R6 Ballot (3rd Draft) FHIR CI-Build

This page is part of the FHIR Specification v6.0.0-ballot3: Release 6 Ballot (3rd Draft) (see Ballot Notes ). The current version is 5.0.0 . For a full list Continuous Integration Build of available versions, see FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions icon

9.4 Resource FamilyMemberHistory - Content

Responsible Owner: Patient Care icon Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Patient

Significant health conditions for a person related to the patient relevant in the context of care for the patient.

9.4.1 Scope and Usage

FamilyMemberHistory is one of the event resources in the FHIR workflow specification.

This resource records significant health conditions for a particular individual related to the subject. This information can be known to different levels of accuracy. Sometimes the exact condition ('asthma') is known, and sometimes it is less precise ('some sort of cancer'). Equally, sometimes the person can be identified ('my aunt Agatha') and sometimes all that is known is that the person was an uncle.

This resource represents a simple structure used to capture an 'elementary' family history for a particular family member. However, it can also be the basis for capturing a more rigorous history useful for genetic and other analysis - refer to the Genetic Pedigree profile for an example.

The entire family history for an individual can be represented by combining references to FamilyMemberHistory instances into a List resource instance.

9.4.2 References to this Resource

9.4.3 Resource Content

Structure

0..* CodeableConcept Type of involvement Binding: Participation Role Type ( Extensible ) actor Σ 1..1 Who
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . FamilyMemberHistory TU DomainResource Information about patient's relatives, relevant for patient
+ Rule: Can have age[x] or born[x], but not both
+ Rule: Can only have estimatedAge if age[x] is present
+ Rule: Can have age[x] or deceased[x], but not both

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External Id(s) for this record

. . . status ?! Σ 1..1 code partial | completed | entered-in-error | health-unknown
Binding: Family History Status ( Required )
. . . dataAbsentReason Σ 0..1 CodeableConcept subject-unknown | withheld | unable-to-obtain | deferred
Binding: Family History Absent Reason ( Example )
. . . date Σ 0..1 dateTime When history was recorded or last updated
. . participant . recorder Σ 0..1 BackboneElement Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Organization | CareTeam | Group ) Who or what participated in the activities related to recorded the family member history and how they were involved
. . function . asserter Σ 0..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam | Device | Group ) Person or what participated in the activities related to the device that asserts this family member history
. . . name Σ 0..1 string The family member described
. . . relationship Σ 1..1 CodeableConcept Relationship to the subject
Binding: FamilyMember icon ( Example )
. . . sex Σ 0..1 CodeableConcept male | female | other | unknown
Binding: AdministrativeGender ( Extensible )
. . . born[x] C 0..1 (approximate) date of birth
. . . . bornPeriod Period
. . . . bornDate date
. . . . bornString string
. . . age[x] Σ C 0..1 (approximate) age
. . . . ageAge Age
. . . . ageRange Range
. . . . ageString string
. . . estimatedAge Σ C 0..1 boolean Age is estimated?
. . . deceased[x] Σ C 0..1 Dead? How old/when?
. . . . deceasedBoolean boolean
. . . . deceasedAge Age
. . . . deceasedRange Range
. . . . deceasedDate date
. . . . deceasedString string
. . . reason Σ 0..* CodeableReference ( Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference ) Why was family member history performed?
Binding: SNOMED CT Clinical Findings ( Example )

. . . note 0..* Annotation General note about related person

. . . condition Σ 0..* BackboneElement Condition that the related person had

. . . . code Σ 1..1 CodeableConcept Condition, allergy, or intolerance suffered by relation
Binding: Condition/Problem/Diagnosis Codes ( Example )
. . . . outcome 0..1 CodeableConcept deceased | permanent disability | etc
Binding: Condition Outcome Codes ( Example )
. . . . contributedToDeath 0..1 boolean Whether the condition contributed to the cause of death
. . . . onset[x] 0..1 When condition first manifested
. . . . . onsetAge Age
. . . . . onsetRange Range
. . . . . onsetPeriod Period
. . . . . onsetString string
. . . . note 0..* Annotation Extra information about condition

. . . procedure 0..* BackboneElement Procedures that the related person had

. . . . code 1..1 CodeableConcept Procedures performed on the related person
Binding: Procedure Codes (SNOMED CT) ( Example )
. . . . outcome 0..1 CodeableConcept What happened following the procedure
Binding: SNOMED CT Clinical Findings ( Example )
. . . . contributedToDeath 0..1 boolean Whether the procedure contributed to the cause of death
. . . . performed[x] 0..1 When the procedure was performed
. . . . . performedAge Age
. . . . . performedRange Range
. . . . . performedPeriod Period
. . . . . performedString string
. . . . . performedDateTime dateTime
. . . . note 0..* Annotation Extra information about the procedure


