Patient Profile

Canonical	https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient
Status	draft · 1.25.1
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.

Overview

Overview

The Nexus EMR Core Patient profile represents patient demographic and administrative information within primary care EMR systems. This profile establishes the foundational requirements for patient identification, demographics, and care relationships across the Nexus EMR ecosystem.

Identity and demographic surface (as of 1.12.0)

Four things on this profile are easy to get wrong. All are constrained, so a validator catches them, but the shapes are worth knowing up front.

Gender identity and pronouns are COMPLEX extensions. individual-genderIdentity and individual-pronouns each carry the concept in a value sub-extension — the extension root's value[x] is 0..0, so valueCodeableConcept on the root is not valid. Bindings therefore sit on extension[value].value[x]. The gender-identity value set is deliberately broader than the HL7 value set it inherits: 10 of its 13 SNOMED concepts are Canada Health Infoway namespace (pan-Canadian GSSO) and are not members of hl7.org/fhir/ValueSet/gender-identity. Pronouns are bound extensible rather than required, because pronoun sets are open-ended. For "asked but declined" or "unknown", put a data-absent-reason extension on the value — those are absence reasons, not concepts, and are deliberately not value-set members.

address.state and address.country are bound required. state takes the bare two-letter subdivision code (ON, not CA-ON, not Ontario); country takes ISO 3166-1 alpha-2 (CA, not CAN, not Canada). Stricter than the rest of this IG on purpose — consumers gate jurisdictional behaviour on these values, and inconsistent input has produced malformed outbound jurisdictional HL7. See the element definitions for the legacy-data migration caveat.

No health card? Say why, using Ontario's extension. Patient.identifier carries CA-eReC-reason-for-no-HCN-EXT (Ontario's canonical, adopted rather than re-minted). Note it sits on an identifier — in the case it describes there is no jurisdictional identifier to attach it to, so it rides on one the patient does have, in practice the MRN. Ontario's vocabulary is a single clinical code plus two data-absent reasons, so operational specifics belong in .text.

Birth sex is modelled, via CA Baseline ext-patientbirthsex — distinct from both administrative gender and gender identity.

See Patient/rowan-mercier-no-health-card for a worked instance exercising all of the above.

Terminology bindings

Path	Strength	Value set
Patient.extension.extension.value[x]	required	Gender Identity Value Set
Patient.extension.extension.value[x]	extensible	Personal Pronouns Value Set
Patient.extension.value[x]	extensible	Indigenous Identity Value Set
Patient.extension.value[x]	extensible	Racialized Group Value Set
Patient.identifier.system	required	Canadian Provincial Health Number Systems
Patient.gender	required	administrative-gender
Patient.address.state	required	Province / Territory / State Value Set
Patient.address.country	required	iso3166-1-2