New Zealand Rheumatic Fever FHIR Implementation Guide
0.4.7 - draft

New Zealand Rheumatic Fever FHIR Implementation Guide - Local Development build (v0.4.7) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: RheumaticFeverPatient - Detailed Descriptions

Draft as of 2024-08-08

Definitions for the nz-rheumaticfever-patient resource profile.

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

0. Patient
2. Patient.meta
InvariantsRFNZTagConstraint: All instances shall have an #rf-nz meta.tag (the NZ rheumatic fever generic code defined in this IG) (tag.code contains 'rf-nz')
4. Patient.implicitRules
Control0..0
6. Patient.language
Control0..0
8. Patient.extension:interpreterRequired
Slice NameinterpreterRequired
ShortDoes this person require an interpreter?
Control0..*
TypeExtension(Patient Interpreter Required) (Extension Type: boolean)
10. Patient.name
Control1..1
12. Patient.contact
14. Patient.contact.extension
SlicingThis element introduces a set of slices on Patient.contact.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 16. Patient.contact.extension:whanauMemberCareRole
    Slice NamewhanauMemberCareRole
    Control0..1
    TypeExtension(Codifies role taken by a whanau member of patient's care team) (Extension Type: Coding)
    18. Patient.contact.extension:whanauMemberCareRelationship
    Slice NamewhanauMemberCareRelationship
    Control0..1
    TypeExtension(Relationship of whanau member to patient in care team) (Extension Type: string)
    20. Patient.contact.extension:whanauMemberCarePrimary
    Slice NamewhanauMemberCarePrimary
    Control0..1
    TypeExtension(Denotes if the member is to be used a primary contact) (Extension Type: boolean)
    22. Patient.link
    24. Patient.link.other
    TypeReference(Patient)
    26. Patient.link.type
    Pattern Valueseealso

    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
    Summaryfalse
    Alternate NamesSubjectOfCare Client Resident
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.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-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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    nz-pat-1: only a single official NHI (Patient.identifier.where(system='https://standards.digital.health.nz/ns/nhi-id' and use='official').count() < 2)
    2. 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
    TypeMeta
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    RFNZTagConstraint: All instances shall have an #rf-nz meta.tag (the NZ rheumatic fever generic code defined in this IG) (tag.code contains 'rf-nz')
    4. 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..01
    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()))
    6. 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..01
    BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages
    (preferred to http://hl7.org/fhir/ValueSet/languages)

    A human language.

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

    The ethnic group or groups that a person identifies with or feels they belong to. Ethnicity is a measure of cultural affiliation as opposed to race, ancestry, nationality or citizen. Ethnicity is self-perceived and a person can belong to more than one group.

    The Stats New Zealand standard can be found here.

    ShortNZ Ethnicity
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(NZ Ethnicity) (Extension Type: CodeableConcept)
    Is Modifierfalse
    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())
    10. Patient.extension:nzCitizen
    Slice NamenzCitizen
    Definition

    New Zealand citizenship

    ShortIs this person a New Zealand citizen
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(NZ Citizenship) (Complex Extension)
    Is Modifierfalse
    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())
    12. Patient.extension:dhb
    Slice Namedhb
    Definition

    District Health Board relating to a NZ Healthcare Service, Location (Facility) or Patient (primary, physical home address).

    ShortDistrict Health Board linked to a NZ Healthcare Service, Location or Patient
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(District Health Board linked to a NZ Healthcare Service, Location or Patient) (Extension Type: CodeableConcept)
    Is Modifierfalse
    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())
    14. Patient.extension:domicile-code
    Slice Namedomicile-code
    Definition

    NZ Domicile Code. Derived from a patient's primary physical, home address.

    ShortNZ Domicile Code
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(NZ Domicile Code) (Extension Type: CodeableConcept)
    Is Modifierfalse
    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())
    16. Patient.extension:pho
    Slice Namepho
    Definition

    Primary Healthcare Organisation associated with a General Practice linked to a NZ Healthcare Service, Location (Facility) or Patient (GP).

