Represents a human that practices medicine -- the stable clinical identity that an EMR user login resolves to.
Practitioner holds identity, demographics, and qualifications, and carries the EMR user-account identifier.
The person's role(s) at organizations/locations are represented by PractitionerRole (0..*), which is the
tenant-scoped role binding -- NOT the EMR user. A person may work at multiple organizations, each represented
by a PractitionerRole.
Elements / Details
Every element this profile touches, with its full definition. Element names in the tables link here.
Represents healthcare professionals and their qualifications, capturing key details
like identifiers, name, contact information, and credentials using standard
Nexus EMR references. Uses instance-specific identifiers for tracking practitioners
across systems.
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Comments
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
When the resource last changed - e.g. when the version changed.
Comments
This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
Identifies EMR instance & pipeline version the resource came from
Definition
A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.
Comments
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.
This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Comments
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Comments
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Cardinality
0..1
Type
uri
Modifier
yes — This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Comments
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
A human-readable narrative summary of the NexusEmrCorePractitioner resource for human interpretation.
Comments
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality
0..*
Type
Extension
Modifier
yes — Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifiers for the practitioner.
Practitioners may have multiple identifiers from different systems.
A business identifier is recommended but not required; no specific canonical system is mandated.
A source system's own identifier SHOULD be carried alongside this one, flagged use = secondary. See Carrying the raw code.
Requirements
Often, specific identities are assigned for the agent.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
EMR user-account identifier (the id a login resolves to)
Definition
The EMR user-account identifier -- the login this clinical identity resolves to (e.g. the Auth0
user id). The Practitioner is the stable clinical identity; PractitionerRole is the role binding
at an organization, not the user.
Private infrastructure -- external consumers must not depend on this. The system
(http://services.well.com/fhir/NamingSystem/user-id) names an internal authority: it is not
resolvable, the value is opaque, and neither the authority nor the value format is a published
contract. Use it, if at all, only to correlate with an authenticated session inside the
platform. Do not parse it, do not display it, and do not treat its absence as meaningful --
a Practitioner without a login (an external referral target, a historical provider) is normal
and conformant, which is why this slice is 0..1.
Requirements
Often, specific identities are assigned for the agent.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
Ontario OHIP billing number. Maps to provider.ohip_no in Oscar Pro. Required for
submitting OHIP claims; absent for providers who do not bill OHIP directly (e.g. residents,
allied-health staff).
Requirements
Often, specific identities are assigned for the agent.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The OHIP billing number value (typically 6 digits)
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
Reciprocal Medical Association (RMA) / group billing identifier. Maps to provider.rma_no in
Oscar Pro. Used on Ontario claims when the billing provider is submitting under a group billing
arrangement. Optional — absent for providers who bill individually.
Requirements
Often, specific identities are assigned for the agent.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
The practitioner's College of Physicians and Surgeons of Ontario (CPSO) registration number, under
the licence namespace registered for it in Canada Health Infoway's Canadian URI Registry. This
slice fixes system to the URI that registry publishes as the namespace's preferred form, so it is
the address to author against.
It is not the only address the number appears at, and this slice is not the whole of what to
read. The same namespace is registered under an OID and an eHealth Ontario alias, and two further
unregistered forms carry the same numbers in real data -- one written historically by this
platform, one used by Ontario's published e-referral package. The complete list, with what each
address is, is on the CaOnLicensePhysician naming
system. Identifier slicing here is open, so a number carried at any of those addresses is a
conformant unsliced repeat of Practitioner.identifier rather than a member of this slice: resolve
this slice first, then scan the remaining identifier repeats for the other addresses, and treat a
value found under any of them as one licence number held under one authority rather than as
several.
Optional, and absence is ordinary rather than an error: nurses, medical office assistants and
administrative users hold no CPSO number. The College assigns and governs these values; this
specification neither mints nor validates them, and a well-formed number is not thereby a number
in good standing.
Requirements
Often, specific identities are assigned for the agent.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Where typed, a v2-0203 identifier-type code -- producers disagree on which; optional, and usually absent
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
⚠ DO NOT RELY ON THIS ELEMENT, and do not pin it. Ontario publishes two answers for what a licence identifier is typed as, and they disagree. The Canadian URI Registry entry for this namespace declares NamingSystem.type as v2-0203 MD (Medical License number) for the physician namespace and PRN (Provider number) for the nurse one. Ontario eReferral's own published Practitioner examples write LN (License number) on the identifier instead. A reader that filters on any one of the three drops conformant data from the other producers, and most stored identifiers carry no type at all. Match on system, which every producer agrees on; treat a type, when present, as a hint.
