`ele-1`

`Patient.meta.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.meta.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.meta.versionId`¶

Short	Version specific identifier
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.
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.
Cardinality	`0..1`
Type	id
Invariants	`ele-1`

`Patient.meta.lastUpdated`¶

Short	When the resource version last changed
Definition	When the resource last changed - e.g. when the version 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.
Cardinality	`0..1`
Type	instant
Invariants	`ele-1`

`Patient.meta.source`¶

Short	Identifies EMR instance & pipeline version the resource came from
Definition	A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.
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.
Cardinality	`0..1`
Type	uri
Must Support	yes
Invariants	`ele-1`

`Patient.meta.profile`¶

Short	Profiles this resource claims to conform to
Definition	A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.
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.
Cardinality	`0..*`
Type	canonical
Invariants	`ele-1`

`Patient.meta.security`¶

Short	Security Labels applied to this resource
Definition	Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
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.
Cardinality	`0..*`
Type	Coding
Binding	security-labels (`extensible`)
Invariants	`ele-1`

`Patient.meta.tag`¶

Short	Tags applied to this resource
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.
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.
Cardinality	`0..*`
Type	Coding
Binding	common-tags (`example`)
Invariants	`ele-1`

`Patient.implicitRules`¶

Short	A set of rules under which this content was created
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.
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.
Cardinality	`0..1`
Type	uri
Modifier	yes — 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
Invariants	`ele-1`

`Patient.language`¶

Short	Language of the resource content
Definition	The base language in which the resource is written.
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).
Cardinality	`0..1`
Type	code
Binding	languages (`preferred`)
Invariants	`ele-1`

`Patient.text`¶

Short	Narrative
Definition	A human-readable narrative 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.
Cardinality	`0..1`
Type	Narrative
Invariants	`ele-1`
Also called	narrative, html, xhtml, display

`Patient.contained`¶

Short	Contained, inline Resources
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.
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.
Cardinality	`0..*`
Type	Resource
Also called	inline resources, anonymous resources, contained resources

`Patient.extension`¶

Short	Additional content defined by implementations
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:genderIdentity`¶

Short	Gender identity (distinct from administrative gender)
Definition	The patient's gender identity, distinct from administrative gender and birth sex. Uses the HL7 individual-genderIdentity extension.
Comments	For 'asked but declined' or 'unknown', place a data-absent-reason extension on the value element -- those are absence reasons, not gender identities, and are deliberately not members of NexusEmrGenderIdentityVS. Same rule as pronouns below.
Cardinality	`0..1`
Type	Extension(individual-genderIdentity)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:genderIdentity.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:genderIdentity.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`1..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:genderIdentity.extension:value`¶

Short	The individual's gender identity
Definition	An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else.
Comments	This represents an individual’s identity, ascertained by asking them what that identity is.
Cardinality	`1..1`
Type	Extension
Invariants	`ele-1`, `ext-1`

`Patient.extension:genderIdentity.extension:value.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:genderIdentity.extension:value.extension`¶

`Patient.extension:genderIdentity.extension:value.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	uri
Fixed value	`value`

`Patient.extension:genderIdentity.extension:value.value[x]`¶

Short	Value of extension
Definition	Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality	`1..1`
Type	CodeableConcept
Binding	Gender Identity Value Set (`required`)
Invariants	`ele-1`

`Patient.extension:genderIdentity.extension:period`¶

`Patient.extension:genderIdentity.extension:period.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:genderIdentity.extension:period.extension`¶

`Patient.extension:genderIdentity.extension:period.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	uri
Fixed value	`period`

`Patient.extension:genderIdentity.extension:period.value[x]`¶

`Patient.extension:genderIdentity.extension:comment`¶

`Patient.extension:genderIdentity.extension:comment.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:genderIdentity.extension:comment.extension`¶

`Patient.extension:genderIdentity.extension:comment.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	uri
Fixed value	`comment`

`Patient.extension:genderIdentity.extension:comment.value[x]`¶

`Patient.extension:genderIdentity.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	http://hl7.org/fhirpath/System.String
Fixed value	`http://hl7.org/fhir/StructureDefinition/individual-genderIdentity`

`Patient.extension:genderIdentity.value[x]`¶

Short	Value of extension
Definition	Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality	`0..0`
Type	base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
Invariants	`ele-1`

`Patient.extension:pronouns`¶

Short	Personal pronouns
Definition	The patient's personal pronouns. Uses the HL7 individual-pronouns extension.
Comments	For 'asked but declined', place a data-absent-reason extension on the value element rather than using a data-absent-reason coding as the pronoun value.
Cardinality	`0..*`
Type	Extension(individual-pronouns)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:pronouns.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:pronouns.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`1..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:pronouns.extension:value`¶

Short	The individual's pronouns
Definition	The pronouns to use when referring to an individual in verbal or written communication.
Cardinality	`1..1`
Type	Extension
Invariants	`ele-1`, `ext-1`

`Patient.extension:pronouns.extension:value.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:pronouns.extension:value.extension`¶

`Patient.extension:pronouns.extension:value.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	uri
Fixed value	`value`

`Patient.extension:pronouns.extension:value.value[x]`¶

Short	Value of extension
Definition	Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality	`1..1`
Type	CodeableConcept
Binding	Personal Pronouns Value Set (`extensible`)
Invariants	`ele-1`

`Patient.extension:pronouns.extension:period`¶

`Patient.extension:pronouns.extension:period.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:pronouns.extension:period.extension`¶

`Patient.extension:pronouns.extension:period.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	uri
Fixed value	`period`

`Patient.extension:pronouns.extension:period.value[x]`¶

`Patient.extension:pronouns.extension:comment`¶

`Patient.extension:pronouns.extension:comment.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:pronouns.extension:comment.extension`¶

`Patient.extension:pronouns.extension:comment.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	uri
Fixed value	`comment`

