PFLIP HL7 FHIR Implementation Guide
0.9.0 - draft

PFLIP HL7 FHIR Implementation Guide - Local Development build (v0.9.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Patient_Bewohner_Pseudonymisiert - Detailed Descriptions

Draft as of 2024-12-05

Definitions for the patient-bewohner-pseudonymisiert resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Patient
2. Patient.name
Control0..0
4. Patient.telecom
Control0..0
6. Patient.birthDate
Control1..?
8. Patient.birthDate.extension
Control1..?
SlicingThis element introduces a set of slices on Patient.birthDate.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
  • value @ url
  • 10. Patient.birthDate.extension:geburtstag-mm-yyyy
    Slice Namegeburtstag-mm-yyyy
    Control1..1
    TypeExtension(Geburtstag MM-YYYY) (Extension Type: string)
    Must Supporttrue
    12. Patient.address
    Control0..0
    14. Patient.address:Strassenanschrift
    Slice NameStrassenanschrift
    Control0..0
    16. Patient.address:Postfach
    Slice NamePostfach
    Control0..0
    18. Patient.maritalStatus
    Control0..0
    20. Patient.multipleBirth[x]
    Control0..0
    22. Patient.photo
    Control0..0
    24. Patient.contact
    Control0..0
    26. Patient.communication
    Control0..0
    28. Patient.generalPractitioner
    Control0..0
    30. Patient.managingOrganization
    Control0..0
    32. Patient.link
    Control0..0

    Guidance on how to interpret the contents of this table can be found here

    0. Patient
    Definition

    Demographics and other administrative information about an individual or animal receiving care or other health-related services.

    ShortInformation about an individual or animal receiving health care services
    Control0..*
    Is Modifierfalse
    Alternate NamesSubjectOfCare Client Resident
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    mii-pat-1: Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden (gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists())
    2. Patient.id
    Definition

    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

    ShortLogical id of this artifact
    Comments

    The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

    Control0..1
    Typeidstring
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    4. Patient.meta
    Definition

    The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

    ShortMetadata about the resource
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeMeta
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    6. Patient.meta.profile
    Definition

    A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.


    A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

    ShortProfiles this resource claims to conform to
    Comments

    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.

    Control0..*
    This element is affected by the following invariants: ele-1
    Typecanonical(StructureDefinition)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Patient.implicitRules
    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.

    ShortA set of rules under which this content was created
    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.

    Control0..1
    This element is affected by the following invariants: ele-1
    Typeuri
    Is Modifiertrue because 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
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Patient.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    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.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Standard StatusNormative (from Normative)
    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.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on Patient.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 12. Patient.identifier
      Definition

      An identifier for this patient.

      ShortAn identifier for this patient
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..*
      This element is affected by the following invariants: ele-1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Standard StatusNormative (from Normative)
      Summarytrue
      Requirements

      Patients are almost always assigned specific numerical identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • pattern @ $this
      • 14. Patient.identifier:PseudonymisierterIdentifier
        Slice NamePseudonymisierterIdentifier
        Definition

        An identifier for this patient.

        ShortAn identifier for this patient
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeIdentifier
        Is Modifierfalse
        Must Supporttrue
        Standard StatusNormative (from Normative)
        Summarytrue
        Requirements

        Patients are almost always assigned specific numerical identifiers.

        Pattern Value{
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
              "code" : "PSEUDED"
            }]
          }
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Patient.identifier:AnonymisierterIdentifier
        Slice NameAnonymisierterIdentifier
        Definition

        An identifier for this patient.

        ShortAn identifier for this patient
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeIdentifier
        Is Modifierfalse
        Must Supporttrue
        Standard StatusNormative (from Normative)
        Summarytrue
        Requirements

        Patients are almost always assigned specific numerical identifiers.

        Pattern Value{
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
              "code" : "ANONYED"
            }]
          }
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. Patient.active
        Definition

        Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

        It is often used to filter patient lists to exclude inactive patients

        Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

        ShortWhether this patient's record is in active use
        Comments

        If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

        Control0..1
        This element is affected by the following invariants: ele-1
        Typeboolean
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Need to be able to mark a patient record as not to be used because it was created in error.

        Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Patient.name
        Definition

        A name associated with the individual.

