Demographics and other administrative information about a patient receiving care or other health-related services

The time of day that the Patient was born. This includes the date to ensure that the timezone information can be communicated effectively.

Ethnicity of the patient

The religion as specified by the patient

An indicator that the patient is listed as an organ donor.

The residential status of the patient. For example if this patient is a UK resident.

The treatment category for this patient. For example if this patient is entitled to free healthcare treatment.

Communication preferences including a list of Languages which may be used for communication

An NHS Number identifier for this patient

Patients are almost always assigned specific numerical identifiers.

The verification/tracing status of the NHS number.

Establishes the namespace in which set of possible id values is unique

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

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

Each NHS Number is made up of 10 digits shown in a 3-3-4 format.

An identifier for this patient.

Patients are almost always assigned specific numerical identifiers.

Establishes the namespace in which set of possible id values is unique

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

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

Each NHS Number is made up of 10 digits shown in a 3-3-4 format.

Whether this patient record is in active use

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

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

A name associated with the individual.

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

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.

Identifies the purpose for this name

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

This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

A full text representation of the name

A renderable, unencoded form.

Can provide both a text representation and structured parts

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father

For family name, hyphenated names such as "Smith-Jones" are a single name, but names with spaces such as "Smith Jones" are broken into multiple parts.

Given name

If only initials are recorded, they may be used in place of the full name. Not called "first name" since given names do not always come first.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name

Indicates the period of time when this name was valid for the named person

Allows names to be placed in historical context.

The start of the period. The boundary is inclusive

If the low element is missing, the meaning is that the low boundary is not known.

A name associated with the individual.

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

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.

Identifies the purpose for this name

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

This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

A full text representation of the name

A renderable, unencoded form.

Can provide both a text representation and structured parts

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father

For family name, hyphenated names such as "Smith-Jones" are a single name, but names with spaces such as "Smith Jones" are broken into multiple parts.

Given name

If only initials are recorded, they may be used in place of the full name. Not called "first name" since given names do not always come first.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name

Indicates the period of time when this name was valid for the named person

Allows names to be placed in historical context.

The start of the period. The boundary is inclusive

If the low element is missing, the meaning is that the low boundary is not known.

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

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

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 may 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).

Telecommunications form for contact point - what communications system is required to make use of the contact.

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

Need to support legacy numbers that are not in a tightly controlled format.

Additional out of band data such as extensions, or notes about use of the contact are sometimes included in the value.

Identifies the purpose for the contact point.

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc for a current/permanent one. Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Time period when the contact point was/is in use.

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

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

Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.

The gender may not match the biological sex as determined by genetics, or the individual's preferred identification.

The date of birth for the patient

Age of the individual drives many clinical processes.

At least an estimated year should be provided as a guess if the real date of birth is unknown.

Indicates if the individual is deceased or not.

• Boolean
• DateTime

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.

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.

Address details for the patient

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

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

The purpose of this address

Allows an appropriate address to be chosen from a list of many.

This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc for a current/permanent one. Applications can assume that an address is current unless it explicitly says that it is temporary or old.

Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both

A full text representation of the address

A renderable, unencoded form.

Can provide both a text representation and parts.

This component contains the house number, apartment number, street name, street direction, delivery hints, and similar address information

home | work | temp | old - purpose of this address.

The name of the city, town, village or other community or delivery center

The name of the administrative area (county)

District is sometimes known as county, but in some regions 'county' in used in place of city (municipality), so county name should be conveyed in city instead.

A postal code designating a region defined by the postal service

Country - a nation as commonly understood or generally accepted

ISO 3166 3 letter codes can be used in place of a full country name.

Time period when address was/is in use

Allows addresses to be placed in historical context.

The start of the period. The boundary is inclusive

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

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

Most, if not all systems capture it.

A code taken from the marital status list of codes.

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the V3 Core Principles for more information. Ordering of codings is undefined and SHALL not be used to infer meaning.

The identification of the code system that defines the meaning of the symbol in the code.

Need to be unambiguous about the source of the definition of the symbol.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Need to refer to a particular code in the system.

A representation of the meaning of the code in the system, following the rules of the system.

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Very often the text is the same as a displayName of one of the codings.

Indicates whether the patient is part of a multiple or indicates the actual birth order.

• Boolean
• Integer

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

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

Need to track people you can contact about the patient.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

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

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

A code taken from the CDA Person Relationship Type list of codes.

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the V3 Core Principles for more information. Ordering of codings is undefined and SHALL not be used to infer meaning.

The identification of the code system that defines the meaning of the symbol in the code.

Need to be unambiguous about the source of the definition of the symbol.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Need to refer to a particular code in the system.

A representation of the meaning of the code in the system, following the rules of the system.

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Very often the text is the same as a displayName of one of the codings.

A name associated with the contact person.

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

Identifies the purpose for this name.

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

This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.

A full text representation of the name.

A renderable, unencoded form.

Can provide both a text representation and structured parts.

The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

For family name, hyphenated names such as "Smith-Jones" are a single name, but names with spaces such as "Smith Jones" are broken into multiple parts.

Given name.

If only initials are recorded, they may be used in place of the full name. Not called "first name" since given names do not always come first.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

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

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

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.

Telecommunications form for contact point - what communications system is required to make use of the contact.

The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

Need to support legacy numbers that are not in a tightly controlled format.

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

Identifies the purpose for the contact point.

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc for a current/permanent one. Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Time period when the contact point was/is in use.

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

Address for the contact person.

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

The purpose of this address.

Allows an appropriate address to be chosen from a list of many.

This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc for a current/permanent one. Applications can assume that an address is current unless it explicitly says that it is temporary or old.

Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

A full text representation of the address.

A renderable, unencoded form.

Can provide both a text representation and parts.

This component contains the house number, apartment number, street name, street direction, number, delivery hints, and similar address information.

home | work | temp | old - purpose of this address.

The name of the city, town, village or other community or delivery center.

The name of the administrative area (county).

District is sometimes known as county, but in some regions 'county' in used in place of city (municipality), so county name should be conveyed in city instead.

A postal code designating a region defined by the postal service.

Country - a nation as commonly understood or generally accepted.

ISO 3166 3 letter codes can be used in place of a full country name.

Time period when address was/is in use.

Allows addresses to be placed in historical context.

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

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

Needed to address the person correctly.

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

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

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the url conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Plain text narrative that identifies the resource in addition to the resource reference

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

Patient's nominated care provider or GP details.

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles. This is not to be used to record Care Teams, these should be recorded on either the CarePlan or EpisodeOfCare resources.

Organization that is the custodian of the patient record.

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

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).

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the url conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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

There are multiple usecases: * Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers.

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

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

The other patient resource that the link refers to.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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