`Patient.extension:pronouns.extension:comment.value[x]`¶

`Patient.extension:pronouns.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	http://hl7.org/fhirpath/System.String
Fixed value	`http://hl7.org/fhir/StructureDefinition/individual-pronouns`

`Patient.extension:pronouns.value[x]`¶

Short	Value of extension
Definition	Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality	`0..0`
Type	base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
Invariants	`ele-1`

`Patient.extension:birthSex`¶

Short	Sex assigned at birth (CA Baseline)
Definition	Sex assigned at birth, distinct from administrative gender and gender identity. Uses the CA Baseline ext-patientbirthsex extension -- a known Canadian must-support.
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.
Cardinality	`0..1`
Type	Extension(ext-patientbirthsex)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:recordInactiveReason`¶

Short	Why a heritage patient record is inactive
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Cardinality	`0..1`
Type	Extension(Patient Record Inactive Reason Extension)
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:indigenousIdentity`¶

Short	The Indigenous identity a patient self-identifies with
Definition	Self-identified Indigenous identity, carried on CA Core+ patient-indigenousIdentity (reused, not minted — review finding 2026-08-13; the extension is draft in the 1.2.0-dft-ballot package, pinned in the IG dependencies). Repetition is one answer per extension INSTANCE. UNLIKE genderIdentity/pronouns, the absence concepts are first-class VALUES of this field per the source composition — readers must not filter the NullFlavor/DataAbsentReason systems out. MS: reporting-bound (ON RFP 3.2.1.16). WHEN AGGREGATING, absence concepts are not identities: exclude by SYSTEM (`v3-NullFlavor`, `data-absent-reason`), never by a hand-copied code list -- that is the same test the absence-exclusive invariant uses, so the rule stays true if the source composition adds a concept. Displaying them and counting them are different jobs: a decline is a real recorded answer to show, and not a group to tally.
Comments	Repeatable, with one answer per instance. Declining to answer must be non-blocking.
Cardinality	`0..*`
Type	Extension(patient-indigenousIdentity)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:indigenousIdentity.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:indigenousIdentity.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..0`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:indigenousIdentity.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	http://hl7.org/fhirpath/System.String
Fixed value	`http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity`

`Patient.extension:indigenousIdentity.value[x]`¶

Short	Value of extension
Definition	Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality	`0..1`
Type	CodeableConcept
Binding	Indigenous Identity Value Set (`extensible`)
Invariants	`ele-1`

`Patient.extension:racializedGroup`¶

Short	The racialized group a patient self-identifies with
Definition	Self-identified racialized group, carried on CA Core+ patient-racializedGroup (reused, not minted; NOT ethnicity — CA Baseline ext-ethnicity is a distinct concept). Repetition is one answer per extension INSTANCE. Absence concepts are first-class VALUES per the source composition — readers must not filter the NullFlavor/DataAbsentReason systems out. MS: reporting-bound (ON RFP 3.2.1.16). WHEN AGGREGATING, absence concepts are not identities: exclude by SYSTEM (`v3-NullFlavor`, `data-absent-reason`), never by a hand-copied code list -- that is the same test the absence-exclusive invariant uses, so the rule stays true if the source composition adds a concept. Displaying them and counting them are different jobs: a decline is a real recorded answer to show, and not a group to tally.
Comments	Repeatable, with one answer per instance.
Cardinality	`0..*`
Type	Extension(patient-racializedGroup)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:racializedGroup.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.extension:racializedGroup.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..0`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:racializedGroup.url`¶

Short	identifies the meaning of the extension
Definition	Source of the definition for the extension code - a logical name or a URL.
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	`1..1`
Type	http://hl7.org/fhirpath/System.String
Fixed value	`http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup`

`Patient.extension:racializedGroup.value[x]`¶

Short	Value of extension
Definition	Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality	`0..1`
Type	CodeableConcept
Binding	Racialized Group Value Set (`extensible`)
Invariants	`ele-1`

`Patient.extension:indianActRegistrationStatus`¶

Short	Indian Act registration status, as stated
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Cardinality	`0..1`
Type	Extension(Indian Act Registration Status Extension)
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:firstNationRegistryGroup`¶

Short	Registry group (band) the registration is held under
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Cardinality	`0..1`
Type	Extension(First Nation Registry Group Extension)
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:firstNationCommunity`¶

Short	First Nation community the patient affiliates with
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Cardinality	`0..1`
Type	Extension(First Nation Community Extension)
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:interpreterRequired`¶

Short	Whether this patient needs an interpreter
Definition	Whether an interpreter is required to communicate with the patient. HL7's own extension, adopted here rather than restated: this specification declares no address of its own for it. Read `Patient.communication` for WHICH language; this element says only that help is needed.
Comments	Absence means NOT RECORDED, not "no interpreter needed". Producers in this estate write the extension only when the answer is true, so a patient with no extension is one nobody was asked about. Treating absence as a negative answer asserts a determination that was never made -- and the population it would silently mislabel is exactly the one the field exists to find.
Cardinality	`0..1`
Type	Extension(patient-interpreterRequired)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.extension:primaryCareAttachment`¶

Short	Current primary-care roster/enrollment/attachment
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Cardinality	`0..1`
Type	Extension(Primary Care Attachment)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.modifierExtension`¶

Short	Extensions that cannot be ignored
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).
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.
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.
Cardinality	`0..*`
Type	Extension
Modifier	yes — Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier`¶

Short	Patient identifiers (Nexus EMR ID recommended)
Definition	Patient identifiers. Identifier is optional (0..); patient identity rests on the FHIR logical `id` plus any business identifiers present. Types include: - Recommended: a Nexus EMR system identifier - Optional: Provincial/Territorial Health Numbers (PHN/JHN) - Optional: Indian Act registration / status number, under the Canadian URI Registry system `https://fhir.infoway-inforoute.ca/NamingSystem/ca-indigenous-northern-affairs-number` — validity period carries the card's issue/expiry, the IndianStatusCardTypeExtension the presented document form, and a data-absent-reason on `value` stands in while card facets are recorded before the number - Optional: Raw codes from source EMR systems - Optional*: Medical Record Numbers (MRN), other local identifiers A source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See Carrying the raw code.
Requirements	Patients are almost always assigned specific numerical identifiers.
Cardinality	`0..*`
Type	Identifier
Must Support	yes
Invariants	`ele-1`

