{ "resourceType": "StructureDefinition", "id": "nexus-emr-core-patient", "extension": [ { "url": "https://fhir.apps.health/StructureDefinition/effective-date", "extension": [ { "url": "none", "valueBoolean": true } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "given_name" }, { "url": "expression", "valueString": "name.first().given.first()" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "middle_name" }, { "url": "expression", "valueString": "name.first().given.tail().join(' ')" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "family_name" }, { "url": "expression", "valueString": "name.first().family" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "gender" }, { "url": "expression", "valueString": "gender" }, { "url": "type", "valueCode": "code" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "birth_date" }, { "url": "expression", "valueString": "birthDate" }, { "url": "type", "valueCode": "dateTime" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "phone" }, { "url": "expression", "valueString": "telecom.where(system='phone').first().value" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "email" }, { "url": "expression", "valueString": "telecom.where(system='email').first().value" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/smart-exposed", "extension": [ { "url": "read", "valueString": "patient:read" }, { "url": "write", "valueString": "patient:write" } ] } ], "url": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient", "name": "NexusEmrCorePatient", "title": "Patient Profile", "status": "draft", "description": "Generic Nexus EMR core profile for patient demographic and administrative information, based on CA Core+. Designed to support a broad range of integration needs.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "loinc", "uri": "http://loinc.org", "name": "LOINC code for the element" } ], "kind": "resource", "abstract": false, "type": "Patient", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Patient", "derivation": "constraint", "snapshot": { "element": [ { "id": "Patient", "path": "Patient", "short": "Nexus EMR Patient Core", "definition": "Represents patient demographic and administrative information, capturing key details\nlike identifiers, name, gender, birth date, and contact information using standard\nNexus EMR references. Uses instance-specific identifiers for tracking patients\nacross systems.", "alias": [ "SubjectOfCare Client Resident" ], "min": 0, "max": "*", "base": { "path": "Patient", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "patient-name-family-or-given", "severity": "warning", "human": "Patient.name: at least one name SHALL carry a family name, a given name, or text -- or a data-absent-reason extension (CA Baseline ipa-pat-2). Ontario's stricter 'family required' is applied as an edge transform on submission, not in the core profile.", "expression": "name.where(family.exists() or given.exists() or text.exists()).exists() or name.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-indigenous-identity-absence-exclusive", "severity": "warning", "human": "If a not-answered value (Asked But Declined / Do not know/ Not applicable) is recorded, it SHOULD be the only instance of the extension.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').value.ofType(CodeableConcept).coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' or system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists() implies extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').count() = 1", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-indigenous-identity-instances-clean", "severity": "warning", "human": "Each instance SHOULD carry exactly one coding, and no two instances SHOULD repeat the same system|code answer.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').value.ofType(CodeableConcept).all(coding.count() = 1) and extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').value.ofType(CodeableConcept).coding.select(system & '|' & code).isDistinct()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-racialized-group-absence-exclusive", "severity": "warning", "human": "If a not-answered value (Asked But Declined / Do not know / Another race category) is recorded, it SHOULD be the only instance of the extension.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').value.ofType(CodeableConcept).coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' or system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists() implies extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').count() = 1", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-racialized-group-instances-clean", "severity": "warning", "human": "Each instance SHOULD carry exactly one coding, and no two instances SHOULD repeat the same system|code answer.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').value.ofType(CodeableConcept).all(coding.count() = 1) and extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').value.ofType(CodeableConcept).coding.select(system & '|' & code).isDistinct()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-indian-registration-number-format", "severity": "warning", "human": "An Indian registration number identifier's value, when carried, SHOULD be 9 or 10 digits.", "expression": "identifier.where(system = 'https://fhir.infoway-inforoute.ca/NamingSystem/ca-indigenous-northern-affairs-number').all(value.empty() or value.matches('^[0-9]{9,10}$'))", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "Patient[classCode=PAT]" }, { "identity": "cda", "map": "ClinicalDocument.recordTarget.patientRole" } ] }, { "id": "Patient.id", "path": "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.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "Patient.meta", "path": "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.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Patient.meta.id", "path": "Patient.meta.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.meta.extension", "path": "Patient.meta.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.meta.versionId", "path": "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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Meta.versionId", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Patient.meta.lastUpdated", "path": "Patient.meta.lastUpdated", "short": "When the resource version last changed", "definition": "When the resource last changed - e.g. when the version changed.", "comment": "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](http.html#read) interaction.", "min": 0, "max": "1", "base": { "path": "Meta.lastUpdated", "min": 0, "max": "1" }, "type": [ { "code": "instant" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Patient.meta.source", "path": "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.", "comment": "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. \n\nThis 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.", "min": 0, "max": "1", "base": { "path": "Meta.source", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "Patient.meta.profile", "path": "Patient.meta.profile", "short": "Profiles this resource claims to conform to", "definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Meta.profile", "min": 0, "max": "*" }, "type": [ { "code": "canonical", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Patient.meta.security", "path": "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.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Meta.security", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SecurityLabels" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet": "http://hl7.org/fhir/ValueSet/security-labels" } }, { "id": "Patient.meta.tag", "path": "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.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Meta.tag", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Tags" } ], "strength": "example", "description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".", "valueSet": "http://hl7.org/fhir/ValueSet/common-tags" } }, { "id": "Patient.implicitRules", "path": "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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "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", "isSummary": true }, { "id": "Patient.language", "path": "Patient.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "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).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } }, { "id": "Patient.text", "path": "Patient.text", "short": "Narrative", "definition": "A human-readable narrative summary of the resource for human interpretation.", "comment": "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.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Act.text?" } ] }, { "id": "Patient.contained", "path": "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.", "comment": "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.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension", "path": "Patient.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/individual-genderIdentity" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.id", "path": "Patient.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:genderIdentity.extension", "path": "Patient.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 1, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:genderIdentity.extension:value", "path": "Patient.extension.extension", "sliceName": "value", "short": "The individual's gender identity", "definition": "An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else. ", "comment": "This represents an individual’s identity, ascertained by asking them what that identity is.", "min": 1, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:genderIdentity.extension:value.id", "path": "Patient.extension.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:genderIdentity.extension:value.extension", "path": "Patient.extension.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extension", "definition": "An Extension", "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:genderIdentity.extension:value.url", "path": "Patient.extension.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "value", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.extension:value.value[x]", "path": "Patient.extension.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "strength": "required", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-gender-identity" }, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.extension:period", "path": "Patient.extension.extension", "sliceName": "period", "short": "The time period during which the gender identity applies to the individual", "definition": "The time period during which the gender identity applies to the individual", "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:genderIdentity.extension:period.id", "path": "Patient.extension.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:genderIdentity.extension:period.extension", "path": "Patient.extension.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extension", "definition": "An Extension", "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:genderIdentity.extension:period.url", "path": "Patient.extension.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "period", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.extension:period.value[x]", "path": "Patient.extension.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.extension:comment", "path": "Patient.extension.extension", "sliceName": "comment", "short": "Text to further explain the use of the specified gender identity", "definition": "Text to further explain the use of the specified gender identity", "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:genderIdentity.extension:comment.id", "path": "Patient.extension.