| Australian Digital Health Agency FHIR Implementation Guide 1.1.0

This page is part of the Australian Digital Health Agency FHIR Implementation Guide 1.1.0. It is based on FHIR® version 4.0.1. See the Directory of published versions for a list of available previous versions.

#### StructureDefinition: ADHA Core Patient - Detailed Descriptions

Definitions for the dh-patient-core-1 Profile.

1. Patient
Definition | Demographics and other administrative information about an individual receiving care or other health-related services.
Control | 0..*
Alternate Names | SubjectOfCare Client Resident
2. Patient.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | id
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.
3. 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.
Control | 0..1
Type | Meta
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
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.
Control | 0..1
Type | uri
Is Modifier | true
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. Patient.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages A human language
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. 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.
Control | 0..1
Type | Narrative
Alternate Names | narrativehtmlxhtmldisplay
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. 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.
Control | 0..*
Type | Resource
Alternate Names | inline resourcesanonymous resourcescontained 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.
8. Patient.extension
Definition | An Extension
Control | 0..*
Type | Extension
Invariants | Defined on this element ele-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())
Slicing | This element introduces a set of slices on Patient.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
9. Patient.extension:birthPlace
SliceName | birthPlace
Definition | The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(birthPlace) (Extension Type: Address)
Must Support | true
Invariants | Defined on this element ele-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())
10. Patient.extension:indigenousStatus
SliceName | indigenousStatus
Definition | National Health Data Dictionary (NHDD) based indigenous status for a patient.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(AustralianIndigenousStatus) (Extension Type: Coding)
Must Support | true
Comments | See Australian Institute of Health and Welfare (AIHW) Person—Indigenous status (ID 602543) for further information.
Invariants | Defined on this element ele-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())
11. Patient.extension:closingTheGapRegistration
SliceName | closingTheGapRegistration
Definition | Indication of eligibility for the Closing the Gap co-payment.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(ClosingTheGapRegistration) (Extension Type: boolean)
Comments | See Australian Institute of Health and Welfare (AIHW) Patient—Closing the Gap co-payment eligibility indicator (ID 603671) for further information.
Invariants | Defined on this element ele-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:mothersMaidenName
SliceName | mothersMaidenName
Definition | Mother's maiden (unmarried) name, commonly collected to help verify patient identity.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(mothersMaidenName) (Extension Type: string)
Invariants | Defined on this element ele-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())
13. Patient.extension:interpreterRequired
SliceName | interpreterRequired
Definition | This Patient requires an interpreter to communicate healthcare information to the practitioner.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(interpreterRequired) (Extension Type: boolean)
Must Support | true
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.
Invariants | Defined on this element ele-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())
14. Patient.extension:dateOfArrival
SliceName | dateOfArrival
Definition | The date a person first arrived in Australia, from another country, with the intention of living in Australia for one year or more. This date is captured once for a person and is not subsequently updated with subsequent arrivals.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(DateOfArrivalAustralia) (Extension Type: date)
Must Support | true
Comments | See Australian Bureau of Statics (ABS) 1200.0.55.007 - Year of Arrival Standard, 2014, Version 1.5 and the Australian Institute of Health and Welfare (AIHW) Person—year of first arrival in Australia (ID 269447) for further materials.
Invariants | Defined on this element ele-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())
15. 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).
Control | 0..*
Type | Extension
Is Modifier | true
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 Names | extensionsuser content
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.