        ShortA name associated with the patient
        Comments

        A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

        Control0..0*
        This element is affected by the following invariants: ele-1
        TypeHumanName
        Is Modifierfalse
        Summarytrue
        Requirements

        Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Patient.telecom
        Definition

        A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

        ShortA contact detail for the individual
        Comments

        A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

        Control0..0*
        This element is affected by the following invariants: ele-1
        TypeContactPoint
        Is Modifierfalse
        Summarytrue
        Requirements

        People have (primary) ways to contact them in some way such as phone, email.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        cpt-2: A system is required if a value is provided. (value.empty() or system.exists())
        24. Patient.gender
        Definition

        Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

        Shortmale | female | other | unknown
        Comments

        The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

        Control0..1
        This element is affected by the following invariants: ele-1
        BindingThe codes SHALL be taken from AdministrativeGenderhttp://hl7.org/fhir/ValueSet/administrative-gender|4.0.1
        (required to http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1)

        The gender of a person used for administrative purposes.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Needed for identification of the individual, in combination with (at least) name and birth date.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Patient.gender.extension:other-amtlich
        Slice Nameother-amtlich
        Definition

        Optional Extension Element - found in all resources.

        ShortOptional Extensions Element
        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.

        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Differenzierung des administrativen Geschlechts 'other') (Extension Type: Coding)
        Must Supporttrue
        Standard StatusNormative (from Normative)
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        28. Patient.birthDate
        Definition

        The date of birth for the individual.

        ShortThe date of birth for the individual
        Comments

        At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

        Control10..1
        This element is affected by the following invariants: ele-1
        Typedate
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Age of the individual drives many clinical processes.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Patient.birthDate.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional content defined by implementations
        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.

        Control10..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Patient.birthDate.extension. The slices areUnordered and ClosedOpen, and can be differentiated using the following discriminators:
        • value @ url
        • 32. Patient.birthDate.extension:geburtstag-mm-yyyy
          Slice Namegeburtstag-mm-yyyy
          Definition

          Die Angabe des Geburtstages eingegrenzt auf das Format MM-YYYY

          ShortGeburtstag MM-YYYY
          Control1..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Geburtstag MM-YYYY) (Extension Type: string)
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          34. Patient.deceased[x]
          Definition

          Indicates if the individual is deceased or not.

          ShortIndicates if the individual is deceased or not
          Comments

          If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

          Control0..1
          This element is affected by the following invariants: ele-1
          TypeChoice of: boolean, dateTime
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Standard StatusNormative (from Normative)
          Summarytrue
          Requirements

          The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Patient.deceased[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • type @ $this
          • 36. Patient.deceased[x]:deceasedDateTime
            Slice NamedeceasedDateTime
            Definition

            Indicates if the individual is deceased or not.

            ShortIndicates if the individual is deceased or not
            Comments

            If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

            Control0..1
            This element is affected by the following invariants: ele-1
            TypedateTime, boolean
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Standard StatusNormative (from Normative)
            Summarytrue
            Requirements

            The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. Patient.address
            Definition

            An address for the individual.

            ShortAn address for the individual
            Comments

            Patient may have multiple addresses with different uses or applicable periods.

            Control0..0*
            This element is affected by the following invariants: ele-1
            TypeAddress
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Patient.address. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ $this
            • 40. Patient.address:Strassenanschrift
              Slice NameStrassenanschrift
              Definition

              Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.

              Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.

              Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.


              An address for the individual.

              ShortEine Adresse gemäß postalischer KonventionenAn address for the individual
              Comments

              Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).


              Patient may have multiple addresses with different uses or applicable periods.

              Control0..0*
              This element is affected by the following invariants: ele-1
              TypeAddress(Adresse, deutsches Basisprofil)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

              Pattern Value{
                "type" : "both"
              }
              Example<br/><b>Beispiel für einfache Adresse</b>:{ "use" : "home", "type" : "postal", "line" : ["Musterweg 42"], "city" : "Musterhausen", "postalCode" : "99999" }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue()))
              add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue()))
              add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()))
              add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty())
              add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue()))
              add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty())))
              add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. (extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string)))
              pat-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. (country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
              55. Patient.address:Postfach
              Slice NamePostfach
              Definition

              Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.

              Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.

              Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.


              An address for the individual.

              ShortEine Adresse gemäß postalischer KonventionenAn address for the individual
              Comments

              Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).


              Patient may have multiple addresses with different uses or applicable periods.