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:genderIdentity.extension:comment.extension", "path": "Patient.extension.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extension", "definition": "An Extension", "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:genderIdentity.extension:comment.url", "path": "Patient.extension.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "comment", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.extension:comment.value[x]", "path": "Patient.extension.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.url", "path": "Patient.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "uri" } ] } ], "fixedUri": "http://hl7.org/fhir/StructureDefinition/individual-genderIdentity", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:genderIdentity.value[x]", "path": "Patient.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 0, "max": "0", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "base64Binary" }, { "code": "boolean" }, { "code": "canonical" }, { "code": "code" }, { "code": "date" }, { "code": "dateTime" }, { "code": "decimal" }, { "code": "id" }, { "code": "instant" }, { "code": "integer" }, { "code": "markdown" }, { "code": "oid" }, { "code": "positiveInt" }, { "code": "string" }, { "code": "time" }, { "code": "unsignedInt" }, { "code": "uri" }, { "code": "url" }, { "code": "uuid" }, { "code": "Address" }, { "code": "Age" }, { "code": "Annotation" }, { "code": "Attachment" }, { "code": "CodeableConcept" }, { "code": "Coding" }, { "code": "ContactPoint" }, { "code": "Count" }, { "code": "Distance" }, { "code": "Duration" }, { "code": "HumanName" }, { "code": "Identifier" }, { "code": "Money" }, { "code": "Period" }, { "code": "Quantity" }, { "code": "Range" }, { "code": "Ratio" }, { "code": "Reference" }, { "code": "SampledData" }, { "code": "Signature" }, { "code": "Timing" }, { "code": "ContactDetail" }, { "code": "Contributor" }, { "code": "DataRequirement" }, { "code": "Expression" }, { "code": "ParameterDefinition" }, { "code": "RelatedArtifact" }, { "code": "TriggerDefinition" }, { "code": "UsageContext" }, { "code": "Dosage" }, { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns", "path": "Patient.extension", "sliceName": "pronouns", "short": "Personal pronouns", "definition": "The patient's personal pronouns. Uses the HL7 individual-pronouns extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/individual-pronouns" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.id", "path": "Patient.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:pronouns.extension", "path": "Patient.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 1, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:pronouns.extension:value", "path": "Patient.extension.extension", "sliceName": "value", "short": "The individual's pronouns", "definition": "The pronouns to use when referring to an individual in verbal or written communication.", "min": 1, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:pronouns.extension:value.id", "path": "Patient.extension.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:pronouns.extension:value.extension", "path": "Patient.extension.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extension", "definition": "An Extension", "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:pronouns.extension:value.url", "path": "Patient.extension.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "value", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.extension:value.value[x]", "path": "Patient.extension.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-pronouns" }, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.extension:period", "path": "Patient.extension.extension", "sliceName": "period", "short": "When the pronouns apply to the individual", "definition": "The time period during which the pronouns apply to the individual", "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:pronouns.extension:period.id", "path": "Patient.extension.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:pronouns.extension:period.extension", "path": "Patient.extension.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extension", "definition": "An Extension", "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:pronouns.extension:period.url", "path": "Patient.extension.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "period", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.extension:period.value[x]", "path": "Patient.extension.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.extension:comment", "path": "Patient.extension.extension", "sliceName": "comment", "short": "Explaination about the use of the pronouns", "definition": "Text to further explain the use of the specified pronouns", "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:pronouns.extension:comment.id", "path": "Patient.extension.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:pronouns.extension:comment.extension", "path": "Patient.extension.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extension", "definition": "An Extension", "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Patient.extension:pronouns.extension:comment.url", "path": "Patient.extension.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "comment", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.extension:comment.value[x]", "path": "Patient.extension.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.url", "path": "Patient.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "uri" } ] } ], "fixedUri": "http://hl7.org/fhir/StructureDefinition/individual-pronouns", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:pronouns.value[x]", "path": "Patient.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min": 0, "max": "0", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "base64Binary" }, { "code": "boolean" }, { "code": "canonical" }, { "code": "code" }, { "code": "date" }, { "code": "dateTime" }, { "code": "decimal" }, { "code": "id" }, { "code": "instant" }, { "code": "integer" }, { "code": "markdown" }, { "code": "oid" }, { "code": "positiveInt" }, { "code": "string" }, { "code": "time" }, { "code": "unsignedInt" }, { "code": "uri" }, { "code": "url" }, { "code": "uuid" }, { "code": "Address" }, { "code": "Age" }, { "code": "Annotation" }, { "code": "Attachment" }, { "code": "CodeableConcept" }, { "code": "Coding" }, { "code": "ContactPoint" }, { "code": "Count" }, { "code": "Distance" }, { "code": "Duration" }, { "code": "HumanName" }, { "code": "Identifier" }, { "code": "Money" }, { "code": "Period" }, { "code": "Quantity" }, { "code": "Range" }, { "code": "Ratio" }, { "code": "Reference" }, { "code": "SampledData" }, { "code": "Signature" }, { "code": "Timing" }, { "code": "ContactDetail" }, { "code": "Contributor" }, { "code": "DataRequirement" }, { "code": "Expression" }, { "code": "ParameterDefinition" }, { "code": "RelatedArtifact" }, { "code": "TriggerDefinition" }, { "code": "UsageContext" }, { "code": "Dosage" }, { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:birthSex", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-patientbirthsex" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:recordInactiveReason", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-patient-record-inactive-reason" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:indigenousIdentity", "path": "Patient.extension", "sliceName": "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.", "comment": "Repeatable, with one answer per instance. Declining to answer must be non-blocking.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:indigenousIdentity.id", "path": "Patient.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:indigenousIdentity.extension", "path": "Patient.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:indigenousIdentity.url", "path": "Patient.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "uri" } ] } ], "fixedUri": "http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity", "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:indigenousIdentity.value[x]", "path": "Patient.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).", "min": 0, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-indigenous-identity" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:racializedGroup", "path": "Patient.extension", "sliceName": "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.", "comment": "Repeatable, with one answer per instance.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:racializedGroup.id", "path": "Patient.extension.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.extension:racializedGroup.extension", "path": "Patient.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:racializedGroup.url", "path": "Patient.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "uri" } ] } ], "fixedUri": "http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup", "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:racializedGroup.value[x]", "path": "Patient.extension.value[x]", "short": "Value of extension", "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).", "min": 0, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-racialized-group" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:indianActRegistrationStatus", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-indian-act-registration-status" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:firstNationRegistryGroup", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-first-nation-registry-group" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:firstNationCommunity", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-first-nation-community" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:interpreterRequired", "path": "Patient.extension", "sliceName": "interpreterRequired", "short": "Whether this patient needs an interpreter", "definition": "Whether an interpreter is required to communicate with the patient. HL7's own extension, adopted\nhere rather than restated: this specification declares no address of its own for it.\n\nRead `Patient.communication` for WHICH language; this element says only that help is needed.", "comment": "**Absence means NOT RECORDED, not \"no interpreter needed\".** Producers in this estate write the\nextension only when the answer is true, so a patient with no extension is one nobody was asked\nabout. Treating absence as a negative answer asserts a determination that was never made -- and the\npopulation it would silently mislabel is exactly the one the field exists to find.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.extension:primaryCareAttachment", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-primary-care-attachment" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.modifierExtension", "path": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.identifier", "path": "Patient.identifier", "slicing": { "discriminator": [ { "type": "pattern", "path": "type" } ], "rules": "open", "description": "Slice identifiers by type" }, "short": "Patient identifiers (Nexus EMR ID recommended)", "definition": "Patient identifiers. Identifier is optional (0..*); patient identity rests on the FHIR logical `id`\nplus any business identifiers present. Types include:\n- **Recommended**: a Nexus EMR system identifier\n- **Optional**: Provincial/Territorial Health Numbers (PHN/JHN)\n- **Optional**: Indian Act registration / status number, under the Canadian URI Registry system\n `https://fhir.infoway-inforoute.ca/NamingSystem/ca-indigenous-northern-affairs-number` —\n validity period carries the card's issue/expiry, the IndianStatusCardTypeExtension the\n presented document form, and a data-absent-reason on `value` stands in while card facets are\n recorded before the number\n- **Optional**: Raw codes from source EMR systems\n- **Optional**: Medical Record Numbers (MRN), other local identifiers\n\nA source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "requirements": "Patients are almost always assigned specific numerical identifiers.", "min": 0, "max": "*", "base": { "path": "Patient.