Invariants | Defined on this element ele-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())
16. Patient.identifier
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..* This element is affected by the following invariants: ele-1inv-dh-pat-01
Type | Identifier(Identifier AUIHI AUMedicareCardNumber AUDVANumber AUHealthCareCardNumber AUPensionerConcessionCardNumber AUCwlthSeniorsHealthCardNumber AUMedicalRecordNumber AUInsuranceMemberNumber)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Requirements | Patients are almost always assigned specific numerical identifiers.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on Patient.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators: pattern @ type
17. Patient.identifier:ihi
SliceName | ihi
Definition | Individual Healthcare Identifier (IHI) assigned under the HI Service to a patient.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier(AUIHI)
Must Support | true
Requirements | Patients are almost always assigned specific numerical identifiers.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) inv-ihi-value-0: IHI shall be an exactly 16 digit number (: value.matches('^([0-9]{16})$')) inv-ihi-value-1: IHI prefix is 800360 (: value.startsWith('800360')) inv-ihi-value-2: IHI shall pass the Luhn algorithm check (: (((select(value.substring(0,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(1,1).toInteger())+(select(value.substring(2,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(3,1).toInteger())+(select(value.substring(4,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(5,1).toInteger())+(select(value.substring(6,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(7,1).toInteger())+(select(value.substring(8,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(9,1).toInteger())+(select(value.substring(10,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(11,1).toInteger())+(select(value.substring(12,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(13,1).toInteger())+(select(value.substring(14,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(15,1).toInteger()))mod 10=0))
18. Patient.identifier:medicare
SliceName | medicare
Definition | Medicare card number as either the the 10 digit Medicare card number or the 11 digit number (includes the individual reference number (IRN)). A Medicare card is provided to individuals who are enrolled in Medicare.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier(AUMedicareCardNumber)
Must Support | true
Requirements | Patients are almost always assigned specific numerical identifiers.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. Patient.identifier:dva
SliceName | dva
Definition | Department of Veterans’ Affairs (DVA) file number displayed on a Veteran Card.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier(AUDVANumber)
Must Support | true
Requirements | Patients are almost always assigned specific numerical identifiers.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. 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.
Control | 0..1
Type | boolean
Is Modifier | true
Requirements | Need to be able to mark a patient record as not to be used because it was created in error.
Comments | If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Meaning if Missing | This resource is generally assumed to be active if no value is provided for the active element
Fixed Value | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. Patient.name
Definition | A name associated with the individual.
Control | 1..* This element is affected by the following invariants: inv-dh-pat-02inv-dh-pat-04
Type | HumanName
Must Support | true
Requirements | Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Comments | A patient may have multiple names with different uses or applicable periods. At least one name SHOULD be the name the patient is considered to have for administrative and record keeping purposes - family name is used to enable matching against patient records.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) inv-dh-pat-04: At least text, family name, or given name shall be present (: text.exists() or family.exists() or given.exists())
22. Patient.telecom
Definition | A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Control | 0..*
Type | ContactPoint
Must Support | true
Requirements | People have (primary) ways to contact them in some way such as phone, email.
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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. Patient.gender
Definition | Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Control | 1..1
Binding | The codes SHALL be taken from AdministrativeGender The gender of a person used for administrative purposes
Type | code
Must Support | true
Requirements | Needed for identification of the individual, in combination with (at least) name and birth date.
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. Patient.birthDate
Definition | The date of birth for the individual.
Control | 1..1
Type | date
Must Support | true
Requirements | Age of the individual drives many clinical processes. May include accuracy indicator and specific birth time.
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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
LOINC Code | 21112-8
25. Patient.birthDate.id
Definition | unique id for the element within a resource (for internal references)
Control | 0..1
Type | string
XML Representation | In the XML format, this property is represented as an attribute.
26. Patient.birthDate.extension
Definition | An Extension
Control | 0..*
Type | Extension
Invariants | Defined on this element ele-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())
Slicing | This element introduces a set of slices on Patient.birthDate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
27. Patient.birthDate.extension:accuracyIndicator
SliceName | accuracyIndicator
Definition | General date accuracy indicator coding.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(DateAccuracyIndicator) (Extension Type: Coding)
Must Support | true
Comments | In some circumstances, systems may capture date or dateTime data that has unknown or estimated parts. This coding indicates the accuracy of the day, month and year parts. See Australian Institute of Health and Welfare (AIHW) Date—accuracy indicator (ID 294418) for further information.
Invariants | Defined on this element ele-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.birthDate.extension:birthTime
SliceName | birthTime
Definition | The time of day that the Patient was born. This includes the date to ensure that the timezone information can be communicated effectively.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(birthTime) (Extension Type: dateTime)
Must Support | true
Invariants | Defined on this element ele-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())
29. Patient.birthDate.value
Definition | The actual value
Control | 0..1
Type | date
XML Representation | In the XML format, this property is represented as an attribute.