    ShortPrimary Healthcare Organisation
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Primary Healthcare Organisation) (Extension Type: CodeableConcept)
    Is Modifierfalse
    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())
    18. Patient.extension:sex-at-birth
    Slice Namesex-at-birth
    Definition

    A person’s sex at the time of their birth (considered to be immutable).

    ShortSex At Birth
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Sex At Birth) (Extension Type: CodeableConcept)
    Is Modifierfalse
    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())
    20. Patient.extension:iwi
    Slice Nameiwi
    Definition

    Persons Iwi affiliation

    ShortExtension
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Nz_iwi) (Extension Type: CodeableConcept)
    Is Modifierfalse
    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())
    22. Patient.extension:interpreterRequired
    Slice NameinterpreterRequired
    Definition

    This Patient requires an interpreter to communicate healthcare information to the practitioner.

    ShortDoes this person require an interpreter?
    Comments

    The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.

    Control0..*
    TypeExtension(Patient Interpreter Required) (Extension Type: boolean)
    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())
    24. 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..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    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())
    26. Patient.identifier
    Definition

    An identifier for this patient.

    ShortAn identifier for this patient
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    TypeIdentifier
    Is Modifierfalse
    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:
    • value @ system
    • 28. Patient.identifier:NHI
      Slice NameNHI
      Definition

      An identifier for this patient.

      ShortAn identifier for this patient
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      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()))
      30. Patient.identifier:NHI.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from Valid use values for NHIhttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to https://nzhts.digital.health.nz/fhir/ValueSet/nhi-use-code)
      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Patient.identifier:NHI.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Fixed Valuehttps://standards.digital.health.nz/ns/nhi-id
      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. 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
      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()))
      36. 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.

      Control10..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()))
      38. 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
      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
      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()))
      40. 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..*
      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'
      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()))
      42. Patient.link.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      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..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      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, modifiers
      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())
      44. Patient.link.other
      Definition

      The other patient resource that the link refers to.

      ShortThe other patient or related person resource that the link refers to
      Comments

      Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

      Control1..1
      TypeReference(Patient, RelatedPerson)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. Patient.link.type
      Definition

      The type of link between this patient resource and another patient resource.

      Shortreplaced-by | replaces | refer | seealso
      Control1..1
      BindingThe codes SHALL be taken from LinkTypehttp://hl7.org/fhir/ValueSet/link-type|4.0.1
      (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

      The type of link between this patient resource and another patient resource.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Pattern Valueseealso
      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..*
      Is Modifierfalse
      Summaryfalse
      Alternate NamesSubjectOfCare Client Resident
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.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-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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      nz-pat-1: only a single official NHI (Patient.identifier.where(system='https://standards.digital.health.nz/ns/nhi-id' and use='official').count() < 2)
      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
      Is Modifierfalse
      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
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      RFNZTagConstraint: All instances shall have an #rf-nz meta.tag (the NZ rheumatic fever generic code defined in this IG) (tag.code contains 'rf-nz')
      6. 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..0
      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()))
      8. 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..0
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. 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
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. 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
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. Patient.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Patient.extension:ethnicity
        Slice Nameethnicity
        Definition

        The ethnic group or groups that a person identifies with or feels they belong to. Ethnicity is a measure of cultural affiliation as opposed to race, ancestry, nationality or citizen. Ethnicity is self-perceived and a person can belong to more than one group.

        The Stats New Zealand standard can be found here.

        ShortNZ Ethnicity
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(NZ Ethnicity) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        18. Patient.extension:nzCitizen
        Slice NamenzCitizen
        Definition

        New Zealand citizenship

        ShortIs this person a New Zealand citizen
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(NZ Citizenship) (Complex Extension)
        Is Modifierfalse
        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())
        20. Patient.extension:dhb
        Slice Namedhb
        Definition

        District Health Board relating to a NZ Healthcare Service, Location (Facility) or Patient (primary, physical home address).

        ShortDistrict Health Board linked to a NZ Healthcare Service, Location or Patient
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(District Health Board linked to a NZ Healthcare Service, Location or Patient) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        22. Patient.extension:domicile-code
        Slice Namedomicile-code
        Definition

        NZ Domicile Code. Derived from a patient's primary physical, home address.