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "v2", "map": "PID-3" }, { "identity": "rim", "map": "id" }, { "identity": "cda", "map": ".id" } ] }, { "id": "Patient.identifier.id", "path": "Patient.identifier.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier.extension", "path": "Patient.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier.extension:reasonForNoHCN", "path": "Patient.identifier.extension", "sliceName": "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\nOntario's CA-eReC `reason-for-no-HCN` extension.\n\nOntario eReferral requires `Patient.identifier` to carry either the health card number or a\ndocumented reason for its absence; this is that reason. Present at most once per patient.\n\nBecause the extension's declared context is `Patient.identifier`, it is carried on an identifier\nthe patient DOES have (typically the MRN slice) when no jurisdictional health number exists --\nthere is no jurisdictional identifier repeat to attach it to in exactly the case it describes.\n\nSHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory,\nand a reader encountering both should trust the identifier. It also says nothing about WHICH\njurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province\npatient, not a patient without a health card.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-reason-for-no-HCN-EXT" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier.use", "path": "Patient.identifier.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Patient.identifier.type", "path": "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.", "comment": "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.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 0, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Patient.identifier.system", "path": "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.", "comment": "Identifier.system is always case sensitive.", "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.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "Patient.identifier.value", "path": "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.", "comment": "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](extension-rendered-value.html). 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.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" } ] }, { "id": "Patient.identifier.period", "path": "Patient.identifier.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Patient.identifier.assigner", "path": "Patient.identifier.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "Patient.identifier:jurisdictional", "path": "Patient.identifier", "sliceName": "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.", "min": 0, "max": "*", "base": { "path": "Patient.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "v2", "map": "PID-3" }, { "identity": "rim", "map": "id" }, { "identity": "cda", "map": ".id" } ] }, { "id": "Patient.identifier:jurisdictional.id", "path": "Patient.identifier.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.extension", "path": "Patient.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.extension:reasonForNoHCN", "path": "Patient.identifier.extension", "sliceName": "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\nOntario's CA-eReC `reason-for-no-HCN` extension.\n\nOntario eReferral requires `Patient.identifier` to carry either the health card number or a\ndocumented reason for its absence; this is that reason. Present at most once per patient.\n\nBecause the extension's declared context is `Patient.identifier`, it is carried on an identifier\nthe patient DOES have (typically the MRN slice) when no jurisdictional health number exists --\nthere is no jurisdictional identifier repeat to attach it to in exactly the case it describes.\n\nSHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory,\nand a reader encountering both should trust the identifier. It also says nothing about WHICH\njurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province\npatient, not a patient without a health card.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-reason-for-no-HCN-EXT" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.extension:healthCardVersion", "path": "Patient.identifier.extension", "sliceName": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-identifierversion" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.use", "path": "Patient.identifier.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "patternCode": "official", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Patient.identifier:jurisdictional.type", "path": "Patient.identifier.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.", "comment": "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.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 1, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "code": "JHN", "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "display": "Jurisdictional health number" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Patient.identifier:jurisdictional.type.id", "path": "Patient.identifier.type.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.type.extension", "path": "Patient.identifier.type.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding", "path": "Patient.identifier.type.coding", "short": "Code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "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.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 1, "max": "1", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding.id", "path": "Patient.identifier.type.coding.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding.extension", "path": "Patient.identifier.type.coding.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding.system", "path": "Patient.identifier.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.", "comment": "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.", "requirements": "Need to be unambiguous about the source of the definition of the symbol.", "min": 0, "max": "1", "base": { "path": "Coding.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "http://terminology.hl7.org/CodeSystem/v2-0203", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.3" }, { "identity": "rim", "map": "./codeSystem" }, { "identity": "orim", "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding.version", "path": "Patient.identifier.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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Coding.version", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.7" }, { "identity": "rim", "map": "./codeSystemVersion" }, { "identity": "orim", "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding.code", "path": "Patient.identifier.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.", "min": 0, "max": "1", "base": { "path": "Coding.code", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "patternCode": "JHN", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1" }, { "identity": "rim", "map": "./code" }, { "identity": "orim", "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Patient.identifier.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.", "min": 0, "max": "1", "base": { "path": "Coding.display", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "patternString": "Jurisdictional health number", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.2 - but note this is not well followed" }, { "identity": "rim", "map": "CV.displayName" }, { "identity": "orim", "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" } ] }, { "id": "Patient.identifier:jurisdictional.type.coding.userSelected", "path": "Patient.identifier.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).", "comment": "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.", "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.", "min": 0, "max": "1", "base": { "path": "Coding.userSelected", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "Sometimes implied by being first" }, { "identity": "rim", "map": "CD.codingRationale" }, { "identity": "orim", "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]" } ] }, { "id": "Patient.identifier:jurisdictional.type.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Patient.identifier.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.", "comment": "Very often the text is the same as a displayName of one of the codings.", "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.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "Patient.identifier:jurisdictional.system", "path": "Patient.identifier.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)", "comment": "Identifier.system is always case sensitive.", "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.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "strength": "required", "valueSet": "https://fhir.apps.health/ValueSet/canadian-phn-systems" }, "mapping": [ { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "Patient.identifier:jurisdictional.value", "path": "Patient.identifier.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.", "comment": "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](extension-rendered-value.html). 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.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" } ] }, { "id": "Patient.identifier:jurisdictional.period", "path": "Patient.identifier.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Patient.identifier:jurisdictional.assigner", "path": "Patient.identifier.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "Patient.identifier:mrn", "path": "Patient.identifier", "sliceName": "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.", "min": 0, "max": "1", "base": { "path": "Patient.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "v2", "map": "PID-3" }, { "identity": "rim", "map": "id" }, { "identity": "cda", "map": ".id" } ] }, { "id": "Patient.identifier:mrn.id", "path": "Patient.identifier.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:mrn.extension", "path": "Patient.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:mrn.extension:reasonForNoHCN", "path": "Patient.identifier.extension", "sliceName": "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\nOntario's CA-eReC `reason-for-no-HCN` extension.\n\nOntario eReferral requires `Patient.identifier` to carry either the health card number or a\ndocumented reason for its absence; this is that reason. Present at most once per patient.\n\nBecause the extension's declared context is `Patient.identifier`, it is carried on an identifier\nthe patient DOES have (typically the MRN slice) when no jurisdictional health number exists --\nthere is no jurisdictional identifier repeat to attach it to in exactly the case it describes.\n\nSHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory,\nand a reader encountering both should trust the identifier. It also says nothing about WHICH\njurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province\npatient, not a patient without a health card.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-reason-for-no-HCN-EXT" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:mrn.use", "path": "Patient.identifier.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Patient.identifier:mrn.type", "path": "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.", "comment": "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.