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Primary Care Attachment Extension

Canonical../StructureDefinition/nexus-emr-primary-care-attachment
Statusdraft · 1.26.0
BaseExtension (constraint)
ContextPatient (element)
SourceFSH · JSON

A patient's current formal primary-care roster/enrollment/attachment. Distinct from Patient.generalPractitioner (local clinical responsibility / MRP): this captures the provider(s) to whom the patient is formally rostered/enrolled/attached, who may be local or remote. At most one attachment per patient per clinic/EMR tenant.

Elements / Details

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

Extension

Short Patient's current primary-care attachment/enrollment
Definition A patient's current formal primary-care roster/enrollment/attachment. Distinct from Patient.generalPractitioner (local clinical responsibility / MRP): this captures the provider(s) to whom the patient is formally rostered/enrolled/attached, who may be local or remote. At most one attachment per patient per clinic/EMR tenant. Modeled as a Patient extension (not EpisodeOfCare or Coverage) deliberately: at most one current attachment per tenant, it must travel with the Patient, and Ontario's HALO FHIR guide models enrolment as a Patient operation. No published pan-Canadian FHIR enrolment-status value set exists yet (CIHI's PHC Minimum Data Set was retired 2026-04-01, folded into CACDI / the Pan-Canadian Health Data Content Framework); NexusEmrAttachmentStatus is the local layer and will be mapped to CACDI and to Ontario PCAR reporting codes when those publish. externalIdentifier / jurisdictionalStatus are the seams for that round-trip.
Cardinality 0..*
Invariants ele-1, ext-1

Extension.id

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

Extension.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 1..*
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:providers

Short Enrolled/attached provider(s) (normally one; >1 for Alberta shared panels)
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..*
Type Extension
Must Support yes
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:providers.id

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

Extension.extension:providers.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 1..*
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:providers.extension:provider

Short Provider to whom the patient is formally attached (may be local or remote)
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 1..1
Type Extension
Must Support yes
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:providers.extension:provider.id

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

Extension.extension:providers.extension:provider.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:providers.extension:provider.url

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

Extension.extension:providers.extension:provider.value[x]

Short Value of extension
Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality 0..1
Type Reference(PractitionerRole Profile | Practitioner Profile)
Invariants ele-1

Extension.extension:providers.extension:confirmedAt

Short Date this patient-provider relationship was confirmed (not a generic audit timestamp)
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..1
Type Extension
Must Support yes
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:providers.extension:confirmedAt.id

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

Extension.extension:providers.extension:confirmedAt.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:providers.extension:confirmedAt.url

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

Extension.extension:providers.extension:confirmedAt.value[x]

Short Value of extension
Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality 0..1
Type dateTime
Invariants ele-1

Extension.extension:providers.url

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

Extension.extension:providers.value[x]

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

Extension.extension:status

Short pending | enrolled | attached | terminated | not-enrolled | fee-for-service
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments Binding is extensible (not required): where none of the standard codes fit (e.g. an OSCAR clinic-custom status), a source system MAY carry its own status code value directly. The status element is a single code, not a CodeableConcept.
Cardinality 1..1
Type Extension
Must Support yes
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:status.id

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

Extension.extension:status.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:status.url

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

Extension.extension:status.value[x]

Short Value of extension
Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality 0..1
Type code
Binding Primary Care Attachment Status (extensible)
Invariants ele-1

Extension.extension:effectivePeriod

Short When the attachment is/was effective
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..1
Type Extension
Must Support yes
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:effectivePeriod.id

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

Extension.extension:effectivePeriod.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:effectivePeriod.url

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

Extension.extension:effectivePeriod.value[x]

Short Value of extension
Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality 0..1
Type Period
Invariants ele-1

Extension.extension:consentStatus

Short Consent status for the attachment (text or code)
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..1
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:consentStatus.id

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

Extension.extension:consentStatus.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:consentStatus.url

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

Extension.extension:consentStatus.value[x]

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

Extension.extension:terminationReason

Short Why the attachment ended (text or code)
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..1
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:terminationReason.id

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

Extension.extension:terminationReason.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:terminationReason.url

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

Extension.extension:terminationReason.value[x]

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

Extension.extension:externalIdentifier

Short External/provincial attachment identifier, if any
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..1
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:externalIdentifier.id

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

Extension.extension:externalIdentifier.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:externalIdentifier.url

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

Extension.extension:externalIdentifier.value[x]

Short Value of extension
Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality 0..1
Type Identifier
Invariants ele-1

Extension.extension:jurisdictionalStatus

Short Provincial/jurisdictional attachment status, if tracked (text or code)
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..1
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:jurisdictionalStatus.id

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

Extension.extension:jurisdictionalStatus.extension

Short Additional content defined by implementations
Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality 0..0
Type Extension
Invariants ele-1, ext-1
Also called extensions, user content

Extension.extension:jurisdictionalStatus.url

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

Extension.extension:jurisdictionalStatus.value[x]

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

Extension.url

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

Extension.value[x]

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