{ "resourceType": "StructureDefinition", "id": "pcr-replaced-by-propagated", "url": "https://fhir.apps.health/StructureDefinition/pcr-replaced-by-propagated", "name": "PcrReplacedByPropagated", "title": "PCR Replaced-By Propagated Extension", "status": "draft", "date": "2026-09-04", "publisher": "WELLSTAR Technologies Corp.", "description": "One `Patient.link` of type `replaced-by` whose merge has already been sent to the provincial client\nregistry. REPEATS: a record merged more than once carries one of these per merge that has been\nsent.\n\n**The value is the surviving patient's reference as a plain string** -- `Patient/` -- and it is\ncompared literally against `Patient.link.other.reference`. It is a string rather than a `Reference`\nbecause it is a marker matched against a reference that already exists on the record, not a second\nway of pointing at the surviving patient. The link is the merge; this only says the registry has\nbeen told about it.\n\n**READ IT AS A PAIR WITH `Patient.link`, AND READ THE ABSENCE.** A `replaced-by` link with no\nmatching value here is a merge this EMR has recorded and the registry has not yet been sent. That\ngap is the whole point of the element: it is what lets the integration find a merge still owing\ntransmission after the chart has already been updated. A consumer that reads only `Patient.link`\nsees the merge and cannot tell whether the province knows about it; a consumer that reads only this\nelement sees the merges already reported and misses the ones outstanding.\n\n**It is not a merge status from the registry.** Nothing here reflects what the registry did with\nthe merge afterwards, and nothing removes the value if the registry later disagrees.\n\n**MIGRATION.** Nexus EMR writes this extension today at\n`http://services.well.com/fhir/pcr/replacedByInPcr` (FHIR-381): that address is live in stored\npatient records and in code, and is under migration to the canonical declared here. Write the\ncanonical; when reading, match both addresses exactly -- the two share no segment, so a suffix rule\ndoes not reach the pre-migration one.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "Patient" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "snapshot": { "element": [ { "id": "Extension", "path": "Extension", "short": "A replaced-by merge already sent to the provincial client registry", "definition": "One `Patient.link` of type `replaced-by` whose merge has already been sent to the provincial client\nregistry. REPEATS: a record merged more than once carries one of these per merge that has been\nsent.\n\n**The value is the surviving patient's reference as a plain string** -- `Patient/` -- and it is\ncompared literally against `Patient.link.other.reference`. It is a string rather than a `Reference`\nbecause it is a marker matched against a reference that already exists on the record, not a second\nway of pointing at the surviving patient. The link is the merge; this only says the registry has\nbeen told about it.\n\n**READ IT AS A PAIR WITH `Patient.link`, AND READ THE ABSENCE.** A `replaced-by` link with no\nmatching value here is a merge this EMR has recorded and the registry has not yet been sent. That\ngap is the whole point of the element: it is what lets the integration find a merge still owing\ntransmission after the chart has already been updated. A consumer that reads only `Patient.link`\nsees the merge and cannot tell whether the province knows about it; a consumer that reads only this\nelement sees the merges already reported and misses the ones outstanding.\n\n**It is not a merge status from the registry.** Nothing here reflects what the registry did with\nthe merge afterwards, and nothing removes the value if the registry later disagrees.\n\n**MIGRATION.** Nexus EMR writes this extension today at\n`http://services.well.com/fhir/pcr/replacedByInPcr` (FHIR-381): that address is live in stored\npatient records and in code, and is under migration to the canonical declared here. Write the\ncanonical; when reading, match both addresses exactly -- the two share no segment, so a suffix rule\ndoes not reach the pre-migration one.", "min": 0, "max": "*", "base": { "path": "Extension", "min": 0, "max": "*" }, "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')])" } ], "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Extension.id", "path": "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": "Extension.extension", "path": "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" } ], "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": "Extension.url", "path": "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": "https://fhir.apps.health/StructureDefinition/pcr-replaced-by-propagated", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "short": "The surviving patient's reference, as it appears on Patient.link.other.reference", "definition": "The surviving patient's reference written as a plain string (`Patient/`), matched literally against `Patient.link.other.reference`. NOT a `Reference`: it marks which of the record's existing replaced-by links has been sent to the registry.", "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" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] } ] }, "differential": { "element": [ { "id": "Extension", "path": "Extension", "short": "A replaced-by merge already sent to the provincial client registry", "definition": "One `Patient.link` of type `replaced-by` whose merge has already been sent to the provincial client\nregistry. REPEATS: a record merged more than once carries one of these per merge that has been\nsent.\n\n**The value is the surviving patient's reference as a plain string** -- `Patient/` -- and it is\ncompared literally against `Patient.link.other.reference`. It is a string rather than a `Reference`\nbecause it is a marker matched against a reference that already exists on the record, not a second\nway of pointing at the surviving patient. The link is the merge; this only says the registry has\nbeen told about it.\n\n**READ IT AS A PAIR WITH `Patient.link`, AND READ THE ABSENCE.** A `replaced-by` link with no\nmatching value here is a merge this EMR has recorded and the registry has not yet been sent. That\ngap is the whole point of the element: it is what lets the integration find a merge still owing\ntransmission after the chart has already been updated. A consumer that reads only `Patient.link`\nsees the merge and cannot tell whether the province knows about it; a consumer that reads only this\nelement sees the merges already reported and misses the ones outstanding.\n\n**It is not a merge status from the registry.** Nothing here reflects what the registry did with\nthe merge afterwards, and nothing removes the value if the registry later disagrees.\n\n**MIGRATION.** Nexus EMR writes this extension today at\n`http://services.well.com/fhir/pcr/replacedByInPcr` (FHIR-381): that address is live in stored\npatient records and in code, and is under migration to the canonical declared here. Write the\ncanonical; when reading, match both addresses exactly -- the two share no segment, so a suffix rule\ndoes not reach the pre-migration one." }, { "id": "Extension.extension", "path": "Extension.extension", "max": "0" }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "https://fhir.apps.health/StructureDefinition/pcr-replaced-by-propagated" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "short": "The surviving patient's reference, as it appears on Patient.link.other.reference", "definition": "The surviving patient's reference written as a plain string (`Patient/`), matched literally against `Patient.link.other.reference`. NOT a `Reference`: it marks which of the record's existing replaced-by links has been sent to the registry.", "min": 1, "type": [ { "code": "string" } ], "mustSupport": true } ] } }