`Patient.identifier.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.identifier.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier.extension:reasonForNoHCN`¶

Short	Why the patient has no health card number (Ontario CA-eReC extension)
Definition	The documented reason the patient has no provincial/territorial health card number, using Ontario's CA-eReC `reason-for-no-HCN` extension. Ontario eReferral requires `Patient.identifier` to carry either the health card number or a documented reason for its absence; this is that reason. Present at most once per patient. Because the extension's declared context is `Patient.identifier`, it is carried on an identifier the patient DOES have (typically the MRN slice) when no jurisdictional health number exists -- there is no jurisdictional identifier repeat to attach it to in exactly the case it describes. SHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory, and a reader encountering both should trust the identifier. It also says nothing about WHICH jurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province patient, not a patient without a health card.
Comments	Binding is extensible and Ontario's value set carries only one clinical code (#no-HC) plus data-absent-reason #not-asked / #asked-declined. Where a more specific local reason matters (newborn awaiting registration, refugee/IFHP, card not presented), carry it as an ADDITIONAL coding beside the Ontario code -- do not mint a competing extension.
Cardinality	`0..1`
Type	Extension(CA-eReC-reason-for-no-HCN-EXT)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier.use`¶

Short	usual \| official \| temp \| secondary \| old (If known)
Definition	The purpose of this identifier.
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Cardinality	`0..1`
Type	code
Modifier	yes — This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Binding	identifier-use (`required`)
Invariants	`ele-1`

`Patient.identifier.type`¶

Short	Description of identifier
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements	Allows users to make use of identifiers when the identifier system is not known.
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.
Cardinality	`0..1`
Type	CodeableConcept
Binding	identifier-type (`extensible`)
Invariants	`ele-1`

`Patient.identifier.system`¶

Short	The namespace for the identifier value
Definition	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
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.
Comments	Identifier.system is always case sensitive.
Cardinality	`1..1`
Type	uri
Invariants	`ele-1`

`Patient.identifier.value`¶

Short	The value that is unique
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of 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.
Cardinality	`1..1`
Type	string
Invariants	`ele-1`

`Patient.identifier.period`¶

`Patient.identifier.assigner`¶

Short	Organization that issued id (may be just text)
Definition	Organization that issued/manages the identifier.
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.
Cardinality	`0..1`
Type	Reference(Organization)
Invariants	`ele-1`

`Patient.identifier:jurisdictional`¶

Short	Provincial/Territorial Health Number
Definition	Provincial or Territorial Health Number (PHN/JHN) from Canadian jurisdictions
Requirements	Patients are almost always assigned specific numerical identifiers.
Cardinality	`0..*`
Type	Identifier
Must Support	yes
Invariants	`ele-1`

`Patient.identifier:jurisdictional.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.identifier:jurisdictional.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:jurisdictional.extension:reasonForNoHCN`¶

Short	Why the patient has no health card number (Ontario CA-eReC extension)
Definition	The documented reason the patient has no provincial/territorial health card number, using Ontario's CA-eReC `reason-for-no-HCN` extension. Ontario eReferral requires `Patient.identifier` to carry either the health card number or a documented reason for its absence; this is that reason. Present at most once per patient. Because the extension's declared context is `Patient.identifier`, it is carried on an identifier the patient DOES have (typically the MRN slice) when no jurisdictional health number exists -- there is no jurisdictional identifier repeat to attach it to in exactly the case it describes. SHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory, and a reader encountering both should trust the identifier. It also says nothing about WHICH jurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province patient, not a patient without a health card.
Comments	Binding is extensible and Ontario's value set carries only one clinical code (#no-HC) plus data-absent-reason #not-asked / #asked-declined. Where a more specific local reason matters (newborn awaiting registration, refugee/IFHP, card not presented), carry it as an ADDITIONAL coding beside the Ontario code -- do not mint a competing extension.
Cardinality	`0..1`
Type	Extension(CA-eReC-reason-for-no-HCN-EXT)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:jurisdictional.extension:healthCardVersion`¶

Short	Health card version code (CA Baseline ext-identifierversion)
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.
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.
Cardinality	`0..1`
Type	Extension(ext-identifierversion)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:jurisdictional.use`¶

Short	usual \| official \| temp \| secondary \| old (If known)
Definition	The purpose of this identifier.
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Cardinality	`0..1`
Type	code
Modifier	yes — This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Binding	identifier-use (`required`)
Pattern	`official`
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type`¶

Short	Type or jurisdiction of the health card, which drives format validation
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Comments	Slice membership is discriminated by `type`, so a jurisdictional PHN MUST carry the v2-0203 #JHN type coding. Ingest/edge transforms should stamp this type on every provincial/territorial health number; a PHN with only system+value falls outside this slice and its constraints (system binding, healthCardVersion) do not apply.
Cardinality	`1..1`
Type	CodeableConcept
Binding	identifier-type (`extensible`)
Pattern	`{"coding":[{"code":"JHN","system":"http://terminology.hl7.org/CodeSystem/v2-0203","display":"Jurisdictional health numb…`
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.identifier:jurisdictional.type.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:jurisdictional.type.coding`¶

Short	Code defined by a terminology system
Definition	A reference to a code defined by a terminology system.
Requirements	Allows for alternative encodings within a code system, and translations to other code systems.
Comments	Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Cardinality	`1..1`
Type	Coding
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type.coding.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.identifier:jurisdictional.type.coding.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:jurisdictional.type.coding.system`¶