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 1, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "code": "MR", "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "display": "Medical record number" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Patient.identifier:mrn.type.id", "path": "Patient.identifier.type.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:mrn.type.extension", "path": "Patient.identifier.type.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:mrn.type.coding", "path": "Patient.identifier.type.coding", "short": "Code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "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.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 1, "max": "1", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "Patient.identifier:mrn.type.coding.id", "path": "Patient.identifier.type.coding.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:mrn.type.coding.extension", "path": "Patient.identifier.type.coding.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.identifier:mrn.type.coding.system", "path": "Patient.identifier.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.", "comment": "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.", "requirements": "Need to be unambiguous about the source of the definition of the symbol.", "min": 0, "max": "1", "base": { "path": "Coding.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "http://terminology.hl7.org/CodeSystem/v2-0203", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.3" }, { "identity": "rim", "map": "./codeSystem" }, { "identity": "orim", "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" } ] }, { "id": "Patient.identifier:mrn.type.coding.version", "path": "Patient.identifier.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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Coding.version", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.7" }, { "identity": "rim", "map": "./codeSystemVersion" }, { "identity": "orim", "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" } ] }, { "id": "Patient.identifier:mrn.type.coding.code", "path": "Patient.identifier.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.", "min": 0, "max": "1", "base": { "path": "Coding.code", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "patternCode": "MR", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1" }, { "identity": "rim", "map": "./code" }, { "identity": "orim", "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" } ] }, { "id": "Patient.identifier:mrn.type.coding.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Patient.identifier.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.", "min": 0, "max": "1", "base": { "path": "Coding.display", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "patternString": "Medical record number", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.2 - but note this is not well followed" }, { "identity": "rim", "map": "CV.displayName" }, { "identity": "orim", "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" } ] }, { "id": "Patient.identifier:mrn.type.coding.userSelected", "path": "Patient.identifier.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).", "comment": "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.", "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.", "min": 0, "max": "1", "base": { "path": "Coding.userSelected", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "Sometimes implied by being first" }, { "identity": "rim", "map": "CD.codingRationale" }, { "identity": "orim", "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]" } ] }, { "id": "Patient.identifier:mrn.type.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Patient.identifier.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.", "comment": "Very often the text is the same as a displayName of one of the codings.", "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.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "Patient.identifier:mrn.system", "path": "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.", "comment": "Identifier.system is always case sensitive.", "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.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "https://fhir.apps.health/NamingSystem/patient-mrn", "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "Patient.identifier:mrn.value", "path": "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.", "comment": "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](extension-rendered-value.html). 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.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" } ] }, { "id": "Patient.identifier:mrn.period", "path": "Patient.identifier.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Patient.identifier:mrn.assigner", "path": "Patient.identifier.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "Patient.active", "path": "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.", "comment": "If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.", "requirements": "Need to be able to mark a patient record as not to be used because it was created in error.", "min": 0, "max": "1", "base": { "path": "Patient.active", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "meaningWhenMissing": "This resource is generally assumed to be active if no value is provided for the active element", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "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", "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": "statusCode" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.name", "path": "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.", "comment": "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.", "requirements": "Need to be able to track the patient by multiple names. Examples are your official name and a partner name.", "min": 1, "max": "*", "base": { "path": "Patient.name", "min": 0, "max": "*" }, "type": [ { "code": "HumanName" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "PID-5, PID-9" }, { "identity": "rim", "map": "name" }, { "identity": "cda", "map": ".patient.name" } ] }, { "id": "Patient.name.id", "path": "Patient.name.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.name.extension", "path": "Patient.name.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.name.use", "path": "Patient.name.use", "short": "usual | official | temp | nickname | anonymous | old | maiden", "definition": "Identifies the purpose for this name.", "comment": "Applications can assume that a name is current unless it explicitly says that it is temporary or old.", "requirements": "Allows the appropriate name for a particular context of use to be selected from among a set of names.", "min": 0, "max": "1", "base": { "path": "HumanName.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary or old name etc.for a current/permanent one", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "NameUse" } ], "strength": "required", "description": "The use of a human name.", "valueSet": "http://hl7.org/fhir/ValueSet/name-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "XPN.7, but often indicated by which field contains the name" }, { "identity": "rim", "map": "unique(./use)" }, { "identity": "servd", "map": "./NamePurpose" } ] }, { "id": "Patient.name.text", "path": "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.", "comment": "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.", "requirements": "A renderable, unencoded form.", "min": 0, "max": "1", "base": { "path": "HumanName.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "implied by XPN.11" }, { "identity": "rim", "map": "./formatted" } ] }, { "id": "Patient.name.family", "path": "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.", "comment": "Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).", "alias": [ "surname" ], "min": 0, "max": "1", "base": { "path": "HumanName.family", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XPN.1/FN.1" }, { "identity": "rim", "map": "./part[partType = FAM]" }, { "identity": "servd", "map": "./FamilyName" } ] }, { "id": "Patient.name.given", "path": "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.", "comment": "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.", "alias": [ "first name", "middle name" ], "min": 0, "max": "*", "base": { "path": "HumanName.given", "min": 0, "max": "*" }, "type": [ { "code": "string" } ], "orderMeaning": "Given Names appear in the correct order for presenting the name", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XPN.2 + XPN.3" }, { "identity": "rim", "map": "./part[partType = GIV]" }, { "identity": "servd", "map": "./GivenNames" } ] }, { "id": "Patient.name.prefix", "path": "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).", "min": 0, "max": "*", "base": { "path": "HumanName.prefix", "min": 0, "max": "*" }, "type": [ { "code": "string" } ], "orderMeaning": "Prefixes appear in the correct order for presenting the name", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XPN.5" }, { "identity": "rim", "map": "./part[partType = PFX]" }, { "identity": "servd", "map": "./TitleCode" } ] }, { "id": "Patient.name.suffix", "path": "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).", "min": 0, "max": "*", "base": { "path": "HumanName.suffix", "min": 0, "max": "*" }, "type": [ { "code": "string" } ], "orderMeaning": "Suffixes appear in the correct order for presenting the name", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XPN/4" }, { "identity": "rim", "map": "./part[partType = SFX]" } ] }, { "id": "Patient.name.period", "path": "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.", "min": 0, "max": "1", "base": { "path": "HumanName.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XPN.13 + XPN.14" }, { "identity": "rim", "map": "./usablePeriod[type=\"IVL\"]" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Patient.telecom", "path": "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.", "comment": "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).", "requirements": "People have (primary) ways to contact them in some way such as phone, email.", "min": 0, "max": "*", "base": { "path": "Patient.telecom", "min": 0, "max": "*" }, "type": [ { "code": "ContactPoint" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "PID-13, PID-14, PID-40" }, { "identity": "rim", "map": "telecom" }, { "identity": "cda", "map": ".telecom" } ] }, { "id": "Patient.gender", "path": "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.", "comment": "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.", "requirements": "Needed for identification of the individual, in combination with (at least) name and birth date.", "min": 0, "max": "1", "base": { "path": "Patient.gender", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdministrativeGender" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The gender of a person used for administrative purposes.", "valueSet": "http://hl7.org/fhir/ValueSet/administrative-gender" }, "mapping": [ { "identity": "v2", "map": "PID-8" }, { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender" }, { "identity": "cda", "map": ".patient.administrativeGenderCode" } ] }, { "id": "Patient.birthDate", "path": "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.", "comment": "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).", "requirements": "Age of the individual drives many clinical processes.", "min": 0, "max": "1", "base": { "path": "Patient.birthDate", "min": 0, "max": "1" }, "type": [ { "code": "date" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "PID-7" }, { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime" }, { "identity": "cda", "map": ".patient.birthTime" }, { "identity": "loinc", "map": "21112-8" } ] }, { "id": "Patient.deceased[x]", "path": "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.", "comment": "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.", "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.", "min": 0, "max": "1", "base": { "path": "Patient.deceased[x]", "min": 0, "max": "1" }, "type": [ { "code": "boolean" }, { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "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.", "isSummary": true, "mapping": [ { "identity": "v2", "map": "PID-30 (bool) and PID-29 (datetime)" }, { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.address", "path": "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).", "comment": "Patient may have multiple addresses with different uses or applicable periods.", "requirements": "May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.", "min": 0, "max": "*", "base": { "path": "Patient.address", "min": 0, "max": "*" }, "type": [ { "code": "Address" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "patient-address-country-alpha2", "severity": "warning", "human": "Address.country SHOULD be an ISO 3166-1 alpha-2 code ('CA'), not alpha-3 ('CAN') and not a country name ('Canada'). Alpha-3 is an edge/submission form only and must not be stored.", "expression": "country.empty() or country.matches('^[A-Za-z]{2}$')", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "PID-11" }, { "identity": "rim", "map": "addr" }, { "identity": "cda", "map": ".addr" } ] }, { "id": "Patient.address.id", "path": "Patient.address.