        ShortNZ Domicile Code
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(NZ Domicile Code) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        24. Patient.extension:pho
        Slice Namepho
        Definition

        Primary Healthcare Organisation associated with a General Practice linked to a NZ Healthcare Service, Location (Facility) or Patient (GP).

        ShortPrimary Healthcare Organisation
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Primary Healthcare Organisation) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        26. Patient.extension:sex-at-birth
        Slice Namesex-at-birth
        Definition

        A person’s sex at the time of their birth (considered to be immutable).

        ShortSex At Birth
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Sex At Birth) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        28. Patient.extension:iwi
        Slice Nameiwi
        Definition

        Persons Iwi affiliation

        ShortExtension
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Nz_iwi) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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())
        30. Patient.extension:interpreterRequired
        Slice NameinterpreterRequired
        Definition

        This Patient requires an interpreter to communicate healthcare information to the practitioner.

        ShortDoes this person require an interpreter?
        Comments

        The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.

        Control0..*
        TypeExtension(Patient Interpreter Required) (Extension Type: boolean)
        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())
        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..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        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())
        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)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        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:
        • value @ system
        • 36. Patient.identifier:NHI
          Slice NameNHI
          Definition

          An identifier for this patient.

          ShortAn identifier for this patient
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          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()))
          38. Patient.identifier:NHI.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
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          40. Patient.identifier:NHI.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..*
          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())
          SlicingThis element introduces a set of slices on Patient.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 42. Patient.identifier:NHI.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control0..1
            BindingThe codes SHALL be taken from Valid use values for NHI
            (required to https://nzhts.digital.health.nz/fhir/ValueSet/nhi-use-code)
            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

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

            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

            ShortDescription of identifier
            Comments

            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows users to make use of identifiers when the identifier system is not known.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. Patient.identifier:NHI.system
            Definition

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

            ShortThe namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

            Control1..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

            Fixed Valuehttps://standards.digital.health.nz/ns/nhi-id
            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. Patient.identifier:NHI.value
            Definition

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

            ShortThe value that is unique
            Comments

            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Example<br/><b>General</b>:123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. Patient.identifier:NHI.period
            Definition

            Time period during which identifier is/was valid for use.

            ShortTime period when id is/was valid for use
            Control0..1
            TypePeriod
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. Patient.identifier:NHI.assigner
            Definition

            Organization that issued/manages the identifier.

            ShortOrganization that issued id (may be just text)
            Comments

            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

            Control0..1
            TypeReference(Organization)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. 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
            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()))
            56. 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.

            Control1..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()))
            58. Patient.telecom
            Definition

            Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.

            ShortDetails of a Technology mediated contact point (phone, fax, email, etc.)
            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..*
            This element is affected by the following invariants: ele-1
            TypeContactPoint(Common NZ ContactPoint datatype)
            Is Modifierfalse
            Requirements

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

            Invariantscpt-2: A system is required if a value is provided. (value.empty() or system.exists())
            ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. 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
            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
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            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()))
            62. 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).

            Control0..1
            Typedate
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            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()))
            LOINC Code21112-8
            64. 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
            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
            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()))
            66. Patient.address
            Definition

            An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.

            ShortAn address expressed using postal conventions (as opposed to GPS or other location definition formats)
            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..*
            This element is affected by the following invariants: ele-1
            TypeAddress(Common NZ Address datatype)
            Is Modifierfalse
            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()))
            68. Patient.maritalStatus
            Definition

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

            ShortMarital (civil) status of a patient
            Control0..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
            Is Modifierfalse
            Summaryfalse
            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()))
            70. 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..1
            TypeChoice of: boolean, integer
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            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()))
            72. 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..*
            TypeAttachment
            Is Modifierfalse
            Summaryfalse
            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()))
            74. 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..*
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            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())
            76. Patient.contact.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
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            78. Patient.contact.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            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.contact.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 80. Patient.contact.extension:whanauMemberCareRole
              Slice NamewhanauMemberCareRole
              Definition

              Codifies role this whanau member plays in a patient's care team

              ShortCodifies role taken by a whanau member of patient's care team
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Codifies role taken by a whanau member of patient's care team) (Extension Type: Coding)
              Is Modifierfalse
              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())
              82. Patient.contact.extension:whanauMemberCareRelationship
              Slice NamewhanauMemberCareRelationship
              Definition