Short	Identity of the terminology system
Definition	The identification of the code system that defines the meaning of the symbol in the code.
Requirements	Need to be unambiguous about the source of the definition of the symbol.
Comments	The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Cardinality	`0..1`
Type	uri
Fixed value	`http://terminology.hl7.org/CodeSystem/v2-0203`
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type.coding.version`¶

Short	Version of the system - if relevant
Definition	The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Comments	Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type.coding.code`¶

Short	Symbol in syntax defined by the system
Definition	A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Requirements	Need to refer to a particular code in the system.
Cardinality	`0..1`
Type	code
Pattern	`JHN`
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type.coding.display`¶

Short	Representation defined by the system
Definition	A representation of the meaning of the code in the system, following the rules of the system.
Requirements	Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Cardinality	`0..1`
Type	string
Pattern	`Jurisdictional health number`
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type.coding.userSelected`¶

Short	If this coding was chosen directly by the user
Definition	Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Requirements	This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Comments	Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
Cardinality	`0..1`
Type	boolean
Invariants	`ele-1`

`Patient.identifier:jurisdictional.type.text`¶

Short	Plain text representation of the concept
Definition	A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Requirements	The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Comments	Very often the text is the same as a displayName of one of the codings.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`

`Patient.identifier:jurisdictional.system`¶

Short	PHN system from Canadian PHN systems ValueSet
Definition	Must be one of the defined Canadian PHN system URIs (e.g., ca-ab-patient-healthcare-id for Alberta)
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.
Comments	Identifier.system is always case sensitive.
Cardinality	`1..1`
Type	uri
Binding	Canadian Provincial Health Number Systems (`required`)
Invariants	`ele-1`

`Patient.identifier:jurisdictional.value`¶

Short	The actual PHN value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of 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.
Cardinality	`1..1`
Type	string
Invariants	`ele-1`

`Patient.identifier:jurisdictional.period`¶

`Patient.identifier:jurisdictional.assigner`¶

Short	Organization that issued id (may be just text)
Definition	Organization that issued/manages the identifier.
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.
Cardinality	`0..1`
Type	Reference(Organization)
Invariants	`ele-1`

`Patient.identifier:mrn`¶

Short	Medical Record Number (chart number)
Definition	The patient's local Medical Record Number / chart number from the source EMR.
Requirements	Patients are almost always assigned specific numerical identifiers.
Cardinality	`0..1`
Type	Identifier
Must Support	yes
Invariants	`ele-1`

`Patient.identifier:mrn.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.identifier:mrn.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:mrn.extension:reasonForNoHCN`¶

Short	Why the patient has no health card number (Ontario CA-eReC extension)
Definition	The documented reason the patient has no provincial/territorial health card number, using Ontario's CA-eReC `reason-for-no-HCN` extension. Ontario eReferral requires `Patient.identifier` to carry either the health card number or a documented reason for its absence; this is that reason. Present at most once per patient. Because the extension's declared context is `Patient.identifier`, it is carried on an identifier the patient DOES have (typically the MRN slice) when no jurisdictional health number exists -- there is no jurisdictional identifier repeat to attach it to in exactly the case it describes. SHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory, and a reader encountering both should trust the identifier. It also says nothing about WHICH jurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province patient, not a patient without a health card.
Comments	Binding is extensible and Ontario's value set carries only one clinical code (#no-HC) plus data-absent-reason #not-asked / #asked-declined. Where a more specific local reason matters (newborn awaiting registration, refugee/IFHP, card not presented), carry it as an ADDITIONAL coding beside the Ontario code -- do not mint a competing extension.
Cardinality	`0..1`
Type	Extension(CA-eReC-reason-for-no-HCN-EXT)
Must Support	yes
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:mrn.use`¶

Short	usual \| official \| temp \| secondary \| old (If known)
Definition	The purpose of this identifier.
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Cardinality	`0..1`
Type	code
Modifier	yes — This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Binding	identifier-use (`required`)
Invariants	`ele-1`

`Patient.identifier:mrn.type`¶

Short	Description of identifier
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements	Allows users to make use of identifiers when the identifier system is not known.
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.
Cardinality	`1..1`
Type	CodeableConcept
Binding	identifier-type (`extensible`)
Pattern	`{"coding":[{"code":"MR","system":"http://terminology.hl7.org/CodeSystem/v2-0203","display":"Medical record number"}]}`
Invariants	`ele-1`

`Patient.identifier:mrn.type.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.identifier:mrn.type.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:mrn.type.coding`¶

Short	Code defined by a terminology system
Definition	A reference to a code defined by a terminology system.
Requirements	Allows for alternative encodings within a code system, and translations to other code systems.
Comments	Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Cardinality	`1..1`
Type	Coding
Invariants	`ele-1`

`Patient.identifier:mrn.type.coding.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.identifier:mrn.type.coding.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.identifier:mrn.type.coding.system`¶

Short	Identity of the terminology system
Definition	The identification of the code system that defines the meaning of the symbol in the code.
Requirements	Need to be unambiguous about the source of the definition of the symbol.
Comments	The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Cardinality	`0..1`
Type	uri
Fixed value	`http://terminology.hl7.org/CodeSystem/v2-0203`
Invariants	`ele-1`

`Patient.identifier:mrn.type.coding.version`¶

Short	Version of the system - if relevant
Definition	The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Comments	Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`

`Patient.identifier:mrn.type.coding.code`¶

Short	Symbol in syntax defined by the system
Definition	A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Requirements	Need to refer to a particular code in the system.
Cardinality	`0..1`
Type	code
Pattern	`MR`
Invariants	`ele-1`

`Patient.identifier:mrn.type.coding.display`¶

Short	Representation defined by the system
Definition	A representation of the meaning of the code in the system, following the rules of the system.
Requirements	Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Cardinality	`0..1`
Type	string
Pattern	`Medical record number`
Invariants	`ele-1`