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.address.extension", "path": "Patient.address.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.address.use", "path": "Patient.address.use", "short": "home | work | temp | old | billing - purpose of this address", "definition": "The purpose of this address.", "comment": "Applications can assume that an address is current unless it explicitly says that it is temporary or old.", "requirements": "Allows an appropriate address to be chosen from a list of many.", "min": 0, "max": "1", "base": { "path": "Address.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "example": [ { "label": "General", "valueCode": "home" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary or old address etc.for a current/permanent one", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AddressUse" } ], "strength": "required", "description": "The use of an address.", "valueSet": "http://hl7.org/fhir/ValueSet/address-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "XAD.7" }, { "identity": "rim", "map": "unique(./use)" }, { "identity": "servd", "map": "./AddressPurpose" } ] }, { "id": "Patient.address.type", "path": "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.", "comment": "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](location.html#) resource).", "min": 0, "max": "1", "base": { "path": "Address.type", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "example": [ { "label": "General", "valueCode": "both" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AddressType" } ], "strength": "required", "description": "The type of an address (physical / postal).", "valueSet": "http://hl7.org/fhir/ValueSet/address-type|4.0.1" }, "mapping": [ { "identity": "v2", "map": "XAD.18" }, { "identity": "rim", "map": "unique(./use)" }, { "identity": "vcard", "map": "address type parameter" } ] }, { "id": "Patient.address.text", "path": "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.", "comment": "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.", "requirements": "A renderable, unencoded form.", "min": 0, "max": "1", "base": { "path": "Address.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "137 Nowhere Street, Erewhon 9132" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XAD.1 + XAD.2 + XAD.3 + XAD.4 + XAD.5 + XAD.6" }, { "identity": "rim", "map": "./formatted" }, { "identity": "vcard", "map": "address label parameter" } ] }, { "id": "Patient.address.line", "path": "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.", "min": 0, "max": "*", "base": { "path": "Address.line", "min": 0, "max": "*" }, "type": [ { "code": "string" } ], "orderMeaning": "The order in which lines should appear in an address label", "example": [ { "label": "General", "valueString": "137 Nowhere Street" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XAD.1 + XAD.2 (note: XAD.1 and XAD.2 have different meanings for a company address than for a person address)" }, { "identity": "rim", "map": "AD.part[parttype = AL]" }, { "identity": "vcard", "map": "street" }, { "identity": "servd", "map": "./StreetAddress (newline delimitted)" } ] }, { "id": "Patient.address.city", "path": "Patient.address.city", "short": "Name of city, town etc.", "definition": "The name of the city, town, suburb, village or other community or delivery center.", "alias": [ "Municpality" ], "min": 0, "max": "1", "base": { "path": "Address.city", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "Erewhon" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XAD.3" }, { "identity": "rim", "map": "AD.part[parttype = CTY]" }, { "identity": "vcard", "map": "locality" }, { "identity": "servd", "map": "./Jurisdiction" } ] }, { "id": "Patient.address.district", "path": "Patient.address.district", "short": "District name (aka county)", "definition": "The name of the administrative area (county).", "comment": "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.", "alias": [ "County" ], "min": 0, "max": "1", "base": { "path": "Address.district", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "Madison" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XAD.9" }, { "identity": "rim", "map": "AD.part[parttype = CNT | CPA]" } ] }, { "id": "Patient.address.state", "path": "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,\nwhich matches the Canada Post / USPS abbreviation): `ON`, not `CA-ON`, and not `Ontario`.\n\n**The binding is `required`, which is a deliberate departure from this IG's usual lenient posture.**\nThe reason is that the alternative is silent corruption rather than a clean failure: consumers gate\njurisdictional behaviour on this value (Ontario PCR eligibility is gated on `ON`) and do positional\nstring surgery on it, which has produced malformed outbound jurisdictional HL7 in production. A\nclosed roster makes that fail loudly instead.\n\n**⚠ HERITAGE EMR SITUATION -- UNRESOLVED as of IG 1.12.0.** This binding was validated against the\nIG's own example instances and the synthetic corpus only. **Heritage-EMR data has NOT been\nsurveyed.** Heritage EMRs store province as an unconstrained free-text column typed by front-desk\nstaff over decades, with no validation at entry -- the same systems demonstrably emit uncoded\nfree-text on adjacent fields (the enrolment/roster status is carried as an uncoded `valueString`).\nSo spelled-out province names (\"Ontario\"), lowercase codes, and trailing whitespace are all\nplausible in existing records.\n\nWhere they exist, a `required` binding **rejects real patients** rather than merely flagging them --\nstrictly worse than the outbound corruption it was added to prevent. The distribution has not been\nmeasured, so this is an open risk, not a closed decision.\n\nImplementers migrating a heritage corpus SHOULD profile their actual `state` value distribution\nbefore enforcing, and MAY treat this binding as `extensible` during migration, relying on the\n`patient-address-country-alpha2` warning invariant and an equivalent state-shape check instead.\nNormalizing at ingest (uppercase, trim, map full names to codes) is the intended long-term fix.\nThis caveat comes out once the heritage-data survey is done and the decision is recorded.", "comment": "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.", "alias": [ "Province", "Territory" ], "min": 0, "max": "1", "base": { "path": "Address.state", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "strength": "required", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-province-state" }, "mapping": [ { "identity": "v2", "map": "XAD.4" }, { "identity": "rim", "map": "AD.part[parttype = STA]" }, { "identity": "vcard", "map": "region" }, { "identity": "servd", "map": "./Region" } ] }, { "id": "Patient.address.postalCode", "path": "Patient.address.postalCode", "short": "Postal code for area", "definition": "The postal code for the patient's address. Should be in A1A 1A1 format.", "alias": [ "Zip" ], "min": 0, "max": "1", "base": { "path": "Address.postalCode", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "9132" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XAD.5" }, { "identity": "rim", "map": "AD.part[parttype = ZIP]" }, { "identity": "vcard", "map": "code" }, { "identity": "servd", "map": "./PostalIdentificationCode" } ] }, { "id": "Patient.address.country", "path": "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;\nthis profile pins alpha-2 as the stored form to end the alpha-2/alpha-3 split that has produced\nmalformed outbound values (`\"Ca-io\"` and `\"CANio\"` have both been observed on outbound\njurisdictional HL7, from consumers doing positional string surgery on inconsistent input).\n\nAlpha-3 (`CAN`) and country names (`Canada`) are NOT conformant. Where a downstream interface\nrequires alpha-3, convert at that edge -- the same posture this profile takes on the Ontario\nhealth-card version code.\n\n**⚠ HERITAGE EMR SITUATION -- UNRESOLVED as of IG 1.12.0.** As with `address.state`, this `required`\nbinding was validated against the IG's own examples and the synthetic corpus only. **Heritage-EMR\ndata has NOT been surveyed**, and alpha-3 (`CAN`) or spelled-out country values (`Canada`) are\nplausible in existing records -- one in-repo converter already writes alpha-3, which is how the\nmalformed outbound values above were produced in the first place, so the inconsistency demonstrably\nexists inside our own stack and not only upstream of it.\n\nSurvey the corpus before enforcing, and treat the binding as `extensible` during migration if it is\ndirty -- the `patient-address-country-alpha2` invariant (`#warning`) still reports the specific\nalpha-3 case either way. Normalizing at ingest is the intended long-term fix. This caveat comes out\nonce the heritage-data survey is done and the decision is recorded.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Address.country", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/iso3166-1-2" }, "mapping": [ { "identity": "v2", "map": "XAD.6" }, { "identity": "rim", "map": "AD.part[parttype = CNT]" }, { "identity": "vcard", "map": "country" }, { "identity": "servd", "map": "./Country" } ] }, { "id": "Patient.address.period", "path": "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.", "min": 0, "max": "1", "base": { "path": "Address.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "example": [ { "label": "General", "valuePeriod": { "start": "2010-03-23", "end": "2010-07-01" } } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "XAD.12 / XAD.13 + XAD.14" }, { "identity": "rim", "map": "./usablePeriod[type=\"IVL\"]" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Patient.maritalStatus", "path": "Patient.maritalStatus", "short": "Marital status with raw code support", "definition": "The patient's most recent marital (civil) status.