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

FamilyMemberHistory ( DomainResource ) Business identifiers assigned to this family member history by the performer or other systems which remain constant as the resource is updated and propagates from server to server identifier : Identifier [0..*] A code specifying the status of the record of the family history of a specific family member (this element modifies the meaning of other elements) status : code [1..1] « null (Strength=Required) FamilyHistoryStatus ! » Describes why the family member's history is not available dataAbsentReason : CodeableConcept [0..1] « null (Strength=Example) FamilyHistoryAbsentReason ?? » The person who this history concerns patient : Reference [1..1] « Patient » The date (and possibly time) when the family member history was recorded or last updated date : dateTime [0..1] Individual who recorded the record and takes responsibility for its content recorder : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Organization | CareTeam | Group » Individual or device that is making the family member history statement asserter : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Organization | CareTeam | Device | Group » This will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair" name : string [0..1] The type of relationship this person has to the patient (father, mother, brother etc.) relationship : CodeableConcept [1..1] « null (Strength=Example) FamilyMember ?? » The birth sex of the family member sex : CodeableConcept [0..1] « null (Strength=Extensible) AdministrativeGender + » The actual or approximate date of birth of the relative born[x] : DataType [0..1] « Period | date | string » « This element has or is affected by some invariants C » The age of the relative at the time the family member history is recorded age[x] : DataType [0..1] « Age | Range | string » « This element has or is affected by some invariants C » If true, indicates that the age value specified is an estimated value estimatedAge : boolean [0..1] « This element has or is affected by some invariants C » Deceased flag or the actual or approximate age of the relative at the time of death for the family member history record deceased[x] : DataType [0..1] « boolean | Age | Range | date | string » « This element has or is affected by some invariants C » Describes why the family member history occurred in coded or textual form, or Indicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event reason : CodeableReference [0..*] « Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference ; null (Strength=Example) SNOMEDCTClinicalFindings ?? » This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible note : Annotation [0..*] Participant Distinguishes the type of involvement of the actor in the activities related to the family member history function : CodeableConcept [0..1] « null (Strength=Extensible) ParticipationRoleType + » Indicates who or what participated in the activities related to the family member history actor : Reference [1..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam | Group » Condition The actual condition, allergy, or intolerance specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system code : CodeableConcept [1..1] « null (Strength=Example) ConditionProblemDiagnosisCodes ?? » Indicates what happened following the condition. If the condition resulted in death, deceased date is captured on the relation outcome : CodeableConcept [0..1] « null (Strength=Example) ConditionOutcomeCodes ?? » This condition contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown contributedToDeath : boolean [0..1] Either the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence onset[x] : DataType [0..1] « Age | Range | Period | string » An area where general notes can be placed about this specific condition note : Annotation [0..*] Procedure The actual procedure specified. Could be a coded procedure or a less specific string depending on how much is known about the procedure and the capabilities of the creating system code : CodeableConcept [1..1] « null (Strength=Example) ProcedureCodesSNOMEDCT ?? » Indicates what happened following the procedure. If the procedure resulted in death, deceased date is captured on the relation outcome : CodeableConcept [0..1] « null (Strength=Example) SNOMEDCTClinicalFindings ?? » This procedure contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown contributedToDeath : boolean [0..1] Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured performed[x] : DataType [0..1] « Age | Range | Period | string | dateTime » An area where general notes can be placed about this specific procedure note : Annotation [0..*] Indicates who or what participated in the activities related to the family member history and how they were involved participant [0..*] The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition condition [0..*] The significant Procedures (or procedure) that the family member had. This is a repeating section to allow a system to represent more than one procedure per resource, though there is nothing stopping multiple resources - one per procedure procedure [0..*]

XML Template 

<FamilyMemberHistory xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Id(s) for this record --></identifier>
 <status value="[code]"/><!-- 1..1 partial | completed | entered-in-error | health-unknown -->
 <dataAbsentReason><!-- 0..1 CodeableConcept subject-unknown | withheld | unable-to-obtain | deferred --></dataAbsentReason>
 <patient><!-- 1..1 Reference(Patient) Patient history is about --></patient>
 <date value="[dateTime]"/><!-- 0..1 When history was recorded or last updated -->
 <
  <</function>
  <|
    </actor>
 </participant>

 <recorder><!-- 0..1 Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who recorded the family member history --></recorder>

 <asserter><!-- 0..1 Reference(CareTeam|Device|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Person or device that asserts this family member history --></asserter>
 <name value="[string]"/><!-- 0..1 The family member described -->
 <</relationship>

 <relationship><!-- 1..1 CodeableConcept Relationship to the subject icon --></relationship>

 <sex><!-- 0..1 CodeableConcept male | female | other | unknown --></sex>
 <born[x]><!-- I 0..1 Period|date|string (approximate) date of birth --></born[x]>
 <age[x]><!-- I 0..1 Age|Range|string (approximate) age --></age[x]>
 <estimatedAge value="[boolean]"/><!-- I 0..1 Age is estimated? -->
 <deceased[x]><!-- I 0..1 boolean|Age|Range|date|string Dead? How old/when? --></deceased[x]>
 <reason><!-- 0..* CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|DocumentReference|Observation|QuestionnaireResponse) Why was family member history performed? --></reason>
 <note><!-- 0..* Annotation General note about related person --></note>
 <condition>  <!-- 0..* Condition that the related person had -->
  <code><!-- 1..1 CodeableConcept Condition, allergy, or intolerance suffered by relation --></code>
  <outcome><!-- 0..1 CodeableConcept deceased | permanent disability | etc --></outcome>
  <contributedToDeath value="[boolean]"/><!-- 0..1 Whether the condition contributed to the cause of death -->
  <onset[x]><!-- 0..1 Age|Range|Period|string When condition first manifested --></onset[x]>
  <note><!-- 0..* Annotation Extra information about condition --></note>
 </condition>
 <procedure>  <!-- 0..* Procedures that the related person had -->
  <code><!-- 1..1 CodeableConcept Procedures performed on the related person --></code>
  <outcome><!-- 0..1 CodeableConcept What happened following the procedure --></outcome>
  <contributedToDeath value="[boolean]"/><!-- 0..1 Whether the procedure contributed to the cause of death -->
  <performed[x]><!-- 0..1 Age|Range|Period|string|dateTime When the procedure was performed --></performed[x]>
  <note><!-- 0..* Annotation Extra information about the procedure --></note>
 </procedure>
</FamilyMemberHistory>