              Control0..0*
              This element is affected by the following invariants: ele-1
              TypeAddress(Adresse, deutsches Basisprofil)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

              Pattern Value{
                "type" : "postal"
              }
              Example<br/><b>Beispiel für einfache Adresse</b>:{ "use" : "home", "type" : "postal", "line" : ["Musterweg 42"], "city" : "Musterhausen", "postalCode" : "99999" }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue()))
              add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue()))
              add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()))
              add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty())
              add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue()))
              add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty())))
              add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. (extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string)))
              pat-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. (country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
              70. Patient.maritalStatus
              Definition

              This field contains a patient's most recent marital (civil) status.

              ShortMarital (civil) status of a patient
              Comments

              Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

              Control0..01
              This element is affected by the following invariants: ele-1
              BindingUnless not suitable, these codes SHALL be taken from Marital Status Codeshttp://hl7.org/fhir/ValueSet/marital-status
              (extensible to http://hl7.org/fhir/ValueSet/marital-status)

              The domestic partnership status of a person.

              TypeCodeableConcept
              Is Modifierfalse
              Requirements

              Most, if not all systems capture it.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. Patient.multipleBirth[x]
              Definition

              Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

              ShortWhether patient is part of a multiple birth
              Comments

              Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

              Control0..01
              This element is affected by the following invariants: ele-1
              TypeChoice of: boolean, integer
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Requirements

              For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. Patient.photo
              Definition

              Image of the patient.

              ShortImage of the patient
              Comments

              Guidelines:

              • Use id photos, not clinical photos.
              • Limit dimensions to thumbnail.
              • Keep byte count low to ease resource updates.
              Control0..0*
              This element is affected by the following invariants: ele-1
              TypeAttachment
              Is Modifierfalse
              Requirements

              Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              att-1: If the Attachment has data, it SHALL have a contentType (data.empty() or contentType.exists())
              76. Patient.contact
              Definition

              A contact party (e.g. guardian, partner, friend) for the patient.

              ShortA contact party (e.g. guardian, partner, friend) for the patient
              Comments

              Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

              Control0..0*
              This element is affected by the following invariants: ele-1
              TypeBackboneElement
              Is Modifierfalse
              Requirements

              Need to track people you can contact about the patient.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
              pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
              80. Patient.communication
              Definition

              A language which may be used to communicate with the patient about his or her health.

              ShortA language which may be used to communicate with the patient about his or her health
              Comments

              If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

              Control0..0*
              This element is affected by the following invariants: ele-1
              TypeBackboneElement
              Is Modifierfalse
              Requirements

              If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              84. Patient.generalPractitioner
              Definition

              Patient's nominated care provider.

              ShortPatient's nominated primary care provider
              Comments

              This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

              Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

              Control0..0*
              This element is affected by the following invariants: ele-1
              TypeReference(Organization, Practitioner, PractitionerRole)
              Is Modifierfalse
              Alternate NamescareProvider
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
              86. Patient.managingOrganization
              Definition

              Organization that is the custodian of the patient record.

              ShortOrganization that is the custodian of the patient record
              Comments

              There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

              Control0..01
              This element is affected by the following invariants: ele-1
              TypeReference(Organization)
              Is Modifierfalse
              Summarytrue
              Requirements

              Need to know who recognizes this patient record, manages and updates it.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
              88. Patient.link
              Definition

              Link to another patient resource that concerns the same actual patient.

              ShortLink to another patient resource that concerns the same actual person
              Comments

              There is no assumption that linked patient records have mutual links.

              Control0..0*
              This element is affected by the following invariants: ele-1
              TypeBackboneElement
              Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
              Must Supporttrue
              Summarytrue
              Requirements

              There are multiple use cases:

              • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
              • Distribution of patient information across multiple servers.
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

              Guidance on how to interpret the contents of this table can be found here

              0. Patient
              Definition

              Demographics and other administrative information about an individual or animal receiving care or other health-related services.

              ShortInformation about an individual or animal receiving health care services
              Control0..*
              Alternate NamesSubjectOfCare Client Resident
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              mii-pat-1: Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden (gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists())
              2. Patient.id
              Definition

              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

              ShortLogical id of this artifact
              Comments

              The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

              Control0..1
              Typeid
              Must Supporttrue
              Summarytrue
              4. Patient.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeMeta
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. Patient.meta.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              XML FormatIn the XML format, this property is represented as an attribute.
              8. Patient.meta.extension
              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.

              ShortAdditional content defined by implementations
              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.