Must be https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-license-physician
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The CPSO registration number, as the College issued it
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
The practitioner's College of Nurses of Ontario (CNO) registration number, under the licence
namespace registered for it in Canada Health Infoway's Canadian URI Registry. This slice fixes
system to the URI that registry publishes as the namespace's preferred form, so it is the address
to author against.
It is not the only address the number appears at, and this slice is not the whole of what to
read. The same namespace is registered under an OID and an eHealth Ontario alias, and a third,
unregistered form carries the same numbers in real data. The complete list is on the
CaOnLicenseNurse naming system. Identifier slicing here is
open, so a number carried at any of those addresses is a conformant unsliced repeat rather than a
member of this slice; read them all and treat what you find as one licence number. Unlike the
physician namespace, this one has no older Infoway-hosted http address -- do not assume one by
analogy.
The number does not say which credential is held. Ontario licenses the nurse practitioner, the
registered nurse and the registered practical nurse through the same College and under this same
system. A consumer that reads the presence of this identifier as meaning "nurse practitioner" will
be wrong on most of them: read the credential from Practitioner.qualification, and what the
person does in a given role from PractitionerRole.code.
Optional, and absence is ordinary: physicians, medical office assistants and administrative users
hold no CNO number.
Requirements
Often, specific identities are assigned for the agent.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Where typed, a v2-0203 identifier-type code -- producers disagree on which; optional, and usually absent
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
⚠ DO NOT RELY ON THIS ELEMENT, and do not pin it. Ontario publishes two answers for what a licence identifier is typed as, and they disagree. The Canadian URI Registry entry for this namespace declares NamingSystem.type as v2-0203 MD (Medical License number) for the physician namespace and PRN (Provider number) for the nurse one. Ontario eReferral's own published Practitioner examples write LN (License number) on the identifier instead. A reader that filters on any one of the three drops conformant data from the other producers, and most stored identifiers carry no type at all. Match on system, which every producer agrees on; treat a type, when present, as a hint.
Must be https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-license-nurse
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The CNO registration number, as the College issued it
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
The name(s) associated with the practitioner. At least one official name is required.
Requirements
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
Comments
Practitioners may have multiple names (official, maiden, nickname). The official name should be used for display.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
Requirements
A renderable, unencoded form.
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
Given name(s) of the practitioner, including middle names.
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
Name suffix(es) / post-nominal credentials (e.g. MD, RN, NP)
Definition
Part of the name that appears at the end of the practitioner's name (standard R4 HumanName.suffix), including post-nominal credentials such as MD, RN, NP, or PhD.
Comments
Carries only the DISPLAY form of a credential. It is free text, nothing in this specification
parses it, and it carries no issuer, no number and no expiry -- MD in a suffix says a person
writes MD after their name and nothing more.
Structured licensure lives in two named places on this profile, and both are populated by the EMR:
the registration NUMBER is an identifier under the issuing college's namespace, in the
physicianLicence and nurseLicence slices of Practitioner.identifier;
the REGISTRATION itself -- awarding college, number, expiry -- is a Practitioner.qualification.
Read those rather than the suffix, and do not make the suffix the only home for anything you will
later need to match on.
A credential with no suffix is ordinary, and so is a suffix with no matching qualification: the two
elements are populated from different sources and neither is derived from the other.
A contact detail for the practitioner (that apply to all roles)
Definition
A contact detail for the practitioner, e.g. a telephone number or an email address.
Requirements
Need to know how to reach a practitioner independent to any roles the practitioner may have.
Comments
Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.
Address(es) of the practitioner that are not role specific (typically home address)
Definition
Address(es) of the practitioner that are not role specific (typically home address).
Work addresses are not typically entered in this property as they are usually role dependent.
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
Comments
The PractitionerRole does not have an address value on it, as it is expected that the location property be used for this purpose (which has an address).
Regulatory-college registrations held by this practitioner
Definition
A registration the practitioner holds with a regulatory college: the licence number, what it is a
registration for, and when it lapses. This is the structured home for licensure that name.suffix
is not.