JSON Template 

{doco
  "resourceType" : "FamilyMemberHistory",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Id(s) for this record
  "status" : "<code>", // R!  partial | completed | entered-in-error | health-unknown
  "dataAbsentReason" : { CodeableConcept }, // subject-unknown | withheld | unable-to-obtain | deferred
  "patient" : { Reference(Patient) }, // R!  Patient history is about
  "date" : "<dateTime>", // When history was recorded or last updated
  "
    "
    "|
    
  }],

  "recorder" : { Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who recorded the family member history

  "asserter" : { Reference(CareTeam|Device|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }, // Person or device that asserts this family member history
  "name" : "<string>", // The family member described
  "

  "relationship" : { CodeableConcept }, // R!  Relationship to the subject icon

  "sex" : { CodeableConcept }, // male | female | other | unknown
  // born[x]: (approximate) date of birth. One of these 3:
  "bornPeriod" : { Period },
  "bornDate" : "<date>",
  "bornString" : "<string>",
  // age[x]: (approximate) age. One of these 3:
  "ageAge" : { Age },
  "ageRange" : { Range },
  "ageString" : "<string>",
  "estimatedAge" : <boolean>, // I Age is estimated?
  // deceased[x]: Dead? How old/when?. One of these 5:
  "deceasedBoolean" : <boolean>,
  "deceasedAge" : { Age },
  "deceasedRange" : { Range },
  "deceasedDate" : "<date>",
  "deceasedString" : "<string>",
  "reason" : [{ CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|DocumentReference|Observation|QuestionnaireResponse) }], // Why was family member history performed?
  "note" : [{ Annotation }], // General note about related person
  "condition" : [{ // Condition that the related person had
    "code" : { CodeableConcept }, // R!  Condition, allergy, or intolerance suffered by relation
    "outcome" : { CodeableConcept }, // deceased | permanent disability | etc
    "contributedToDeath" : <boolean>, // Whether the condition contributed to the cause of death
    // onset[x]: When condition first manifested. One of these 4:
    "onsetAge" : { Age },
    "onsetRange" : { Range },
    "onsetPeriod" : { Period },
    "onsetString" : "<string>",
    "note" : [{ Annotation }] // Extra information about condition
  }],
  "procedure" : [{ // Procedures that the related person had
    "code" : { CodeableConcept }, // R!  Procedures performed on the related person
    "outcome" : { CodeableConcept }, // What happened following the procedure
    "contributedToDeath" : <boolean>, // Whether the procedure contributed to the cause of death
    // performed[x]: When the procedure was performed. One of these 5:
    "performedAge" : { Age },
    "performedRange" : { Range },
    "performedPeriod" : { Period },
    "performedString" : "<string>",
    "performedDateTime" : "<dateTime>",
    "note" : [{ Annotation }] // Extra information about the procedure
  }]
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:FamilyMemberHistory;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
  # from 

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External Id(s) for this record
  fhir:status [ code ] ; # 1..1 partial | completed | entered-in-error | health-unknown
  fhir:dataAbsentReason [ CodeableConcept ] ; # 0..1 subject-unknown | withheld | unable-to-obtain | deferred
  fhir:patient [ Reference(Patient) ] ; # 1..1 Patient history is about
  fhir:date [ dateTime ] ; # 0..1 When history was recorded or last updated
  fhir:
    fhir:
    fhir:|
  
  ] ... ) ;

  fhir:recorder [ Reference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who recorded the family member history
  fhir:asserter [ Reference(CareTeam|Device|Group|Organization|Patient|Practitioner|PractitionerRole|
  RelatedPerson) ] ; # 0..1 Person or device that asserts this family member history
  fhir:name [ string ] ; # 0..1 The family member described
  fhir:relationship [ CodeableConcept ] ; # 1..1 Relationship to the subject
  fhir:sex [ CodeableConcept ] ; # 0..1 male | female | other | unknown
  # born[x] : 0..1 I (approximate) date of birth. One of these 3
    fhir:born [  a fhir:Period ; Period ]
    fhir: ]
    fhir: ]

    fhir:born [  a fhir:Date ; date ]
    fhir:born [  a fhir:String ; string ]