30. Patient.deceased[x]
Definition | Indicates if the individual is deceased or not. Deceased date accuracy indicator is optional.
Control | 0..1
Type | Choice of: boolean, dateTime
[x] Note | See Choice of Data Types for further information about how to use [x]
Is Modifier | true
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.
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on Patient.deceased[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators: type @ $this
31. Patient.deceased[x]:deceasedBoolean
SliceName | deceasedBoolean
Definition | Boolean indicator if the individual is deceased or not.
Control | 0..1
Type | boolean
[x] Note | See Choice of Data Types for further information about how to use [x]
Is Modifier | true
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.
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. Patient.deceased[x]:deceasedDateTime
SliceName | deceasedDateTime
Definition | Individual deceased date-time with optional accuracy indicator.
Control | 0..1
Type | dateTime
[x] Note | See Choice of Data Types for further information about how to use [x]
Is Modifier | true
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.
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
33. Patient.deceased[x]:deceasedDateTime.id
Definition | unique id for the element within a resource (for internal references)
Control | 0..1
Type | string
XML Representation | In the XML format, this property is represented as an attribute.
34. Patient.deceased[x]:deceasedDateTime.extension
Definition | An Extension
Control | 0..*
Type | Extension
Invariants | Defined on this element ele-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())
Slicing | This element introduces a set of slices on Patient.deceased[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
35. Patient.deceased[x]:deceasedDateTime.extension:accuracyIndicator
SliceName | accuracyIndicator
Definition | General date accuracy indicator coding.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(DateAccuracyIndicator) (Extension Type: Coding)
Comments | In some circumstances, systems may only have date or datetime data that has unknown or estimated parts. This coding establishes the accuracy of the day, month and year parts.
Invariants | Defined on this element ele-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())
36. Patient.deceased[x]:deceasedDateTime.value
Definition | The actual value
Control | 0..1
Type | dateTime
XML Representation | In the XML format, this property is represented as an attribute.
37. Patient.address
Definition | An Australian address expressed using postal conventions (as opposed to GPS or other location definition formats).
Control | 0..* This element is affected by the following invariants: ele-1
Type | Address(AustralianAddress Address)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Requirements | May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Comments | The 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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) inv-add-0: The address shall at least have text or a line (: text.exists() or line.exists()) inv-add-1: If asserting no fixed address, the type shall be 'physical' (: extension('http://hl7.org.au/fhir/StructureDefinition/no-fixed-address').exists() implies type='physical') inv-add-2: If asserting no fixed address, the address text shall begin with 'NO FIXED ADDRESS' (: extension('http://hl7.org.au/fhir/StructureDefinition/no-fixed-address').exists() implies text.startsWith('NO FIXED ADDRESS'))
38. Patient.maritalStatus
Definition | This field contains a patient's most recent marital (civil) status.
Control | 0..1
Binding | The codes SHALL be taken from Marital Status Codes; other codes may be used where these codes are not suitable The domestic partnership status of a person
Type | CodeableConcept
Requirements | Most, if not all systems capture it.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
39. Patient.multipleBirth[x]
Definition | Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Control | 0..1
Type | Choice of: boolean, integer
[x] Note | See Choice of Data Types for further information about how to use [x]
Requirements | For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
40. Patient.photo
Definition | Image of the patient.
Control | 0..*
Type | Attachment
Requirements | Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Comments | Guidelines: Use id photos, not clinical photos. Limit dimensions to thumbnail. Keep byte count low to ease resource updates.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
41. Patient.contact
Definition | A contact party (e.g. guardian, partner, friend) for the patient.
Control | 0..*
Type | BackboneElement
Requirements | Need to track people you can contact about 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.
Invariants | Defined on this element ele-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())
42. 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.
Control | 0..1
Type | string
XML Representation | In the XML format, this property is represented as an attribute.
43. Patient.contact.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.
Control | 0..*
Type | Extension
Alternate Names | extensionsuser content
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.
Invariants | Defined on this element ele-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.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).