              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension
              Standard StatusNormative (from Normative)
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on Patient.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 10. Patient.meta.versionId
                Definition

                The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                ShortVersion specific identifier
                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.

                Control0..1
                This element is affected by the following invariants: ele-1
                Typeid
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                12. Patient.meta.lastUpdated
                Definition

                When the resource last changed - e.g. when the version changed.

                ShortWhen the resource version last 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.

                Control0..1
                This element is affected by the following invariants: ele-1
                Typeinstant
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                14. Patient.meta.source
                Definition

                A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                ShortIdentifies where the resource comes from
                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.

                Control0..1
                This element is affected by the following invariants: ele-1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                16. Patient.meta.profile
                Definition

                A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                ShortProfiles this resource claims to conform to
                Comments

                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.

                Control0..*
                This element is affected by the following invariants: ele-1
                Typecanonical(StructureDefinition)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                18. Patient.meta.security
                Definition

                Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                ShortSecurity Labels applied to this resource
                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.

                Control0..*
                This element is affected by the following invariants: ele-1
                BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                Security Labels from the Healthcare Privacy and Security Classification System.

                TypeCoding
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                20. Patient.meta.tag
                Definition

                Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                ShortTags applied to this 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.

                Control0..*
                This element is affected by the following invariants: ele-1
                BindingFor example codes, see CommonTags
                (example to http://hl7.org/fhir/ValueSet/common-tags)

                Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                TypeCoding
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                22. Patient.implicitRules
                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.

                ShortA set of rules under which this content was created
                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.

                Control0..1
                This element is affected by the following invariants: ele-1
                Typeuri
                Is Modifiertrue because 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
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                24. Patient.language
                Definition

                The base language in which the resource is written.

                ShortLanguage of the resource content
                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).

                Control0..1
                This element is affected by the following invariants: ele-1
                BindingThe codes SHOULD be taken from CommonLanguages
                (preferred to http://hl7.org/fhir/ValueSet/languages)

                A human language.

                Additional BindingsPurpose
                AllLanguagesMax Binding
                Typecode
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                26. Patient.text
                Definition

                A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                ShortText summary of the 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.

                Control0..1
                This element is affected by the following invariants: ele-1
                TypeNarrative
                Alternate Namesnarrative, html, xhtml, display
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                28. Patient.contained
                Definition

                These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                ShortContained, inline Resources
                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.

                Control0..*
                TypeResource
                Alternate Namesinline resources, anonymous resources, contained resources
                30. Patient.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional content defined by implementations
                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.

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension
                Standard StatusNormative (from Normative)
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 32. Patient.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored
                  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.

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  Standard StatusNormative (from Normative)
                  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.

                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Patient.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 34. Patient.identifier
                    Definition

                    An identifier for this patient.

                    ShortAn identifier for this patient
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control1..*
                    This element is affected by the following invariants: ele-1
                    TypeIdentifier
                    Must Supporttrue
                    Standard StatusNormative (from Normative)
                    Summarytrue
                    Requirements

                    Patients are almost always assigned specific numerical identifiers.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Patient.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • pattern @ $this
                    • 36. Patient.identifier:PseudonymisierterIdentifier
                      Slice NamePseudonymisierterIdentifier
                      Definition

                      An identifier for this patient.

                      ShortAn identifier for this patient
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control0..*
                      This element is affected by the following invariants: ele-1
                      TypeIdentifier
                      Must Supporttrue
                      Standard StatusNormative (from Normative)
                      Summarytrue
                      Requirements

                      Patients are almost always assigned specific numerical identifiers.

                      Pattern Value{
                        "type" : {
                          "coding" : [{
                            "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
                            "code" : "PSEUDED"
                          }]
                        }
                      }
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      38. Patient.identifier:AnonymisierterIdentifier
                      Slice NameAnonymisierterIdentifier
                      Definition

                      An identifier for this patient.

                      ShortAn identifier for this patient
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control0..*
                      This element is affected by the following invariants: ele-1
                      TypeIdentifier
                      Must Supporttrue
                      Standard StatusNormative (from Normative)
                      Summarytrue
                      Requirements

                      Patients are almost always assigned specific numerical identifiers.