  # age[x] : 0..1 I (approximate) age. One of these 3
    fhir:age [  a fhir:Age ; Age ]
    fhir:age [  a fhir:Range ; Range ]
    fhir: ]

    fhir:age [  a fhir:String ; string ]

  fhir:estimatedAge [ boolean ] ; # 0..1 I Age is estimated?
  # deceased[x] : 0..1 I Dead? How old/when?. One of these 5
    fhir: ]

    fhir:deceased [  a fhir:Boolean ; boolean ]

    fhir:deceased [  a fhir:Age ; Age ]
    fhir:deceased [  a fhir:Range ; Range ]
    fhir: ]
    fhir: ]

    fhir:deceased [  a fhir:Date ; date ]
    fhir:deceased [  a fhir:String ; string ]

  fhir:reason  ( [ CodeableReference(AllergyIntolerance|Condition|DiagnosticReport|DocumentReference|Observation|
  QuestionnaireResponse) ] ... ) ; # 0..* Why was family member history performed?
  fhir:note  ( [ Annotation ] ... ) ; # 0..* General note about related person
  fhir:condition ( [ # 0..* Condition that the related person had
    fhir:code [ CodeableConcept ] ; # 1..1 Condition, allergy, or intolerance suffered by relation
    fhir:outcome [ CodeableConcept ] ; # 0..1 deceased | permanent disability | etc
    fhir:contributedToDeath [ boolean ] ; # 0..1 Whether the condition contributed to the cause of death
    # onset[x] : 0..1 When condition first manifested. One of these 4
      fhir:onset [  a fhir:Age ; Age ]
      fhir:onset [  a fhir:Range ; Range ]
      fhir:onset [  a fhir:Period ; Period ]
      fhir: ]

      fhir:onset [  a fhir:String ; string ]

    fhir:note  ( [ Annotation ] ... ) ; # 0..* Extra information about condition
  ] ... ) ;
  fhir:procedure ( [ # 0..* Procedures that the related person had
    fhir:code [ CodeableConcept ] ; # 1..1 Procedures performed on the related person
    fhir:outcome [ CodeableConcept ] ; # 0..1 What happened following the procedure
    fhir:contributedToDeath [ boolean ] ; # 0..1 Whether the procedure contributed to the cause of death
    # performed[x] : 0..1 When the procedure was performed. One of these 5
      fhir:performed [  a fhir:Age ; Age ]
      fhir:performed [  a fhir:Range ; Range ]
      fhir:performed [  a fhir:Period ; Period ]
      fhir: ]
      fhir: ]

      fhir:performed [  a fhir:String ; string ]
      fhir:performed [  a fhir:DateTime ; dateTime ]

    fhir:note  ( [ Annotation ] ... ) ; # 0..* Extra information about the procedure
  ] ... ) ;
]

Changes from both R4 and R4B

FamilyMemberHistory
FamilyMemberHistory.participant Added Element FamilyMemberHistory.participant.function FamilyMemberHistory.recorder
  • Added Element
FamilyMemberHistory.participant.actor FamilyMemberHistory.asserter
  • Added Mandatory Element
FamilyMemberHistory.sex
FamilyMemberHistory.reason
  • Added Element
FamilyMemberHistory.procedure
  • Added Element
FamilyMemberHistory.procedure.code
  • Added Mandatory Element
FamilyMemberHistory.procedure.outcome
  • Added Element
FamilyMemberHistory.procedure.contributedToDeath
  • Added Element
FamilyMemberHistory.procedure.performed[x]
  • Added Element
FamilyMemberHistory.procedure.note
  • Added Element
FamilyMemberHistory.instantiatesCanonical
  • Deleted
FamilyMemberHistory.instantiatesUri
  • Deleted
FamilyMemberHistory.reasonCode
  • Deleted (-> FamilyMemberHistory.reason)
FamilyMemberHistory.reasonReference
  • Deleted (-> FamilyMemberHistory.reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

Structure

0..* CodeableConcept Type of involvement Binding: Participation Role Type ( Extensible ) actor Σ 1..1 Who
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . FamilyMemberHistory TU DomainResource Information about patient's relatives, relevant for patient
+ Rule: Can have age[x] or born[x], but not both
+ Rule: Can only have estimatedAge if age[x] is present
+ Rule: Can have age[x] or deceased[x], but not both

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External Id(s) for this record

. . . status ?! Σ 1..1 code partial | completed | entered-in-error | health-unknown
Binding: Family History Status ( Required )
. . . dataAbsentReason Σ 0..1 CodeableConcept subject-unknown | withheld | unable-to-obtain | deferred
Binding: Family History Absent Reason ( Example )
. . . date Σ 0..1 dateTime When history was recorded or last updated
. . participant . recorder Σ 0..1 BackboneElement Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Organization | CareTeam | Group ) Who or what participated in the activities related to recorded the family member history and how they were involved
. . function . asserter Σ 0..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam | Device | Group ) Person or what participated in the activities related to the device that asserts this family member history
. . . name Σ 0..1 string The family member described
. . . relationship Σ 1..1 CodeableConcept Relationship to the subject
Binding: FamilyMember icon ( Example )
. . . sex Σ 0..1 CodeableConcept male | female | other | unknown
Binding: AdministrativeGender ( Extensible )
. . . born[x] C 0..1 (approximate) date of birth
. . . . bornPeriod Period
. . . . bornDate date
. . . . bornString string
. . . age[x] Σ C 0..1 (approximate) age
. . . . ageAge Age
. . . . ageRange Range
. . . . ageString string
. . . estimatedAge Σ C 0..1 boolean Age is estimated?
. . . deceased[x] Σ C 0..1 Dead? How old/when?
. . . . deceasedBoolean boolean
. . . . deceasedAge Age
. . . . deceasedRange Range
. . . . deceasedDate date
. . . . deceasedString string
. . . reason Σ 0..* CodeableReference ( Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference ) Why was family member history performed?
Binding: SNOMED CT Clinical Findings ( Example )