Absence is ordinary and not an error. Administrative users, medical office assistants and external
referral targets held as directory entries hold no registration, and a Practitioner with none is
complete and conformant.
The list is not guaranteed to be complete. The EMR manages the registrations it provisions and
leaves any others untouched, so a qualification written by another system survives alongside them.
Treat what you find as the registrations this record knows about, not as an exhaustive statement of
what the practitioner holds.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extensions that cannot be ignored even if unrecognized
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality
0..*
Type
Extension
Modifier
yes — Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The registration number, under the issuing college's namespace
Definition
The licence number this registration is held under. The EMR writes exactly one, with the issuing
college's namespace as its system, and reads the first one back -- so a producer writing several
here should not expect the extras to survive a round trip.
This is the same number that appears on Practitioner.identifier under the same namespace. Neither
place is derived from the other and a Practitioner may carry it in one, the other, or both.
Requirements
Often, specific identities are assigned for the qualification.
The College of Physicians and Surgeons of Ontario (CPSO) registration number this qualification records, under the licence namespace registered for it in Canada Health Infoway's Canadian URI Registry. This slice fixes system to that registry's preferred URI for the namespace; the same namespace is also known by an OID, by an eHealth Ontario alias and by two unregistered forms that appear in real data, all listed on the CaOnLicensePhysician naming system. Slicing here is open, so a registration number carried at one of those other addresses is a conformant unsliced repeat rather than a member of this slice. The same number appears in the physicianLicence slice of Practitioner.identifier; read both, and treat a value found in either as one licence number rather than two.
Requirements
Often, specific identities are assigned for the qualification.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Must be https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-license-physician
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The CPSO registration number, as the College issued it
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
The College of Nurses of Ontario (CNO) registration number this qualification records, under the licence namespace registered for it in Canada Health Infoway's Canadian URI Registry. This slice fixes system to that registry's preferred URI for the namespace; the same namespace is also known by an OID, by an eHealth Ontario alias and by one unregistered form that appears in real data, all listed on the CaOnLicenseNurse naming system. Slicing here is open, so a registration number carried at one of those other addresses is a conformant unsliced repeat rather than a member of this slice. The same College licenses the nurse practitioner, the registered nurse and the registered practical nurse, so the number alone does not say which credential is held -- that is what this qualification's code is for.
Requirements
Often, specific identities are assigned for the qualification.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Must be https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-license-nurse
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The CNO registration number, as the College issued it
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
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.
What the registration is -- the college, or the credential, depending on the producer
Definition
What this qualification records. Required by the base resource, and filled two different ways in
practice, which a reader has to expect:
- code.text carrying the COLLEGE, as the source system names it (CPSO, CNO). This is what
the EMR's provisioning path writes, and what it reads back; it writes no coding at all.
- code.coding carrying the CREDENTIAL (MD, NP, RN), from the HL7 degree/licence/
certificate code system bound by the base resource. Other producers write this, with no text.
Those are not the same fact. Do not require a coding, do not require text, and do not read a coding
as a restatement of the text beside it. A registered practical nurse is the clearest case of what
goes wrong: the credential has no code in that HL7 system, so a producer emitting codings honestly
emits none for that person -- an absent coding is a statement about the code system, not a
statement that the person is unregistered.
The issuing college is also recoverable, without ambiguity, from this qualification's identifier
system. Prefer that when what you need is the college.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
A reference to a code defined by a terminology system.
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
Comments
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
The college as the source system names it, e.g. CPSO or CNO
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Requirements
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Comments
Very often the text is the same as a displayName of one of the codings.
The period this registration is valid for. Only period.end is written and only period.end is read: it carries the registration's expiry date. A qualification with no period is a registration with no recorded expiry, which is ordinary -- it does not mean the registration is expired, and it does not mean it is current.
Requirements
Qualifications are often for a limited period of time, and can be revoked.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
The awarding college, when it is carried as an Organization
Definition
The organization that awarded the qualification. Carried and reference-resolved on Practitioners that arrive in a referral bundle; the EMR's own provisioning path does not populate it, so an absent issuer is ordinary and the college should be read from the identifier system or from code.text instead.
A language the practitioner can use in patient communication
Definition
A language the practitioner can use in patient communication.
Requirements
Knowing which language a practitioner speaks can help in facilitating communication with patients.
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.