`Patient.identifier:mrn.type.coding.userSelected`¶

Short	If this coding was chosen directly by the user
Definition	Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Requirements	This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Comments	Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
Cardinality	`0..1`
Type	boolean
Invariants	`ele-1`

`Patient.identifier:mrn.type.text`¶

Short	Plain text representation of the concept
Definition	A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Requirements	The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Comments	Very often the text is the same as a displayName of one of the codings.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`

`Patient.identifier:mrn.system`¶

Short	The namespace for the identifier value
Definition	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
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.
Comments	Identifier.system is always case sensitive.
Cardinality	`1..1`
Type	uri
Fixed value	`../NamingSystem/patient-mrn`
Invariants	`ele-1`

`Patient.identifier:mrn.value`¶

Short	The value that is unique
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of 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.
Cardinality	`1..1`
Type	string
Invariants	`ele-1`

`Patient.identifier:mrn.period`¶

`Patient.identifier:mrn.assigner`¶

Short	Organization that issued id (may be just text)
Definition	Organization that issued/manages the identifier.
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.
Cardinality	`0..1`
Type	Reference(Organization)
Invariants	`ele-1`

`Patient.active`¶

Short	Whether this patient record is in active use
Definition	Indicates whether this patient record is in active use. Many systems use this property to mark as non-active patients who have not been seen for a period of time, died, or left the practice. When absent, the patient record is assumed to be active.
Requirements	Need to be able to mark a patient record as not to be used because it was created in error.
Comments	If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Cardinality	`0..1`
Type	boolean
Must Support	yes
Modifier	yes — 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
Invariants	`ele-1`

`Patient.name`¶

Short	A name associated with the patient
Definition	The patient's name(s). At least one name must be provided with either a family or given name. Multiple names can be recorded to capture legal names, preferred names, previous names, and aliases.
Requirements	Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
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.
Cardinality	`1..*`
Type	HumanName
Must Support	yes
Invariants	`ele-1`

`Patient.name.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.name.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.name.use`¶

Short	usual \| official \| temp \| nickname \| anonymous \| old \| maiden
Definition	Identifies the purpose for this name.
Requirements	Allows the appropriate name for a particular context of use to be selected from among a set of names.
Comments	Applications can assume that a name is current unless it explicitly says that it is temporary or old.
Cardinality	`0..1`
Type	code
Modifier	yes — This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
Binding	name-use (`required`)
Invariants	`ele-1`

`Patient.name.text`¶

Short	Text representation of the full name
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.
Requirements	A renderable, unencoded form.
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.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`

`Patient.name.family`¶

Short	Family name (often called 'Surname')
Definition	The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a child is the given name of their father.
Comments	Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).
Cardinality	`0..1`
Type	string
Must Support	yes
Invariants	`ele-1`
Also called	surname

`Patient.name.given`¶

Short	Given names (not always 'first')
Definition	Given name(s) including first name, middle names, initials. The first given name is typically used as the primary given 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.
Cardinality	`0..*`
Type	string
Must Support	yes
Invariants	`ele-1`
Also called	first name, middle name

`Patient.name.prefix`¶

Short	Honorific prefix(es) (e.g. Dr., Mr., Ms.)
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 (standard R4 HumanName.prefix).
Cardinality	`0..*`
Type	string
Must Support	yes
Invariants	`ele-1`

`Patient.name.suffix`¶

Short	Name suffix(es) (e.g. Jr., Sr.)
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 (standard R4 HumanName.suffix).
Cardinality	`0..*`
Type	string
Must Support	yes
Invariants	`ele-1`

`Patient.name.period`¶

Short	Time period when name was/is in use
Definition	Indicates the period of time when this name was valid for the named person.
Requirements	Allows names to be placed in historical context.
Cardinality	`0..1`
Type	Period
Invariants	`ele-1`

`Patient.telecom`¶

Short	Contact details for the patient
Definition	Contact details (telephone, email, etc.) for the patient. May include phone numbers, email addresses, and other electronic communication methods. Systems should capture the use (home, work, mobile) and preference ranking when available.
Requirements	People have (primary) ways to contact them in some way such as phone, email.
Comments	A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address 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).
Cardinality	`0..*`
Type	ContactPoint
Must Support	yes
Invariants	`ele-1`

`Patient.gender`¶

Short	Administrative gender (male \| female \| other \| unknown)
Definition	Administrative gender used for identification and administrative purposes. When absent, gender is unknown. Note that this may cause challenges with patient matching algorithms. This is distinct from birth sex and clinical sex parameters which may be captured in extensions.
Requirements	Needed for identification of the individual, in combination with (at least) name and birth date.
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.
Cardinality	`0..1`
Type	code
Must Support	yes
Binding	administrative-gender (`required`)
Invariants	`ele-1`

`Patient.birthDate`¶

Short	The date of birth for the patient
Definition	The date of birth for the patient. When absent, birth date is unknown. Note that missing birth dates may impact patient matching accuracy and age-based clinical decision support. Partial dates (year or year-month only) are permitted when full date is unknown.
Requirements	Age of the individual drives many clinical processes.
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).
Cardinality	`0..1`
Type	date
Must Support	yes
Invariants	`ele-1`

`Patient.deceased[x]`¶

Short	Indicates if the patient is deceased
Definition	Indicates if the patient is deceased or not. Can be a boolean (true if deceased) or the actual date/time of death. When absent, the patient is assumed to be alive. Systems should update this field promptly when death information is received.
Requirements	The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
Comments	If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.
Cardinality	`0..1`
Type	boolean, dateTime
Must Support	yes
Modifier	yes — 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.
Invariants	`ele-1`

`Patient.address`¶

Short	Addresses for the patient
Definition	Patient addresses including home, temporary, billing addresses. Should follow Canadian address formatting standards including valid province codes and postal codes in A1A 1A1 format. Multiple addresses can be recorded with different uses (home, work, temp, billing).
Requirements	May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Comments	Patient may have multiple addresses with different uses or applicable periods.
Cardinality	`0..*`
Type	Address
Must Support	yes
Invariants	`ele-1`, `patient-address-country-alpha2`