. . . note 0..* Annotation General note about related person

. . . condition Σ 0..* BackboneElement Condition that the related person had

. . . . code Σ 1..1 CodeableConcept Condition, allergy, or intolerance suffered by relation
Binding: Condition/Problem/Diagnosis Codes ( Example )
. . . . outcome 0..1 CodeableConcept deceased | permanent disability | etc
Binding: Condition Outcome Codes ( Example )
. . . . contributedToDeath 0..1 boolean Whether the condition contributed to the cause of death
. . . . onset[x] 0..1 When condition first manifested
. . . . . onsetAge Age
. . . . . onsetRange Range
. . . . . onsetPeriod Period
. . . . . onsetString string
. . . . note 0..* Annotation Extra information about condition

. . . procedure 0..* BackboneElement Procedures that the related person had

. . . . code 1..1 CodeableConcept Procedures performed on the related person
Binding: Procedure Codes (SNOMED CT) ( Example )
. . . . outcome 0..1 CodeableConcept What happened following the procedure
Binding: SNOMED CT Clinical Findings ( Example )
. . . . contributedToDeath 0..1 boolean Whether the procedure contributed to the cause of death
. . . . performed[x] 0..1 When the procedure was performed
. . . . . performedAge Age
. . . . . performedRange Range
. . . . . performedPeriod Period
. . . . . performedString string
. . . . . performedDateTime dateTime
. . . . note 0..* Annotation Extra information about the procedure


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

FamilyMemberHistory ( DomainResource ) Business identifiers assigned to this family member history by the performer or other systems which remain constant as the resource is updated and propagates from server to server identifier : Identifier [0..*] A code specifying the status of the record of the family history of a specific family member (this element modifies the meaning of other elements) status : code [1..1] « null (Strength=Required) FamilyHistoryStatus ! » Describes why the family member's history is not available dataAbsentReason : CodeableConcept [0..1] « null (Strength=Example) FamilyHistoryAbsentReason ?? » The person who this history concerns patient : Reference [1..1] « Patient » The date (and possibly time) when the family member history was recorded or last updated date : dateTime [0..1] Individual who recorded the record and takes responsibility for its content recorder : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Organization | CareTeam | Group » Individual or device that is making the family member history statement asserter : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Organization | CareTeam | Device | Group » This will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair" name : string [0..1] The type of relationship this person has to the patient (father, mother, brother etc.) relationship : CodeableConcept [1..1] « null (Strength=Example) FamilyMember ?? » The birth sex of the family member sex : CodeableConcept [0..1] « null (Strength=Extensible) AdministrativeGender + » The actual or approximate date of birth of the relative born[x] : DataType [0..1] « Period | date | string » « This element has or is affected by some invariants C » The age of the relative at the time the family member history is recorded age[x] : DataType [0..1] « Age | Range | string » « This element has or is affected by some invariants C » If true, indicates that the age value specified is an estimated value estimatedAge : boolean [0..1] « This element has or is affected by some invariants C » Deceased flag or the actual or approximate age of the relative at the time of death for the family member history record deceased[x] : DataType [0..1] « boolean | Age | Range | date | string » « This element has or is affected by some invariants C » Describes why the family member history occurred in coded or textual form, or Indicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event reason : CodeableReference [0..*] « Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference ; null (Strength=Example) SNOMEDCTClinicalFindings ?? » This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible note : Annotation [0..*] Participant Distinguishes the type of involvement of the actor in the activities related to the family member history function : CodeableConcept [0..1] « null (Strength=Extensible) ParticipationRoleType + » Indicates who or what participated in the activities related to the family member history actor : Reference [1..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam | Group » Condition The actual condition, allergy, or intolerance specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system code : CodeableConcept [1..1] « null (Strength=Example) ConditionProblemDiagnosisCodes ?? » Indicates what happened following the condition. If the condition resulted in death, deceased date is captured on the relation outcome : CodeableConcept [0..1] « null (Strength=Example) ConditionOutcomeCodes ?? » This condition contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown contributedToDeath : boolean [0..1] Either the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence onset[x] : DataType [0..1] « Age | Range | Period | string » An area where general notes can be placed about this specific condition note : Annotation [0..*] Procedure The actual procedure specified. Could be a coded procedure or a less specific string depending on how much is known about the procedure and the capabilities of the creating system code : CodeableConcept [1..1] « null (Strength=Example) ProcedureCodesSNOMEDCT ?? » Indicates what happened following the procedure. If the procedure resulted in death, deceased date is captured on the relation outcome : CodeableConcept [0..1] « null (Strength=Example) SNOMEDCTClinicalFindings ?? » This procedure contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown contributedToDeath : boolean [0..1] Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured performed[x] : DataType [0..1] « Age | Range | Period | string | dateTime » An area where general notes can be placed about this specific procedure note : Annotation [0..*] Indicates who or what participated in the activities related to the family member history and how they were involved participant [0..*] The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition condition [0..*] The significant Procedures (or procedure) that the family member had. This is a repeating section to allow a system to represent more than one procedure per resource, though there is nothing stopping multiple resources - one per procedure procedure [0..*]