\n\nRECOMMENDED: Standard terminology codes (v3 Marital Status) when available\nOPTIONAL: Raw EMR codes for source system preservation\n\nUsed for administrative and billing purposes, may impact insurance coverage and next-of-kin determinations.", "requirements": "Most, if not all systems capture it.", "min": 0, "max": "1", "base": { "path": "Patient.maritalStatus", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MaritalStatus" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "The domestic partnership status of a person.", "valueSet": "http://hl7.org/fhir/ValueSet/marital-status" }, "mapping": [ { "identity": "v2", "map": "PID-16" }, { "identity": "rim", "map": "player[classCode=PSN]/maritalStatusCode" }, { "identity": "cda", "map": ".patient.maritalStatusCode" } ] }, { "id": "Patient.multipleBirth[x]", "path": "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.", "comment": "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).", "requirements": "For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.", "min": 0, "max": "1", "base": { "path": "Patient.multipleBirth[x]", "min": 0, "max": "1" }, "type": [ { "code": "boolean" }, { "code": "integer" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "PID-24 (bool), PID-25 (integer)" }, { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.photo", "path": "Patient.photo", "short": "Image of the patient", "definition": "Image of the patient.", "comment": "Guidelines:\n* Use id photos, not clinical photos.\n* Limit dimensions to thumbnail.\n* Keep byte count low to ease resource updates.", "requirements": "Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.", "min": 0, "max": "*", "base": { "path": "Patient.photo", "min": 0, "max": "*" }, "type": [ { "code": "Attachment" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "OBX-5 - needs a profile" }, { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact", "path": "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.", "comment": "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.", "requirements": "Need to track people you can contact about the patient.", "min": 0, "max": "*", "base": { "path": "Patient.contact", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "pat-1", "severity": "error", "human": "SHALL at least contain a contact's details or a reference to an organization", "expression": "name.exists() or telecom.exists() or address.exists() or organization.exists()", "xpath": "exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization)" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact.id", "path": "Patient.contact.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.contact.extension", "path": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.contact.modifierExtension", "path": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.contact.relationship", "path": "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.", "min": 0, "max": "*", "base": { "path": "Patient.contact.relationship", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ContactRelationship" } ], "strength": "extensible", "description": "The nature of the relationship between a patient and a contact person for that patient.", "valueSet": "http://hl7.org/fhir/ValueSet/patient-contactrelationship" }, "mapping": [ { "identity": "v2", "map": "NK1-7, NK1-3" }, { "identity": "rim", "map": "code" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact.name", "path": "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.", "min": 0, "max": "1", "base": { "path": "Patient.contact.name", "min": 0, "max": "1" }, "type": [ { "code": "HumanName" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "NK1-2" }, { "identity": "rim", "map": "name" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact.telecom", "path": "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.", "comment": "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.", "requirements": "People have (primary) ways to contact them in some way such as phone, email.", "min": 0, "max": "*", "base": { "path": "Patient.contact.telecom", "min": 0, "max": "*" }, "type": [ { "code": "ContactPoint" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "NK1-5, NK1-6, NK1-40" }, { "identity": "rim", "map": "telecom" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact.address", "path": "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.", "min": 0, "max": "1", "base": { "path": "Patient.contact.address", "min": 0, "max": "1" }, "type": [ { "code": "Address" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "NK1-4" }, { "identity": "rim", "map": "addr" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact.gender", "path": "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.", "min": 0, "max": "1", "base": { "path": "Patient.contact.gender", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdministrativeGender" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The gender of a person used for administrative purposes.", "valueSet": "http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1" }, "mapping": [ { "identity": "v2", "map": "NK1-15" }, { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact.organization", "path": "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.", "min": 0, "max": "1", "base": { "path": "Patient.contact.organization", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "pat-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "NK1-13, NK1-30, NK1-31, NK1-32, NK1-41" }, { "identity": "rim", "map": "scoper" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.contact.period", "path": "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.", "min": 0, "max": "1", "base": { "path": "Patient.contact.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "effectiveTime" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.communication", "path": "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.", "comment": "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.", "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.", "min": 0, "max": "*", "base": { "path": "Patient.communication", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "LanguageCommunication" }, { "identity": "cda", "map": "patient.languageCommunication" } ] }, { "id": "Patient.communication.id", "path": "Patient.communication.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.communication.extension", "path": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.communication.modifierExtension", "path": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.communication.language", "path": "Patient.communication.language", "short": "Language with raw code support", "definition": "The language for communication with the patient.\n\nRECOMMENDED: ISO 639 language codes (e.g., en, fr) or BCP 47 codes\nOPTIONAL: Raw EMR codes for source system preservation\n\nShould include relevant languages such as English (en), French (fr), and indigenous languages.\nThe preferred language should be marked with communication.preferred = true.", "comment": "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.", "requirements": "Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.", "min": 1, "max": "1", "base": { "path": "Patient.communication.language", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" }, "mapping": [ { "identity": "v2", "map": "PID-15, LAN-2" }, { "identity": "rim", "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code" }, { "identity": "cda", "map": ".languageCode" } ] }, { "id": "Patient.communication.preferred", "path": "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).", "comment": "This language is specifically identified for communicating healthcare information.", "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.", "min": 0, "max": "1", "base": { "path": "Patient.communication.preferred", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "PID-15" }, { "identity": "rim", "map": "preferenceInd" }, { "identity": "cda", "map": ".preferenceInd" } ] }, { "id": "Patient.generalPractitioner", "path": "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.", "comment": "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.\nMultiple 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.\n\nJurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.", "alias": [ "careProvider" ], "min": 0, "max": "*", "base": { "path": "Patient.generalPractitioner", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "PD1-4" }, { "identity": "rim", "map": "subjectOf.CareEvent.performer.AssignedEntity" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.managingOrganization", "path": "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.", "comment": "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).", "requirements": "Need to know who recognizes this patient record, manages and updates it.", "min": 1, "max": "1", "base": { "path": "Patient.managingOrganization", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "scoper" }, { "identity": "cda", "map": ".providerOrganization" } ] }, { "id": "Patient.link", "path": "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.", "comment": "There is no assumption that linked patient records have mutual links.", "requirements": "There are multiple use cases: \n\n* Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and \n* Distribution of patient information across multiple servers.", "min": 0, "max": "*", "base": { "path": "Patient.link", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "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'", "isSummary": true, "mapping": [ { "identity": "rim", "map": "outboundLink" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.link.id", "path": "Patient.link.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.link.extension", "path": "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Patient.link.modifierExtension", "path": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Patient.link.other", "path": "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.", "comment": "Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.", "min": 1, "max": "1", "base": { "path": "Patient.link.other", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ], "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy", "valueBoolean": false } ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "PID-3, MRG-1" }, { "identity": "rim", "map": "id" }, { "identity": "cda", "map": "n/a" } ] }, { "id": "Patient.link.type", "path": "Patient.link.type", "short": "replaced-by | replaces | refer | seealso", "definition": "The type of link between this patient resource and another patient resource.", "min": 1, "max": "1", "base": { "path": "Patient.link.type", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "LinkType" } ], "strength": "required", "description": "The type of link between this patient resource and another patient resource.", "valueSet": "http://hl7.org/fhir/ValueSet/link-type|4.0.1" }, "mapping": [ { "identity": "rim", "map": "typeCode" }, { "identity": "cda", "map": "n/a" } ] } ] }, "differential": { "element": [ { "id": "Patient", "path": "Patient", "short": "Nexus EMR Patient Core", "definition": "Represents patient demographic and administrative information, capturing key details\nlike identifiers, name, gender, birth date, and contact information using standard\nNexus EMR references. Uses instance-specific identifiers for tracking patients\nacross systems.", "constraint": [ { "key": "patient-name-family-or-given", "severity": "warning", "human": "Patient.name: at least one name SHALL carry a family name, a given name, or text -- or a data-absent-reason extension (CA Baseline ipa-pat-2). Ontario's stricter 'family required' is applied as an edge transform on submission, not in the core profile.", "expression": "name.where(family.exists() or given.exists() or text.exists()).exists() or name.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-indigenous-identity-absence-exclusive", "severity": "warning", "human": "If a not-answered value (Asked But Declined / Do not know/ Not applicable) is recorded, it SHOULD be the only instance of the extension.