`Patient.address.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.address.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.address.use`¶

Short	home \| work \| temp \| old \| billing - purpose of this address
Definition	The purpose of this address.
Requirements	Allows an appropriate address to be chosen from a list of many.
Comments	Applications can assume that an address is current unless it explicitly says that it is temporary or old.
Cardinality	`0..1`
Type	code
Modifier	yes — This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
Binding	address-use (`required`)
Invariants	`ele-1`

`Patient.address.type`¶

Short	postal \| physical \| both
Definition	Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are 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).
Cardinality	`0..1`
Type	code
Binding	address-type (`required`)
Invariants	`ele-1`

`Patient.address.text`¶

Short	Text representation of the address
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.
Requirements	A renderable, unencoded form.
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.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`

`Patient.address.line`¶

Short	Street name, number, direction & P.O. Box etc.
Definition	This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.
Cardinality	`0..*`
Type	string
Invariants	`ele-1`

`Patient.address.city`¶

Short	Name of city, town etc.
Definition	The name of the city, town, suburb, village or other community or delivery center.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`
Also called	Municpality

`Patient.address.district`¶

Short	District name (aka county)
Definition	The name of the administrative area (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.
Cardinality	`0..1`
Type	string
Invariants	`ele-1`
Also called	County

`Patient.address.state`¶

Short	Province / territory / state (bare two-letter subdivision code)
Definition	The province, territory or state, as a bare two-letter subdivision code (ISO 3166-2 suffix form, which matches the Canada Post / USPS abbreviation): `ON`, not `CA-ON`, and not `Ontario`. The binding is `required`, which is a deliberate departure from this IG's usual lenient posture. The reason is that the alternative is silent corruption rather than a clean failure: consumers gate jurisdictional behaviour on this value (Ontario PCR eligibility is gated on `ON`) and do positional string surgery on it, which has produced malformed outbound jurisdictional HL7 in production. A closed roster makes that fail loudly instead. ⚠ HERITAGE EMR SITUATION -- UNRESOLVED as of IG 1.12.0. This binding was validated against the IG's own example instances and the synthetic corpus only. Heritage-EMR data has NOT been surveyed. Heritage EMRs store province as an unconstrained free-text column typed by front-desk staff over decades, with no validation at entry -- the same systems demonstrably emit uncoded free-text on adjacent fields (the enrolment/roster status is carried as an uncoded `valueString`). So spelled-out province names ("Ontario"), lowercase codes, and trailing whitespace are all plausible in existing records. Where they exist, a `required` binding rejects real patients rather than merely flagging them -- strictly worse than the outbound corruption it was added to prevent. The distribution has not been measured, so this is an open risk, not a closed decision. Implementers migrating a heritage corpus SHOULD profile their actual `state` value distribution before enforcing, and MAY treat this binding as `extensible` during migration, relying on the `patient-address-country-alpha2` warning invariant and an equivalent state-shape check instead. Normalizing at ingest (uppercase, trim, map full names to codes) is the intended long-term fix. This caveat comes out once the heritage-data survey is done and the decision is recorded.
Comments	Consumers gate jurisdictional behaviour on this value (e.g. Ontario PCR eligibility on `ON`), so a spelled-out province name is not merely untidy -- it silently fails those gates. See the definition for the unresolved legacy-data migration caveat on the `required` binding.
Cardinality	`0..1`
Type	string
Must Support	yes
Binding	Province / Territory / State Value Set (`required`)
Invariants	`ele-1`
Also called	Province, Territory

`Patient.address.postalCode`¶

Short	Postal code for area
Definition	The postal code for the patient's address. Should be in A1A 1A1 format.
Cardinality	`0..1`
Type	string
Must Support	yes
Invariants	`ele-1`
Also called	Zip

`Patient.address.country`¶

Short	Country as ISO 3166-1 alpha-2 (`CA`, `US`)
Definition	The country, as an ISO 3166-1 alpha-2 code. R4's element comment permits 3-letter codes generally; this profile pins alpha-2 as the stored form to end the alpha-2/alpha-3 split that has produced malformed outbound values (`"Ca-io"` and `"CANio"` have both been observed on outbound jurisdictional HL7, from consumers doing positional string surgery on inconsistent input). Alpha-3 (`CAN`) and country names (`Canada`) are NOT conformant. Where a downstream interface requires alpha-3, convert at that edge -- the same posture this profile takes on the Ontario health-card version code. ⚠ HERITAGE EMR SITUATION -- UNRESOLVED as of IG 1.12.0. As with `address.state`, this `required` binding was validated against the IG's own examples and the synthetic corpus only. Heritage-EMR data has NOT been surveyed, and alpha-3 (`CAN`) or spelled-out country values (`Canada`) are plausible in existing records -- one in-repo converter already writes alpha-3, which is how the malformed outbound values above were produced in the first place, so the inconsistency demonstrably exists inside our own stack and not only upstream of it. Survey the corpus before enforcing, and treat the binding as `extensible` during migration if it is dirty -- the `patient-address-country-alpha2` invariant (`#warning`) still reports the specific alpha-3 case either way. Normalizing at ingest is the intended long-term fix. This caveat comes out once the heritage-data survey is done and the decision is recorded.
Comments	Alpha-3 ('CAN') and country names ('Canada') are NOT conformant here. Where a downstream interface requires alpha-3, convert at that edge. See the definition for the unresolved legacy-data migration caveat on the `required` binding.
Cardinality	`0..1`
Type	string
Must Support	yes
Binding	iso3166-1-2 (`required`)
Invariants	`ele-1`

`Patient.address.period`¶

Short	Time period when address was/is in use
Definition	Time period when address was/is in use.
Requirements	Allows addresses to be placed in historical context.
Cardinality	`0..1`
Type	Period
Invariants	`ele-1`