XML Template 

<FamilyMemberHistory xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Id(s) for this record --></identifier>
 <status value="[code]"/><!-- 1..1 partial | completed | entered-in-error | health-unknown -->
 <dataAbsentReason><!-- 0..1 CodeableConcept subject-unknown | withheld | unable-to-obtain | deferred --></dataAbsentReason>
 <patient><!-- 1..1 Reference(Patient) Patient history is about --></patient>
 <date value="[dateTime]"/><!-- 0..1 When history was recorded or last updated -->
 <
  <</function>
  <|
    </actor>
 </participant>

 <recorder><!-- 0..1 Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who recorded the family member history --></recorder>

 <asserter><!-- 0..1 Reference(CareTeam|Device|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Person or device that asserts this family member history --></asserter>
 <name value="[string]"/><!-- 0..1 The family member described -->
 <</relationship>

 <relationship><!-- 1..1 CodeableConcept Relationship to the subject icon --></relationship>

 <sex><!-- 0..1 CodeableConcept male | female | other | unknown --></sex>
 <born[x]><!-- I 0..1 Period|date|string (approximate) date of birth --></born[x]>
 <age[x]><!-- I 0..1 Age|Range|string (approximate) age --></age[x]>
 <estimatedAge value="[boolean]"/><!-- I 0..1 Age is estimated? -->
 <deceased[x]><!-- I 0..1 boolean|Age|Range|date|string Dead? How old/when? --></deceased[x]>
 <reason><!-- 0..* CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|DocumentReference|Observation|QuestionnaireResponse) Why was family member history performed? --></reason>
 <note><!-- 0..* Annotation General note about related person --></note>
 <condition>  <!-- 0..* Condition that the related person had -->
  <code><!-- 1..1 CodeableConcept Condition, allergy, or intolerance suffered by relation --></code>
  <outcome><!-- 0..1 CodeableConcept deceased | permanent disability | etc --></outcome>
  <contributedToDeath value="[boolean]"/><!-- 0..1 Whether the condition contributed to the cause of death -->
  <onset[x]><!-- 0..1 Age|Range|Period|string When condition first manifested --></onset[x]>
  <note><!-- 0..* Annotation Extra information about condition --></note>
 </condition>
 <procedure>  <!-- 0..* Procedures that the related person had -->
  <code><!-- 1..1 CodeableConcept Procedures performed on the related person --></code>
  <outcome><!-- 0..1 CodeableConcept What happened following the procedure --></outcome>
  <contributedToDeath value="[boolean]"/><!-- 0..1 Whether the procedure contributed to the cause of death -->
  <performed[x]><!-- 0..1 Age|Range|Period|string|dateTime When the procedure was performed --></performed[x]>
  <note><!-- 0..* Annotation Extra information about the procedure --></note>
 </procedure>
</FamilyMemberHistory>

JSON Template 

{doco
  "resourceType" : "FamilyMemberHistory",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Id(s) for this record
  "status" : "<code>", // R!  partial | completed | entered-in-error | health-unknown
  "dataAbsentReason" : { CodeableConcept }, // subject-unknown | withheld | unable-to-obtain | deferred
  "patient" : { Reference(Patient) }, // R!  Patient history is about
  "date" : "<dateTime>", // When history was recorded or last updated
  "
    "
    "|
    
  }],

  "recorder" : { Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who recorded the family member history

  "asserter" : { Reference(CareTeam|Device|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }, // Person or device that asserts this family member history
  "name" : "<string>", // The family member described
  "

  "relationship" : { CodeableConcept }, // R!  Relationship to the subject icon

  "sex" : { CodeableConcept }, // male | female | other | unknown
  // born[x]: (approximate) date of birth. One of these 3:
  "bornPeriod" : { Period },
  "bornDate" : "<date>",
  "bornString" : "<string>",
  // age[x]: (approximate) age. One of these 3:
  "ageAge" : { Age },
  "ageRange" : { Range },
  "ageString" : "<string>",
  "estimatedAge" : <boolean>, // I Age is estimated?
  // deceased[x]: Dead? How old/when?. One of these 5:
  "deceasedBoolean" : <boolean>,
  "deceasedAge" : { Age },
  "deceasedRange" : { Range },
  "deceasedDate" : "<date>",
  "deceasedString" : "<string>",
  "reason" : [{ CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|DocumentReference|Observation|QuestionnaireResponse) }], // Why was family member history performed?
  "note" : [{ Annotation }], // General note about related person
  "condition" : [{ // Condition that the related person had
    "code" : { CodeableConcept }, // R!  Condition, allergy, or intolerance suffered by relation
    "outcome" : { CodeableConcept }, // deceased | permanent disability | etc
    "contributedToDeath" : <boolean>, // Whether the condition contributed to the cause of death
    // onset[x]: When condition first manifested. One of these 4:
    "onsetAge" : { Age },
    "onsetRange" : { Range },
    "onsetPeriod" : { Period },
    "onsetString" : "<string>",
    "note" : [{ Annotation }] // Extra information about condition
  }],
  "procedure" : [{ // Procedures that the related person had
    "code" : { CodeableConcept }, // R!  Procedures performed on the related person
    "outcome" : { CodeableConcept }, // What happened following the procedure
    "contributedToDeath" : <boolean>, // Whether the procedure contributed to the cause of death
    // performed[x]: When the procedure was performed. One of these 5:
    "performedAge" : { Age },
    "performedRange" : { Range },
    "performedPeriod" : { Period },
    "performedString" : "<string>",
    "performedDateTime" : "<dateTime>",
    "note" : [{ Annotation }] // Extra information about the procedure
  }]
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:FamilyMemberHistory;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
  # from 