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').value.ofType(CodeableConcept).coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' or system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists() implies extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').count() = 1", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-indigenous-identity-instances-clean", "severity": "warning", "human": "Each instance SHOULD carry exactly one coding, and no two instances SHOULD repeat the same system|code answer.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').value.ofType(CodeableConcept).all(coding.count() = 1) and extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity').value.ofType(CodeableConcept).coding.select(system & '|' & code).isDistinct()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-racialized-group-absence-exclusive", "severity": "warning", "human": "If a not-answered value (Asked But Declined / Do not know / Another race category) is recorded, it SHOULD be the only instance of the extension.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').value.ofType(CodeableConcept).coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' or system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists() implies extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').count() = 1", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-racialized-group-instances-clean", "severity": "warning", "human": "Each instance SHOULD carry exactly one coding, and no two instances SHOULD repeat the same system|code answer.", "expression": "extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').value.ofType(CodeableConcept).all(coding.count() = 1) and extension.where(url = 'http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup').value.ofType(CodeableConcept).coding.select(system & '|' & code).isDistinct()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" }, { "key": "patient-indian-registration-number-format", "severity": "warning", "human": "An Indian registration number identifier's value, when carried, SHOULD be 9 or 10 digits.", "expression": "identifier.where(system = 'https://fhir.infoway-inforoute.ca/NamingSystem/ca-indigenous-northern-affairs-number').all(value.empty() or value.matches('^[0-9]{9,10}$'))", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" } ] }, { "id": "Patient.id", "path": "Patient.id", "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.", "mustSupport": true }, { "id": "Patient.meta.source", "path": "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.", "mustSupport": true }, { "id": "Patient.text", "path": "Patient.text", "short": "Narrative", "definition": "A human-readable narrative summary of the resource for human interpretation." }, { "id": "Patient.extension", "path": "Patient.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" } }, { "id": "Patient.extension:genderIdentity", "path": "Patient.extension", "sliceName": "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.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/individual-genderIdentity" ] } ], "mustSupport": true }, { "id": "Patient.extension:genderIdentity.extension:value", "path": "Patient.extension.extension", "sliceName": "value" }, { "id": "Patient.extension:genderIdentity.extension:value.value[x]", "path": "Patient.extension.extension.value[x]", "binding": { "strength": "required", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-gender-identity" } }, { "id": "Patient.extension:pronouns", "path": "Patient.extension", "sliceName": "pronouns", "short": "Personal pronouns", "definition": "The patient's personal pronouns. Uses the HL7 individual-pronouns extension.", "comment": "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.", "min": 0, "max": "*", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/individual-pronouns" ] } ], "mustSupport": true }, { "id": "Patient.extension:pronouns.extension:value", "path": "Patient.extension.extension", "sliceName": "value" }, { "id": "Patient.extension:pronouns.extension:value.value[x]", "path": "Patient.extension.extension.value[x]", "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-pronouns" } }, { "id": "Patient.extension:birthSex", "path": "Patient.extension", "sliceName": "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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-patientbirthsex" ] } ], "mustSupport": true }, { "id": "Patient.extension:recordInactiveReason", "path": "Patient.extension", "sliceName": "recordInactiveReason", "short": "Why a heritage patient record is inactive", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-patient-record-inactive-reason" ] } ] }, { "id": "Patient.extension:indigenousIdentity", "path": "Patient.extension", "sliceName": "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.", "comment": "Repeatable, with one answer per instance. Declining to answer must be non-blocking.", "min": 0, "max": "*", "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-indigenousIdentity" ] } ], "mustSupport": true }, { "id": "Patient.extension:indigenousIdentity.value[x]", "path": "Patient.extension.value[x]", "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-indigenous-identity" } }, { "id": "Patient.extension:racializedGroup", "path": "Patient.extension", "sliceName": "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.", "comment": "Repeatable, with one answer per instance.", "min": 0, "max": "*", "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/ca-ext/StructureDefinition/patient-racializedGroup" ] } ], "mustSupport": true }, { "id": "Patient.extension:racializedGroup.value[x]", "path": "Patient.extension.value[x]", "binding": { "strength": "extensible", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-racialized-group" } }, { "id": "Patient.extension:indianActRegistrationStatus", "path": "Patient.extension", "sliceName": "indianActRegistrationStatus", "short": "Indian Act registration status, as stated", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-indian-act-registration-status" ] } ] }, { "id": "Patient.extension:firstNationRegistryGroup", "path": "Patient.extension", "sliceName": "firstNationRegistryGroup", "short": "Registry group (band) the registration is held under", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-first-nation-registry-group" ] } ] }, { "id": "Patient.extension:firstNationCommunity", "path": "Patient.extension", "sliceName": "firstNationCommunity", "short": "First Nation community the patient affiliates with", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-first-nation-community" ] } ] }, { "id": "Patient.extension:interpreterRequired", "path": "Patient.extension", "sliceName": "interpreterRequired", "short": "Whether this patient needs an interpreter", "definition": "Whether an interpreter is required to communicate with the patient. HL7's own extension, adopted\nhere rather than restated: this specification declares no address of its own for it.\n\nRead `Patient.communication` for WHICH language; this element says only that help is needed.", "comment": "**Absence means NOT RECORDED, not \"no interpreter needed\".** Producers in this estate write the\nextension only when the answer is true, so a patient with no extension is one nobody was asked\nabout. Treating absence as a negative answer asserts a determination that was never made -- and the\npopulation it would silently mislabel is exactly the one the field exists to find.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired" ] } ], "mustSupport": true }, { "id": "Patient.extension:primaryCareAttachment", "path": "Patient.extension", "sliceName": "primaryCareAttachment", "short": "Current primary-care roster/enrollment/attachment", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-primary-care-attachment" ] } ], "mustSupport": true }, { "id": "Patient.identifier", "path": "Patient.identifier", "slicing": { "discriminator": [ { "type": "pattern", "path": "type" } ], "rules": "open", "description": "Slice identifiers by type" }, "short": "Patient identifiers (Nexus EMR ID recommended)", "definition": "Patient identifiers. Identifier is optional (0..*); patient identity rests on the FHIR logical `id`\nplus any business identifiers present. Types include:\n- **Recommended**: a Nexus EMR system identifier\n- **Optional**: Provincial/Territorial Health Numbers (PHN/JHN)\n- **Optional**: Indian Act registration / status number, under the Canadian URI Registry system\n `https://fhir.infoway-inforoute.ca/NamingSystem/ca-indigenous-northern-affairs-number` —\n validity period carries the card's issue/expiry, the IndianStatusCardTypeExtension the\n presented document form, and a data-absent-reason on `value` stands in while card facets are\n recorded before the number\n- **Optional**: Raw codes from source EMR systems\n- **Optional**: Medical Record Numbers (MRN), other local identifiers\n\nA source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "mustSupport": true }, { "id": "Patient.identifier.extension:reasonForNoHCN", "path": "Patient.identifier.extension", "sliceName": "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\nOntario's CA-eReC `reason-for-no-HCN` extension.\n\nOntario eReferral requires `Patient.identifier` to carry either the health card number or a\ndocumented reason for its absence; this is that reason. Present at most once per patient.\n\nBecause the extension's declared context is `Patient.identifier`, it is carried on an identifier\nthe patient DOES have (typically the MRN slice) when no jurisdictional health number exists --\nthere is no jurisdictional identifier repeat to attach it to in exactly the case it describes.\n\nSHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory,\nand a reader encountering both should trust the identifier. It also says nothing about WHICH\njurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province\npatient, not a patient without a health card.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-reason-for-no-HCN-EXT" ] } ], "mustSupport": true }, { "id": "Patient.identifier.system", "path": "Patient.identifier.system", "min": 1 }, { "id": "Patient.identifier.value", "path": "Patient.identifier.value", "min": 1 }, { "id": "Patient.identifier:jurisdictional", "path": "Patient.identifier", "sliceName": "jurisdictional", "short": "Provincial/Territorial Health Number", "definition": "Provincial or Territorial Health Number (PHN/JHN) from Canadian jurisdictions", "min": 0, "max": "*", "mustSupport": true }, { "id": "Patient.identifier:jurisdictional.extension:reasonForNoHCN", "path": "Patient.identifier.extension", "sliceName": "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\nOntario's CA-eReC `reason-for-no-HCN` extension.\n\nOntario eReferral requires `Patient.identifier` to carry either the health card number or a\ndocumented reason for its absence; this is that reason. Present at most once per patient.\n\nBecause the extension's declared context is `Patient.identifier`, it is carried on an identifier\nthe patient DOES have (typically the MRN slice) when no jurisdictional health number exists --\nthere is no jurisdictional identifier repeat to attach it to in exactly the case it describes.\n\nSHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory,\nand a reader encountering both should trust the identifier. It also says nothing about WHICH\njurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province\npatient, not a patient without a health card.