`Patient.maritalStatus`¶

Short	Marital status with raw code support
Definition	The patient's most recent marital (civil) status. RECOMMENDED: Standard terminology codes (v3 Marital Status) when available OPTIONAL: Raw EMR codes for source system preservation Used for administrative and billing purposes, may impact insurance coverage and next-of-kin determinations.
Requirements	Most, if not all systems capture it.
Cardinality	`0..1`
Type	CodeableConcept
Must Support	yes
Binding	marital-status (`extensible`)
Invariants	`ele-1`

`Patient.multipleBirth[x]`¶

Short	Whether patient is part of multiple birth
Definition	Indicates whether the patient is part of a multiple birth (twins, triplets, etc.) and if so, the birth order. Can be boolean (true if multiple birth) or integer (birth order: 1, 2, 3, etc.). Important for pediatric care and family medical history.
Requirements	For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Comments	Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in 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).
Cardinality	`0..1`
Type	boolean, integer
Invariants	`ele-1`

`Patient.photo`¶

Short	Image of the patient
Definition	Image of the patient.
Requirements	Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Comments	Guidelines: * Use id photos, not clinical photos. * Limit dimensions to thumbnail. * Keep byte count low to ease resource updates.
Cardinality	`0..*`
Type	Attachment
Invariants	`ele-1`

`Patient.contact`¶

Short	A contact party (e.g. guardian, partner, friend) for the patient
Definition	A contact party (e.g. guardian, partner, friend) for the patient.
Requirements	Need to track people you can contact about the patient.
Comments	Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.
Cardinality	`0..*`
Type	BackboneElement
Invariants	`ele-1`, `pat-1`

`Patient.contact.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.contact.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.contact.modifierExtension`¶

Short	Extensions that cannot be ignored even if unrecognized
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).
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.
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.
Cardinality	`0..*`
Type	Extension
Modifier	yes — Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content, modifiers

`Patient.contact.relationship`¶

Short	The kind of relationship
Definition	The nature of the relationship between the patient and the contact person.
Requirements	Used to determine which contact person is the most relevant to approach, depending on circumstances.
Cardinality	`0..*`
Type	CodeableConcept
Binding	patient-contactrelationship (`extensible`)
Invariants	`ele-1`

`Patient.contact.name`¶

Short	A name associated with the contact person
Definition	A name associated with the contact person.
Requirements	Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
Cardinality	`0..1`
Type	HumanName
Invariants	`ele-1`

`Patient.contact.telecom`¶

Short	A contact detail for the person
Definition	A contact detail for the person, e.g. a telephone number or an email address.
Requirements	People have (primary) ways to contact them in some way such as phone, email.
Comments	Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
Cardinality	`0..*`
Type	ContactPoint
Invariants	`ele-1`

`Patient.contact.address`¶

Short	Address for the contact person
Definition	Address for the contact person.
Requirements	Need to keep track where the contact person can be contacted per postal mail or visited.
Cardinality	`0..1`
Type	Address
Invariants	`ele-1`

`Patient.contact.gender`¶

Short	male \| female \| other \| unknown
Definition	Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Requirements	Needed to address the person correctly.
Cardinality	`0..1`
Type	code
Binding	administrative-gender (`required`)
Invariants	`ele-1`

`Patient.contact.organization`¶

Short	Organization that is associated with the contact
Definition	Organization on behalf of which the contact is acting or for which the contact is working.
Requirements	For guardians or business related contacts, the organization is relevant.
Cardinality	`0..1`
Type	Reference(Organization)
Invariants	`ele-1`

`Patient.contact.period`¶

Short	The period during which this contact person or organization is valid to be contacted relating to this patient
Definition	The period during which this contact person or organization is valid to be contacted relating to this patient.
Cardinality	`0..1`
Type	Period
Invariants	`ele-1`

`Patient.communication`¶

Short	Language communication capabilities
Definition	Languages which may be used to communicate with the patient about their health. Important for ensuring effective communication, interpreter services, and meeting Canadian bilingual healthcare requirements.
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.
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.
Cardinality	`0..*`
Type	BackboneElement
Must Support	yes
Invariants	`ele-1`

`Patient.communication.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.communication.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.communication.modifierExtension`¶

Short	Extensions that cannot be ignored even if unrecognized
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).
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.
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.
Cardinality	`0..*`
Type	Extension
Modifier	yes — Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content, modifiers

`Patient.communication.language`¶

Short	Language with raw code support
Definition	The language for communication with the patient. RECOMMENDED: ISO 639 language codes (e.g., en, fr) or BCP 47 codes OPTIONAL: Raw EMR codes for source system preservation Should include relevant languages such as English (en), French (fr), and indigenous languages. The preferred language should be marked with communication.preferred = true.
Requirements	Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Comments	The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
Cardinality	`1..1`
Type	CodeableConcept
Must Support	yes
Binding	languages (`preferred`)
Invariants	`ele-1`

`Patient.communication.preferred`¶

Short	Language preference indicator
Definition	Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Requirements	People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
Comments	This language is specifically identified for communicating healthcare information.
Cardinality	`0..1`
Type	boolean
Invariants	`ele-1`

`Patient.generalPractitioner`¶

Short	Patient's primary care provider(s)
Definition	Reference to the patient's primary care provider(s), typically their family physician or primary care team. References a Practitioner -- the primary provider identity in this IG -- or a PractitionerRole where the role/organization binding is part of the assertion. Multiple providers can be listed for team-based care models.
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.
Cardinality	`0..*`
Type	Reference(PractitionerRole Profile \| Practitioner Profile)
Must Support	yes
Invariants	`ele-1`
Also called	careProvider

`Patient.managingOrganization`¶

Short	Organization that maintains the patient record
Definition	The organization that has primary responsibility for maintaining this patient record in their EMR system. This is typically the primary care clinic or practice where the patient is rostered. Required to establish data ownership and governance.
Requirements	Need to know who recognizes this patient record, manages and updates it.
Comments	There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
Cardinality	`1..1`
Type	Reference(Organization Profile)
Invariants	`ele-1`