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External Id(s) for this record
  fhir:status [ code ] ; # 1..1 partial | completed | entered-in-error | health-unknown
  fhir:dataAbsentReason [ CodeableConcept ] ; # 0..1 subject-unknown | withheld | unable-to-obtain | deferred
  fhir:patient [ Reference(Patient) ] ; # 1..1 Patient history is about
  fhir:date [ dateTime ] ; # 0..1 When history was recorded or last updated
  fhir:
    fhir:
    fhir:|
  
  ] ... ) ;

  fhir:recorder [ Reference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who recorded the family member history
  fhir:asserter [ Reference(CareTeam|Device|Group|Organization|Patient|Practitioner|PractitionerRole|
  RelatedPerson) ] ; # 0..1 Person or device that asserts this family member history
  fhir:name [ string ] ; # 0..1 The family member described
  fhir:relationship [ CodeableConcept ] ; # 1..1 Relationship to the subject
  fhir:sex [ CodeableConcept ] ; # 0..1 male | female | other | unknown
  # born[x] : 0..1 I (approximate) date of birth. One of these 3
    fhir:born [  a fhir:Period ; Period ]
    fhir: ]
    fhir: ]

    fhir:born [  a fhir:Date ; date ]
    fhir:born [  a fhir:String ; string ]

  # age[x] : 0..1 I (approximate) age. One of these 3
    fhir:age [  a fhir:Age ; Age ]
    fhir:age [  a fhir:Range ; Range ]
    fhir: ]

    fhir:age [  a fhir:String ; string ]

  fhir:estimatedAge [ boolean ] ; # 0..1 I Age is estimated?
  # deceased[x] : 0..1 I Dead? How old/when?. One of these 5
    fhir: ]

    fhir:deceased [  a fhir:Boolean ; boolean ]

    fhir:deceased [  a fhir:Age ; Age ]
    fhir:deceased [  a fhir:Range ; Range ]
    fhir: ]
    fhir: ]

    fhir:deceased [  a fhir:Date ; date ]
    fhir:deceased [  a fhir:String ; string ]

  fhir:reason  ( [ CodeableReference(AllergyIntolerance|Condition|DiagnosticReport|DocumentReference|Observation|
  QuestionnaireResponse) ] ... ) ; # 0..* Why was family member history performed?
  fhir:note  ( [ Annotation ] ... ) ; # 0..* General note about related person
  fhir:condition ( [ # 0..* Condition that the related person had
    fhir:code [ CodeableConcept ] ; # 1..1 Condition, allergy, or intolerance suffered by relation
    fhir:outcome [ CodeableConcept ] ; # 0..1 deceased | permanent disability | etc
    fhir:contributedToDeath [ boolean ] ; # 0..1 Whether the condition contributed to the cause of death
    # onset[x] : 0..1 When condition first manifested. One of these 4
      fhir:onset [  a fhir:Age ; Age ]
      fhir:onset [  a fhir:Range ; Range ]
      fhir:onset [  a fhir:Period ; Period ]
      fhir: ]

      fhir:onset [  a fhir:String ; string ]

    fhir:note  ( [ Annotation ] ... ) ; # 0..* Extra information about condition
  ] ... ) ;
  fhir:procedure ( [ # 0..* Procedures that the related person had
    fhir:code [ CodeableConcept ] ; # 1..1 Procedures performed on the related person
    fhir:outcome [ CodeableConcept ] ; # 0..1 What happened following the procedure
    fhir:contributedToDeath [ boolean ] ; # 0..1 Whether the procedure contributed to the cause of death
    # performed[x] : 0..1 When the procedure was performed. One of these 5
      fhir:performed [  a fhir:Age ; Age ]
      fhir:performed [  a fhir:Range ; Range ]
      fhir:performed [  a fhir:Period ; Period ]
      fhir: ]
      fhir: ]

      fhir:performed [  a fhir:String ; string ]
      fhir:performed [  a fhir:DateTime ; dateTime ]

    fhir:note  ( [ Annotation ] ... ) ; # 0..* Extra information about the procedure
  ] ... ) ;
]