Control | 0..*
Type | Extension
Is Modifier | true
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 Names | extensionsuser contentmodifiers
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.
Invariants | Defined on this element ele-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())
45. Patient.contact.relationship
Definition | The nature of the relationship between the patient and the contact person.
Control | 0..*
Binding | The codes SHALL be taken from https://healthterminologies.gov.au/fhir/ValueSet/contact-relationship-type-3; other codes may be used where these codes are not suitable
Type | CodeableConcept
Requirements | Used to determine which contact person is the most relevant to approach, depending on circumstances.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
46. Patient.contact.name
Definition | A name associated with the contact person.
Control | 0..1
Type | HumanName
Requirements | Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
47. Patient.contact.telecom
Definition | A contact detail for the person, e.g. a telephone number or an email address.
Control | 0..*
Type | ContactPoint
Requirements | People have (primary) ways to contact them in some way such as phone, email.
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
48. Patient.contact.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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Address(Address AustralianAddress)
Requirements | Need to keep track where the contact person can be contacted per postal mail or visited.
Comments | The 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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
49. Patient.contact.gender
Definition | Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Control | 0..1
Binding | The codes SHALL be taken from AdministrativeGender The gender of a person used for administrative purposes
Type | code
Requirements | Needed to address the person correctly.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
50. Patient.contact.organization
Definition | Organization on behalf of which the contact is acting or for which the contact is working.
Control | 0..1 This element is affected by the following invariants: pat-1
Type | Reference(Organization))
Requirements | For guardians or business related contacts, the organization is relevant.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
51. Patient.contact.period
Definition | The period during which this contact person or organization is valid to be contacted relating to this patient.
Control | 0..1
Type | Period
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
52. Patient.communication
Definition | A language which may be used to communicate with the patient about his or her health.
Control | 0..*
Type | BackboneElement
Must Support | true
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.
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
53. 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.
Control | 0..1
Type | string
XML Representation | In the XML format, this property is represented as an attribute.
54. 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.
Control | 0..*
Type | Extension
Alternate Names | extensionsuser content
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.
Invariants | Defined on this element ele-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())
55. 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).
Control | 0..*
Type | Extension
Is Modifier | true
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 Names | extensionsuser contentmodifiers
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.
Invariants | Defined on this element ele-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())
56. 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.
Control | 1..1
Binding | The codes SHALL be taken from https://healthterminologies.gov.au/fhir/ValueSet/common-languages-australia-2; other codes may be used where these codes are not suitable
Type | CodeableConcept
Must Support | true
Requirements | Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
57. Patient.communication.preferred
Definition | Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Control | 0..1
Type | boolean
Must Support | true
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.
Comments | This language is specifically identified for communicating healthcare information.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
58. Patient.generalPractitioner
Definition | Patient's nominated care provider.
Control | 0..* This element is affected by the following invariants: inv-dh-pat-03
Type | Reference(ADHAOrganizationCore ADHAPractitionerRoleCore))
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Alternate Names | careProvider
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
59. Patient.managingOrganization
Definition | Organization that is the custodian of the patient record.
Control | 0..1
Type | Reference(Organization))
Requirements | Need to know who recognizes this patient record, manages and updates it.
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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
60. Patient.link
Definition | Link to a Patient or RelatedPerson resource that concerns the same actual person.
Control | 0..*
Type | BackboneElement
Is Modifier | true
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.
Comments | There is no assumption that linked patient records have mutual links.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
61. 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.
Control | 0..1
Type | string
XML Representation | In the XML format, this property is represented as an attribute.
62. 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.
Control | 0..*
Type | Extension
Alternate Names | extensionsuser content
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.
Invariants | Defined on this element ele-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())
63. 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).
Control | 0..*
Type | Extension
Is Modifier | true
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 Names | extensionsuser contentmodifiers
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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
64. Patient.link.other
Definition | The other patient resource that the link refers to.
Control | 1..1
Type | Reference(Patient RelatedPerson))
Comments | Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
65. Patient.link.type
Definition | The type of link between this patient resource and another patient resource.
Control | 1..1
Binding | The codes SHALL be taken from LinkType The type of link between this patient resource and another patient resource
Type | code
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))