                      Pattern Value{
                        "type" : {
                          "coding" : [{
                            "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
                            "code" : "ANONYED"
                          }]
                        }
                      }
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      40. Patient.active
                      Definition

                      Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

                      It is often used to filter patient lists to exclude inactive patients

                      Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

                      ShortWhether this patient's record is in active use
                      Comments

                      If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

                      Control0..1
                      This element is affected by the following invariants: ele-1
                      Typeboolean
                      Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Need to be able to mark a patient record as not to be used because it was created in error.

                      Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      42. Patient.name
                      Definition

                      A name associated with the individual.

                      ShortA name associated with the patient
                      Comments

                      A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

                      Control0..0
                      This element is affected by the following invariants: ele-1
                      TypeHumanName
                      Summarytrue
                      Requirements

                      Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      44. Patient.telecom
                      Definition

                      A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

                      ShortA contact detail for the individual
                      Comments

                      A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

                      Control0..0
                      This element is affected by the following invariants: ele-1
                      TypeContactPoint
                      Summarytrue
                      Requirements

                      People have (primary) ways to contact them in some way such as phone, email.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      cpt-2: A system is required if a value is provided. (value.empty() or system.exists())
                      46. Patient.gender
                      Definition

                      Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

                      Shortmale | female | other | unknown
                      Comments

                      The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

                      Control0..1
                      This element is affected by the following invariants: ele-1
                      BindingThe codes SHALL be taken from AdministrativeGender
                      (required to http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1)

                      The gender of a person used for administrative purposes.

                      Typecode
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Needed for identification of the individual, in combination with (at least) name and birth date.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      48. Patient.gender.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      XML FormatIn the XML format, this property is represented as an attribute.
                      50. Patient.gender.extension
                      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.

                      ShortAdditional content defined by implementations
                      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.

                      Control0..*
                      This element is affected by the following invariants: ele-1
                      TypeExtension
                      Standard StatusNormative (from Normative)
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on Patient.gender.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 52. Patient.gender.extension:other-amtlich
                        Slice Nameother-amtlich
                        Definition

                        Optional Extension Element - found in all resources.

                        ShortOptional Extensions Element
                        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.

                        Control0..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Differenzierung des administrativen Geschlechts 'other') (Extension Type: Coding)
                        Must Supporttrue
                        Standard StatusNormative (from Normative)
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        54. Patient.gender.value
                        Definition

                        Primitive value for code

                        ShortPrimitive value for code
                        Control0..1
                        Typecode
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Max Length:1048576
                        56. Patient.birthDate
                        Definition

                        The date of birth for the individual.

                        ShortThe date of birth for the individual
                        Comments

                        At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

                        Control1..1
                        This element is affected by the following invariants: ele-1
                        Typedate
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Age of the individual drives many clinical processes.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        58. Patient.birthDate.id
                        Definition

                        unique id for the element within a resource (for internal references)

                        Shortxml:id (or equivalent in JSON)
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        60. Patient.birthDate.extension
                        Definition

                        An Extension

                        ShortExtension
                        Control1..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on Patient.birthDate.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • value @ url
                        • 62. Patient.birthDate.extension:geburtstag-mm-yyyy
                          Slice Namegeburtstag-mm-yyyy
                          Definition

                          Die Angabe des Geburtstages eingegrenzt auf das Format MM-YYYY

                          ShortGeburtstag MM-YYYY
                          Control1..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(Geburtstag MM-YYYY) (Extension Type: string)
                          Is Modifierfalse
                          Must Supporttrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          64. Patient.birthDate.value
                          Definition

                          The actual value

                          ShortPrimitive value for date
                          Control0..1
                          Typedate
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          66. Patient.deceased[x]
                          Definition

                          Indicates if the individual is deceased or not.

                          ShortIndicates if the individual is deceased or not
                          Comments

                          If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeChoice of: boolean, dateTime
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Must Support TypesNo must-support rules about the choice of types/profiles
                          Standard StatusNormative (from Normative)
                          Summarytrue
                          Requirements

                          The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          SlicingThis element introduces a set of slices on Patient.deceased[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • type @ $this
                          • 68. Patient.deceased[x]:deceasedDateTime
                            Slice NamedeceasedDateTime
                            Definition

                            Indicates if the individual is deceased or not.

                            ShortIndicates if the individual is deceased or not
                            Comments

                            If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypedateTime
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Standard StatusNormative (from Normative)
                            Summarytrue
                            Requirements

                            The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            70. Patient.address
                            Definition

                            An address for the individual.

                            ShortAn address for the individual
                            Comments

                            Patient may have multiple addresses with different uses or applicable periods.