              In patient care teams, codifies this whanau member's relationship to the patient

              ShortRelationship of whanau member to patient in care team
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Relationship of whanau member to patient in care team) (Extension Type: string)
              Is Modifierfalse
              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())
              84. Patient.contact.extension:whanauMemberCarePrimary
              Slice NamewhanauMemberCarePrimary
              Definition

              Set to true if this whanau member acts as a primary contact for the patient

              ShortDenotes if the member is to be used a primary contact
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Denotes if the member is to be used a primary contact) (Extension Type: boolean)
              Is Modifierfalse
              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())
              86. Patient.contact.modifierExtension
              Definition

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              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..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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, modifiers
              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())
              88. Patient.contact.relationship
              Definition

              The nature of the relationship between the patient and the contact person.

              ShortThe kind of relationship
              Control0..*
              BindingUnless not suitable, these codes SHALL be taken from PatientContactRelationship
              (extensible to http://hl7.org/fhir/ValueSet/patient-contactrelationship)

              The nature of the relationship between a patient and a contact person for that patient.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Used to determine which contact person is the most relevant to approach, depending on circumstances.

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

              A name associated with the contact person.

              ShortA name associated with the contact person
              Control0..1
              TypeHumanName
              Is Modifierfalse
              Summaryfalse
              Requirements

              Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

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

              A contact detail for the person, e.g. a telephone number or an email address.

              ShortA contact detail for the person
              Comments

              Contact 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.

              Control0..*
              TypeContactPoint
              Is Modifierfalse
              Summaryfalse
              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()))
              94. Patient.contact.address
              Definition

              Address for the contact person.

              ShortAddress for the contact person
              Control0..1
              TypeAddress
              Is Modifierfalse
              Summaryfalse
              Requirements

              Need to keep track where the contact person can be contacted per postal mail or visited.

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

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

              Shortmale | female | other | unknown
              Control0..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
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              Needed to address the person correctly.

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

              Organization on behalf of which the contact is acting or for which the contact is working.

              ShortOrganization that is associated with the contact
              Control0..1
              This element is affected by the following invariants: pat-1
              TypeReference(Organization)
              Is Modifierfalse
              Summaryfalse
              Requirements

              For guardians or business related contacts, the organization is relevant.

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

              The period during which this contact person or organization is valid to be contacted relating to this patient.

              ShortThe period during which this contact person or organization is valid to be contacted relating to this patient
              Control0..1
              TypePeriod
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              102. 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..*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              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()))
              104. Patient.communication.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
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              106. Patient.communication.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..*
              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())
              108. Patient.communication.modifierExtension
              Definition

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              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..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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, modifiers
              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())
              110. Patient.communication.language
              Definition

              The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.

              ShortThe language which can be used to communicate with the patient about his or her health
              Comments

              The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

              Control1..1
              BindingThe codes SHOULD be taken from CommonLanguages
              (preferred to http://hl7.org/fhir/ValueSet/languages)

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

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

              Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

              ShortLanguage preference indicator
              Comments

              This language is specifically identified for communicating healthcare information.

              Control0..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              114. 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..*
              TypeReference(Organization, Practitioner, PractitionerRole)
              Is Modifierfalse
              Summaryfalse
              Alternate NamescareProvider
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              116. 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..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()))
              118. 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..*
              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'
              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()))
              120. Patient.link.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
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              122. Patient.link.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..*
              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())
              124. Patient.link.modifierExtension
              Definition

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              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..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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, modifiers
              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())
              126. Patient.link.other
              Definition

              The other patient resource that the link refers to.

              ShortThe other patient or related person resource that the link refers to
              Comments

              Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

              Control1..1
              TypeReference(Patient)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              128. Patient.link.type
              Definition

              The type of link between this patient resource and another patient resource.

              Shortreplaced-by | replaces | refer | seealso
              Control1..1
              BindingThe codes SHALL be taken from LinkType
              (required to http://hl7.org/fhir/ValueSet/link-type|4.0.1)

              The type of link between this patient resource and another patient resource.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Pattern Valueseealso
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))