`Patient.link`¶

Short	Link to another patient resource that concerns the same actual person
Definition	Link to another patient resource that concerns the same actual patient.
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.
Comments	There is no assumption that linked patient records have mutual links.
Cardinality	`0..*`
Type	BackboneElement
Modifier	yes — 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'
Invariants	`ele-1`

`Patient.link.id`¶

Short	Unique id for inter-element referencing
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	`0..1`
Type	http://hl7.org/fhirpath/System.String

`Patient.link.extension`¶

Short	Additional content defined by implementations
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.
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.
Cardinality	`0..*`
Type	Extension
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content

`Patient.link.modifierExtension`¶

Short	Extensions that cannot be ignored even if unrecognized
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).
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.
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.
Cardinality	`0..*`
Type	Extension
Modifier	yes — Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Invariants	`ele-1`, `ext-1`
Also called	extensions, user content, modifiers

`Patient.link.other`¶

Short	The other patient or related person resource that the link refers to
Definition	The other patient 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.
Cardinality	`1..1`
Type	Reference(Patient \| RelatedPerson)
Invariants	`ele-1`

`Patient.link.type`¶

Short	replaced-by \| replaces \| refer \| seealso
Definition	The type of link between this patient resource and another patient resource.
Cardinality	`1..1`
Type	code
Binding	link-type (`required`)
Invariants	`ele-1`

Short	The time period during which the gender identity applies to the individual
Cardinality	`0..1`
Type	Extension
Invariants	`ele-1`, `ext-1`

Short	Text to further explain the use of the specified gender identity
Cardinality	`0..1`
Type	Extension
Invariants	`ele-1`, `ext-1`

Short	When the pronouns apply to the individual
Definition	The time period during which the pronouns apply to the individual
Cardinality	`0..1`
Type	Extension
Invariants	`ele-1`, `ext-1`

Short	Explaination about the use of the pronouns
Definition	Text to further explain the use of the specified pronouns
Cardinality	`0..1`
Type	Extension
Invariants	`ele-1`, `ext-1`

Short	Time period when id is/was valid for use
Definition	Time period during which identifier is/was valid for use.
Cardinality	`0..1`
Type	Period
Invariants	`ele-1`

Patient Profile¶

Patient¶

Patient.id¶

Patient.meta¶

Patient.meta.id¶

Patient.meta.extension¶

Patient.meta.versionId¶

Patient.meta.lastUpdated¶

Patient.meta.source¶

Patient.meta.profile¶

Patient.meta.security¶

Patient.meta.tag¶

Patient.implicitRules¶

Patient.language¶

Patient.text¶

Patient.contained¶

Patient.extension¶

Patient.extension:genderIdentity¶

Patient.extension:genderIdentity.id¶

Patient.extension:genderIdentity.extension¶

Patient.extension:genderIdentity.extension:value¶

Patient.extension:genderIdentity.extension:value.id¶

Patient.extension:genderIdentity.extension:value.extension¶

Patient.extension:genderIdentity.extension:value.url¶

Patient.extension:genderIdentity.extension:value.value[x]¶

Patient.extension:genderIdentity.extension:period¶

Patient.extension:genderIdentity.extension:period.id¶

Patient.extension:genderIdentity.extension:period.extension¶

Patient.extension:genderIdentity.extension:period.url¶

Patient.extension:genderIdentity.extension:period.value[x]¶

Patient.extension:genderIdentity.extension:comment¶

Patient.extension:genderIdentity.extension:comment.id¶

Patient.extension:genderIdentity.extension:comment.extension¶

Patient.extension:genderIdentity.extension:comment.url¶

Patient.extension:genderIdentity.extension:comment.value[x]¶

Patient.extension:genderIdentity.url¶

Patient.extension:genderIdentity.value[x]¶

Patient.extension:pronouns¶

Patient.extension:pronouns.id¶

Patient.extension:pronouns.extension¶

Patient.extension:pronouns.extension:value¶

Patient.extension:pronouns.extension:value.id¶

Patient.extension:pronouns.extension:value.extension¶

Patient.extension:pronouns.extension:value.url¶

Patient.extension:pronouns.extension:value.value[x]¶

Patient.extension:pronouns.extension:period¶

Patient.extension:pronouns.extension:period.id¶

Patient.extension:pronouns.extension:period.extension¶

Patient.extension:pronouns.extension:period.url¶

Patient.extension:pronouns.extension:period.value[x]¶

Patient.extension:pronouns.extension:comment¶

Patient.extension:pronouns.extension:comment.id¶

Patient.extension:pronouns.extension:comment.extension¶

Patient.extension:pronouns.extension:comment.url¶

Patient.extension:pronouns.extension:comment.value[x]¶

Patient.extension:pronouns.url¶

Patient.extension:pronouns.value[x]¶

Patient.extension:birthSex¶

Patient.extension:recordInactiveReason¶

Patient.extension:indigenousIdentity¶

Patient.extension:indigenousIdentity.id¶

Patient.extension:indigenousIdentity.extension¶

Patient.extension:indigenousIdentity.url¶

Patient.extension:indigenousIdentity.value[x]¶

Patient.extension:racializedGroup¶

Patient.extension:racializedGroup.id¶

Patient.extension:racializedGroup.extension¶

Patient.extension:racializedGroup.url¶

Patient.extension:racializedGroup.value[x]¶

Patient.extension:indianActRegistrationStatus¶

Patient.extension:firstNationRegistryGroup¶

Patient.extension:firstNationCommunity¶

Patient.extension:interpreterRequired¶

Patient.extension:primaryCareAttachment¶

Patient.modifierExtension¶

Patient.identifier¶

Patient.identifier.id¶

Patient.identifier.extension¶

Patient.identifier.extension:reasonForNoHCN¶

Patient.identifier.use¶