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-reason-for-no-HCN-EXT" ] } ], "mustSupport": true }, { "id": "Patient.identifier:jurisdictional.extension:healthCardVersion", "path": "Patient.identifier.extension", "sliceName": "healthCardVersion", "short": "Health card version code (CA Baseline ext-identifierversion)", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-identifierversion" ] } ], "mustSupport": true }, { "id": "Patient.identifier:jurisdictional.use", "path": "Patient.identifier.use", "patternCode": "official" }, { "id": "Patient.identifier:jurisdictional.type", "path": "Patient.identifier.type", "short": "Type or jurisdiction of the health card, which drives format validation", "comment": "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.", "min": 1, "patternCodeableConcept": { "coding": [ { "code": "JHN", "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "display": "Jurisdictional health number" } ] } }, { "id": "Patient.identifier:jurisdictional.type.coding", "path": "Patient.identifier.type.coding", "min": 1, "max": "1" }, { "id": "Patient.identifier:jurisdictional.type.coding.system", "path": "Patient.identifier.type.coding.system", "fixedUri": "http://terminology.hl7.org/CodeSystem/v2-0203" }, { "id": "Patient.identifier:jurisdictional.type.coding.code", "path": "Patient.identifier.type.coding.code", "patternCode": "JHN" }, { "id": "Patient.identifier:jurisdictional.type.coding.display", "path": "Patient.identifier.type.coding.display", "patternString": "Jurisdictional health number" }, { "id": "Patient.identifier:jurisdictional.system", "path": "Patient.identifier.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)", "binding": { "strength": "required", "valueSet": "https://fhir.apps.health/ValueSet/canadian-phn-systems" } }, { "id": "Patient.identifier:jurisdictional.value", "path": "Patient.identifier.value", "short": "The actual PHN value" }, { "id": "Patient.identifier:mrn", "path": "Patient.identifier", "sliceName": "mrn", "short": "Medical Record Number (chart number)", "definition": "The patient's local Medical Record Number / chart number from the source EMR.", "min": 0, "max": "1", "mustSupport": true }, { "id": "Patient.identifier:mrn.extension:reasonForNoHCN", "path": "Patient.identifier.extension", "sliceName": "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\nOntario's CA-eReC `reason-for-no-HCN` extension.\n\nOntario eReferral requires `Patient.identifier` to carry either the health card number or a\ndocumented reason for its absence; this is that reason. Present at most once per patient.\n\nBecause the extension's declared context is `Patient.identifier`, it is carried on an identifier\nthe patient DOES have (typically the MRN slice) when no jurisdictional health number exists --\nthere is no jurisdictional identifier repeat to attach it to in exactly the case it describes.\n\nSHOULD be absent when `identifier[jurisdictional]` is populated: carrying both is contradictory,\nand a reader encountering both should trust the identifier. It also says nothing about WHICH\njurisdiction is missing -- a patient with an Alberta PHN and no Ontario one is an out-of-province\npatient, not a patient without a health card.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://fhir.infoway-inforoute.ca/io/CA-eReC/StructureDefinition/CA-eReC-reason-for-no-HCN-EXT" ] } ], "mustSupport": true }, { "id": "Patient.identifier:mrn.type", "path": "Patient.identifier.type", "min": 1, "patternCodeableConcept": { "coding": [ { "code": "MR", "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "display": "Medical record number" } ] } }, { "id": "Patient.identifier:mrn.type.coding", "path": "Patient.identifier.type.coding", "min": 1, "max": "1" }, { "id": "Patient.identifier:mrn.type.coding.system", "path": "Patient.identifier.type.coding.system", "fixedUri": "http://terminology.hl7.org/CodeSystem/v2-0203" }, { "id": "Patient.identifier:mrn.type.coding.code", "path": "Patient.identifier.type.coding.code", "patternCode": "MR" }, { "id": "Patient.identifier:mrn.type.coding.display", "path": "Patient.identifier.type.coding.display", "patternString": "Medical record number" }, { "id": "Patient.identifier:mrn.system", "path": "Patient.identifier.system", "fixedUri": "https://fhir.apps.health/NamingSystem/patient-mrn" }, { "id": "Patient.active", "path": "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.", "mustSupport": true }, { "id": "Patient.name", "path": "Patient.name", "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.", "min": 1, "mustSupport": true }, { "id": "Patient.name.family", "path": "Patient.name.family", "definition": "The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a child is the given name of their father.", "mustSupport": true }, { "id": "Patient.name.given", "path": "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.", "mustSupport": true }, { "id": "Patient.name.prefix", "path": "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).", "mustSupport": true }, { "id": "Patient.name.suffix", "path": "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).", "mustSupport": true }, { "id": "Patient.telecom", "path": "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.", "mustSupport": true }, { "id": "Patient.gender", "path": "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.", "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdministrativeGender" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The gender of a person used for administrative purposes.", "valueSet": "http://hl7.org/fhir/ValueSet/administrative-gender" } }, { "id": "Patient.birthDate", "path": "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.", "mustSupport": true }, { "id": "Patient.deceased[x]", "path": "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.", "mustSupport": true }, { "id": "Patient.address", "path": "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).", "constraint": [ { "key": "patient-address-country-alpha2", "severity": "warning", "human": "Address.country SHOULD be an ISO 3166-1 alpha-2 code ('CA'), not alpha-3 ('CAN') and not a country name ('Canada'). Alpha-3 is an edge/submission form only and must not be stored.", "expression": "country.empty() or country.matches('^[A-Za-z]{2}$')", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" } ], "mustSupport": true }, { "id": "Patient.address.state", "path": "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,\nwhich matches the Canada Post / USPS abbreviation): `ON`, not `CA-ON`, and not `Ontario`.\n\n**The binding is `required`, which is a deliberate departure from this IG's usual lenient posture.**\nThe reason is that the alternative is silent corruption rather than a clean failure: consumers gate\njurisdictional behaviour on this value (Ontario PCR eligibility is gated on `ON`) and do positional\nstring surgery on it, which has produced malformed outbound jurisdictional HL7 in production. A\nclosed roster makes that fail loudly instead.\n\n**⚠ HERITAGE EMR SITUATION -- UNRESOLVED as of IG 1.12.0.** This binding was validated against the\nIG's own example instances and the synthetic corpus only. **Heritage-EMR data has NOT been\nsurveyed.** Heritage EMRs store province as an unconstrained free-text column typed by front-desk\nstaff over decades, with no validation at entry -- the same systems demonstrably emit uncoded\nfree-text on adjacent fields (the enrolment/roster status is carried as an uncoded `valueString`).\nSo spelled-out province names (\"Ontario\"), lowercase codes, and trailing whitespace are all\nplausible in existing records.\n\nWhere they exist, a `required` binding **rejects real patients** rather than merely flagging them --\nstrictly worse than the outbound corruption it was added to prevent. The distribution has not been\nmeasured, so this is an open risk, not a closed decision.\n\nImplementers migrating a heritage corpus SHOULD profile their actual `state` value distribution\nbefore enforcing, and MAY treat this binding as `extensible` during migration, relying on the\n`patient-address-country-alpha2` warning invariant and an equivalent state-shape check instead.\nNormalizing at ingest (uppercase, trim, map full names to codes) is the intended long-term fix.\nThis caveat comes out once the heritage-data survey is done and the decision is recorded.", "comment": "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.", "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://fhir.apps.health/ValueSet/nexus-emr-province-state" } }, { "id": "Patient.address.postalCode", "path": "Patient.address.postalCode", "definition": "The postal code for the patient's address. Should be in A1A 1A1 format.", "mustSupport": true }, { "id": "Patient.address.country", "path": "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;\nthis profile pins alpha-2 as the stored form to end the alpha-2/alpha-3 split that has produced\nmalformed outbound values (`\"Ca-io\"` and `\"CANio\"` have both been observed on outbound\njurisdictional HL7, from consumers doing positional string surgery on inconsistent input).\n\nAlpha-3 (`CAN`) and country names (`Canada`) are NOT conformant. Where a downstream interface\nrequires alpha-3, convert at that edge -- the same posture this profile takes on the Ontario\nhealth-card version code.\n\n**⚠ HERITAGE EMR SITUATION -- UNRESOLVED as of IG 1.12.0.** As with `address.state`, this `required`\nbinding was validated against the IG's own examples and the synthetic corpus only. **Heritage-EMR\ndata has NOT been surveyed**, and alpha-3 (`CAN`) or spelled-out country values (`Canada`) are\nplausible in existing records -- one in-repo converter already writes alpha-3, which is how the\nmalformed outbound values above were produced in the first place, so the inconsistency demonstrably\nexists inside our own stack and not only upstream of it.\n\nSurvey the corpus before enforcing, and treat the binding as `extensible` during migration if it is\ndirty -- the `patient-address-country-alpha2` invariant (`#warning`) still reports the specific\nalpha-3 case either way. Normalizing at ingest is the intended long-term fix. This caveat comes out\nonce the heritage-data survey is done and the decision is recorded.", "comment": "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.", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/iso3166-1-2" } }, { "id": "Patient.maritalStatus", "path": "Patient.maritalStatus", "short": "Marital status with raw code support", "definition": "The patient's most recent marital (civil) status.\n\nRECOMMENDED: Standard terminology codes (v3 Marital Status) when available\nOPTIONAL: Raw EMR codes for source system preservation\n\nUsed for administrative and billing purposes, may impact insurance coverage and next-of-kin determinations.", "mustSupport": true }, { "id": "Patient.multipleBirth[x]", "path": "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." }, { "id": "Patient.communication", "path": "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.", "mustSupport": true }, { "id": "Patient.communication.language", "path": "Patient.communication.language", "short": "Language with raw code support", "definition": "The language for communication with the patient.\n\nRECOMMENDED: ISO 639 language codes (e.g., en, fr) or BCP 47 codes\nOPTIONAL: Raw EMR codes for source system preservation\n\nShould include relevant languages such as English (en), French (fr), and indigenous languages.\nThe preferred language should be marked with communication.preferred = true.", "mustSupport": true }, { "id": "Patient.generalPractitioner", "path": "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.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "mustSupport": true }, { "id": "Patient.managingOrganization", "path": "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.", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization" ] } ] } ] } }