                            Control0..0
                            This element is affected by the following invariants: ele-1
                            TypeAddress
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on Patient.address. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • pattern @ $this
                            • 72. Patient.address:Strassenanschrift
                              Slice NameStrassenanschrift
                              Definition

                              Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.

                              Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.

                              Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.

                              ShortEine Adresse gemäß postalischer Konventionen
                              Comments

                              Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeAddress(Adresse, deutsches Basisprofil)
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

                              Pattern Value{
                                "type" : "both"
                              }
                              Example<br/><b>Beispiel für einfache Adresse</b>:{ "use" : "home", "type" : "postal", "line" : ["Musterweg 42"], "city" : "Musterhausen", "postalCode" : "99999" }
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue()))
                              add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue()))
                              add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()))
                              add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty())
                              add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue()))
                              add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty())))
                              add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. (extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string)))
                              pat-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. (country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
                              102. Patient.address:Postfach
                              Slice NamePostfach
                              Definition

                              Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.

                              Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.

                              Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.

                              ShortEine Adresse gemäß postalischer Konventionen
                              Comments

                              Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeAddress(Adresse, deutsches Basisprofil)
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

                              Pattern Value{
                                "type" : "postal"
                              }
                              Example<br/><b>Beispiel für einfache Adresse</b>:{ "use" : "home", "type" : "postal", "line" : ["Musterweg 42"], "city" : "Musterhausen", "postalCode" : "99999" }
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue()))
                              add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue()))
                              add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()))
                              add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty())
                              add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue()))
                              add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden (line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty())))
                              add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. (extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string)))
                              pat-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. (country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3')))
                              132. Patient.maritalStatus
                              Definition

                              This field contains a patient's most recent marital (civil) status.

                              ShortMarital (civil) status of a patient
                              Comments

                              Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              BindingUnless not suitable, these codes SHALL be taken from Marital Status Codes
                              (extensible to http://hl7.org/fhir/ValueSet/marital-status)

                              The domestic partnership status of a person.

                              TypeCodeableConcept
                              Requirements

                              Most, if not all systems capture it.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              134. Patient.multipleBirth[x]
                              Definition

                              Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

                              ShortWhether patient is part of a multiple birth
                              Comments

                              Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeChoice of: boolean, integer
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Requirements

                              For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              136. Patient.photo
                              Definition

                              Image of the patient.

                              ShortImage of the patient
                              Comments

                              Guidelines:

                              • Use id photos, not clinical photos.
                              • Limit dimensions to thumbnail.
                              • Keep byte count low to ease resource updates.
                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeAttachment
                              Requirements

                              Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              att-1: If the Attachment has data, it SHALL have a contentType (data.empty() or contentType.exists())
                              138. Patient.contact
                              Definition

                              A contact party (e.g. guardian, partner, friend) for the patient.

                              ShortA contact party (e.g. guardian, partner, friend) for the patient
                              Comments

                              Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeBackboneElement
                              Requirements

                              Need to track people you can contact about the patient.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              pat-1: SHALL at least contain a contact's details or a reference to an organization (name.exists() or telecom.exists() or address.exists() or organization.exists())
                              150. Patient.communication
                              Definition

                              A language which may be used to communicate with the patient about his or her health.

                              ShortA language which may be used to communicate with the patient about his or her health
                              Comments

                              If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeBackboneElement
                              Requirements

                              If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              157. Patient.generalPractitioner
                              Definition

                              Patient's nominated care provider.

                              ShortPatient's nominated primary care provider
                              Comments

                              This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

                              Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeReference(Organization, Practitioner, PractitionerRole)
                              Alternate NamescareProvider
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
                              159. Patient.managingOrganization
                              Definition

                              Organization that is the custodian of the patient record.

                              ShortOrganization that is the custodian of the patient record
                              Comments

                              There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeReference(Organization)
                              Summarytrue
                              Requirements

                              Need to know who recognizes this patient record, manages and updates it.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
                              161. Patient.link
                              Definition

                              Link to another patient resource that concerns the same actual patient.

                              ShortLink to another patient resource that concerns the same actual person
                              Comments

                              There is no assumption that linked patient records have mutual links.

                              Control0..0
                              This element is affected by the following invariants: ele-1
                              TypeBackboneElement
                              Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              There are multiple use cases:

                              • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
                              • Distribution of patient information across multiple servers.
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))