Changes from both R4 and R4B

FamilyMemberHistory
FamilyMemberHistory.participant Added Element FamilyMemberHistory.participant.function FamilyMemberHistory.recorder
  • Added Element
FamilyMemberHistory.participant.actor FamilyMemberHistory.asserter
  • Added Mandatory Element
FamilyMemberHistory.sex
FamilyMemberHistory.reason
  • Added Element
FamilyMemberHistory.procedure
  • Added Element
FamilyMemberHistory.procedure.code
  • Added Mandatory Element
FamilyMemberHistory.procedure.outcome
  • Added Element
FamilyMemberHistory.procedure.contributedToDeath
  • Added Element
FamilyMemberHistory.procedure.performed[x]
  • Added Element
FamilyMemberHistory.procedure.note
  • Added Element
FamilyMemberHistory.instantiatesCanonical
  • Deleted
FamilyMemberHistory.instantiatesUri
  • Deleted
FamilyMemberHistory.reasonCode
  • Deleted (-> FamilyMemberHistory.reason)
FamilyMemberHistory.reasonReference
  • Deleted (-> FamilyMemberHistory.reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

 

Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

9.4.3.1 Terminology Bindings

FamilyMemberHistory.participant.function ParticipationRoleType Extensible This FHIR value set is comprised of Actor participation Type codes, which can be used to value FHIR agents, actors, and other role elements. The codes are intended to express how the agent participated in some activity. Sometimes refered to the agent functional-role relative to the activity.
Path ValueSet Type Documentation
FamilyMemberHistory.status FamilyHistoryStatus Required

A code that identifies the status of the family history record.

FamilyMemberHistory.dataAbsentReason FamilyHistoryAbsentReason Example

Codes describing the reason why a family member's history is not available.

FamilyMemberHistory.relationship FamilyMember icon Example

A relationship between two people characterizing their "familial" relationship

FamilyMemberHistory.sex AdministrativeGender Extensible

The gender of a person used for administrative purposes.

FamilyMemberHistory.reason SNOMEDCTClinicalFindings Example

This value set includes all the "Clinical finding" SNOMED CT icon codes - concepts where concept is-a 404684003 (Clinical finding (finding)).

FamilyMemberHistory.condition.code ConditionProblemDiagnosisCodes Example

Example value set for Condition/Problem/Diagnosis codes.

FamilyMemberHistory.condition.outcome ConditionOutcomeCodes Example

Example value set for condition outcomes.

FamilyMemberHistory.procedure.code ProcedureCodesSNOMEDCT Example

Procedure Code: All SNOMED CT procedure codes.

FamilyMemberHistory.procedure.outcome SNOMEDCTClinicalFindings Example

This value set includes all the "Clinical finding" SNOMED CT icon codes - concepts where concept is-a 404684003 (Clinical finding (finding)).

9.4.3.2 Constraints

UniqueKey Level Location Description Expression
img  fhs-1 Rule (base) Can have age[x] or born[x], but not both age.empty() or born.empty()
img  fhs-2 Rule (base) Can only have estimatedAge if age[x] is present age.exists() or estimatedAge.empty()
img  fhs-3 Rule (base) Can have age[x] or deceased[x], but not both age.empty() or deceased.empty()

9.4.3.3 Processing information about the Family Member History

The Family Member History List may contain other than FamilyMemberHistory resources. For example, a full Family History could be a List that might include a mixture of FamilyMemberHistory records as well as Observation records of things like "maternal family history of breast cancer", "number of siblings", "number of female family members with breast cancer" etc.

The List representing a patient's "family history" can include Condition and Observation records that capture "family-history" relevant assertions about the patient themselves that would typically be captured as part of a family history.

9.4.3.4 No Known Patient History, No Known Problems, and Negated Conditions

Not Reviewed, Not Asked

When a sending system does not have family history about any family members or the statement is about family history not yet being asked, then the List resource should be used to indicate the List.emptyReason="notasked".

Reviewed, None Identified for Family

After reasonable investigation that there are no known items for the family member history list, then the List resource should be used to indicate the List.emptyReason="nilknown". The List.emptyReason represents a statement about the full scope of the list (i.e. the patient or patient's agent/guardian has asserted that there are no conditions or significant events for any family members to record).

Reviewed, No Information Available for a Family Member

When an individual family member's history is not available, FamilyMemberHistory.dataAbsentReason can be used to indicate why that family member's history is not available (e.g. subject unknown).

Reviewed, No Known Problems or Negated Condition for a Family Member

The FamilyMemberHistory.condition.code can be used to capture "No Known Problems" or negated conditions, such as "No history of malignant tumor of breast", for an individual family member.

9.4.4 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource , and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
code token A search by a condition code FamilyMemberHistory.condition.code 21 19 Resources
date date When history was recorded or last updated FamilyMemberHistory.date 25 23 Resources
identifier token A search by a record identifier FamilyMemberHistory.identifier 64 59 Resources
patient reference The identity of a subject to list family member history items for FamilyMemberHistory.patient
( Patient ) 		64 61 Resources
relationship token A search by a relationship type FamilyMemberHistory.relationship
sex token A search by a sex code of a family member FamilyMemberHistory.sex
status token partial | completed | entered-in-error | health-unknown FamilyMemberHistory.status