First Nation Community Extension¶
| Canonical | ../StructureDefinition/nexus-emr-first-nation-community |
|---|---|
| Status | draft · 1.26.0 |
| Base | Extension (constraint) |
| Context | Patient (element) |
| Source | FSH · JSON |
The First Nation community the patient affiliates with, as stated — drawn from the same curated band list as the registry group but independent of it and of the registration status: a community can be recorded whatever the other fields hold. NOTE THAT THE BAND LIST IS AN APPROXIMATION OF THIS FIELD'S DOMAIN: a band is a registry group, and a community is not the same thing — one band may have several communities and reserves, and a person can affiliate with a community whose band does not hold their registration. The band list is the only curated Indigenous reference data this specification holds, so a community is recorded as the band nearest to it. Read a value here as the community the patient named, resolved to a band, and not as a claim about registration.
FSH
The authored source of truth: extensions/PatientFirstNationAffiliationExtensions.fsh (edit on GitHub). One FSH file may define several related artifacts.
// PatientFirstNationAffiliationExtensions.fsh
// The patient's First Nation affiliation: the registry group (band) their
// registration is held under, and the community they affiliate with. Two
// extensions over one value domain — the curated First Nation band list
// (../ValueSet/nexus-first-nation-band), a curated
// seed maintained from the Indigenous Services Canada band list, where the
// code is the federal band number and the display is the band name.
//
// A Canadian URI Registry namespace for the same federal registry, for
// IDENTIFIER use, is believed to exist at
// https://fhir.infoway-inforoute.ca/NamingSystem/ca-federal-firstnation-band-id
// -- UNVERIFIED as of 2026-08-26, and not relied on here. Note that an
// identifier namespace is not a coding system: even once confirmed, that URI
// would be the `Identifier.system` for a band membership rather than the
// `Coding.system` these two extensions bind.
// The value set is seed-managed reference data (like the curated problem and
// procedure lists), not an IG artifact, so membership updates ship as data.
// That is what makes a REQUIRED binding affordable on both extensions: a band
// the list does not carry is added as data, without an IG release, so the
// closed binding never becomes a release gate on recording a patient. It was
// `extensible` until FHIR-94, which is the opposite of what both descriptions
// promised -- extensible permits a code from any system, while the text said a
// band outside the list could not be recorded at all.
//
// AND THE TWO FIELDS DO NOT SHARE A DOMAIN, though they share this value set.
// A band is a REGISTRY GROUP; a community is a place and a people. One band may
// hold several communities and reserves, and a person can affiliate with a
// community whose band does not hold their registration. Binding both here is a
// deliberate approximation, taken because the band list is the only curated
// Indigenous reference data we hold -- not an assertion that the two are the
// same. If a community vocabulary is ever curated, `community` moves to it and
// `registryGroup` does not.
//
// Band names beginning with the glottal stop rendered as a literal "?" (e.g.
// ?Akisq'nuk First Nation) are the names as registered; they sort before "A"
// under plain ordinal comparison by design and must not be "cleaned up".
// ===========================================================================
// First Nation registry group extension (on Patient)
// ===========================================================================
Extension: FirstNationRegistryGroupExtension
Id: nexus-emr-first-nation-registry-group
Title: "First Nation Registry Group Extension"
Description: "The First Nation registry group (band) the patient's Indian Act registration is held under, as stated. Bound REQUIRED to the curated band list: a band the list does not carry cannot be recorded until the list is updated, and because that list is seed-managed reference data rather than an IG artifact, updating it ships as data and needs no release. Independent of the registration status and the community affiliation."
* ^url = "../StructureDefinition/nexus-emr-first-nation-registry-group"
* ^status = #draft
* ^date = "2026-08-19"
* ^publisher = "WELLSTAR Technologies Corp."
* ^contact.name = "Nexus EMR FHIR Implementation Guide"
* ^contact.telecom.system = #url
* ^contact.telecom.value = ".."
* ^jurisdiction = urn:iso:std:iso:3166#CA "Canada"
* ^context[0].type = #element
* ^context[0].expression = "Patient"
* . ^short = "Registry group (band) the registration is held under"
* extension 0..0
* url 1..1
* value[x] 1..1 MS
* value[x] only CodeableConcept
* valueCodeableConcept from ../ValueSet/nexus-first-nation-band (required)
* valueCodeableConcept ^short = "Band, coded by federal band number with the band name as display"
// ===========================================================================
// First Nation community extension (on Patient)
// ===========================================================================
Extension: FirstNationCommunityExtension
Id: nexus-emr-first-nation-community
Title: "First Nation Community Extension"
Description: "The First Nation community the patient affiliates with, as stated — drawn from the same curated band list as the registry group but independent of it and of the registration status: a community can be recorded whatever the other fields hold. NOTE THAT THE BAND LIST IS AN APPROXIMATION OF THIS FIELD'S DOMAIN: a band is a registry group, and a community is not the same thing — one band may have several communities and reserves, and a person can affiliate with a community whose band does not hold their registration. The band list is the only curated Indigenous reference data this specification holds, so a community is recorded as the band nearest to it. Read a value here as the community the patient named, resolved to a band, and not as a claim about registration."
* ^url = "../StructureDefinition/nexus-emr-first-nation-community"
* ^status = #draft
* ^date = "2026-08-19"
* ^publisher = "WELLSTAR Technologies Corp."
* ^contact.name = "Nexus EMR FHIR Implementation Guide"
* ^contact.telecom.system = #url
* ^contact.telecom.value = ".."
* ^jurisdiction = urn:iso:std:iso:3166#CA "Canada"
* ^context[0].type = #element
* ^context[0].expression = "Patient"
* . ^short = "First Nation community the patient affiliates with"
* extension 0..0
* url 1..1
* value[x] 1..1 MS
* value[x] only CodeableConcept
* valueCodeableConcept from ../ValueSet/nexus-first-nation-band (required)
* valueCodeableConcept ^short = "Community, coded by federal band number with the band name as display (the band list approximates this domain -- see the definition)"