This page is part of the FHIR Specification (v0.0.82: DSTU 1). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

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5.1 Resource Patient - Content

Demographics and other administrative information about a person or animal receiving care or other health-related services.

5.1.2 Resource Content

This resource is referenced by AdverseReaction , Alert , AllergyIntolerance , CarePlan , Composition , Condition , Device , DeviceObservationReport , DiagnosticOrder , DiagnosticReport , DocumentManifest , DocumentReference , Encounter , FamilyHistory , Group , ImagingStudy , Immunization , ImmunizationRecommendation , List , Media , MedicationAdministration , MedicationDispense , MedicationPrescription , MedicationStatement , Observation , Order , Other , Procedure , Questionnaire , RelatedPerson , SecurityEvent , Specimen and Supply

<Patient xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: extension, modifierExtension, language, text, and contained -->
 <identifier><!-- 0..* Identifier An identifier for the person as this patient § --></identifier>
 <name><!-- 0..* HumanName A name associated with the patient § --></name>
 <telecom><!-- 0..* Contact A contact detail for the individual § --></telecom>
 <gender><!-- 0..1 CodeableConcept Gender for administrative purposes § --></gender>
 <birthDate value="[dateTime]"/><!-- 0..1 The date and time of birth for the individual § -->
 <deceased[x]><!-- 0..1 boolean|dateTime Indicates if the individual is deceased or not § --></deceased[x]>
 <address><!-- 0..* Address Addresses for the individual § --></address>
 <maritalStatus><!-- 0..1 CodeableConcept Marital (civil) status of a person § --></maritalStatus>
 <multipleBirth[x]><!-- 0..1 boolean|integer 
     Whether patient is part of a multiple birth § --></multipleBirth[x]>
 <photo><!-- 0..* Attachment Image of the person --></photo>
 <contact>  <!-- 0..* A contact party (e.g. guardian, partner, friend) for the patient -->
  <relationship><!-- 0..* CodeableConcept The kind of relationship --></relationship>
  <name><!-- 0..1 HumanName A name associated with the person --></name>
  <telecom><!-- 0..* Contact A contact detail for the person --></telecom>
  <address><!-- 0..1 Address Address for the contact person --></address>
  <gender><!-- 0..1 CodeableConcept Gender for administrative purposes --></gender>
  <organization><!--  0..1 Resource(Organization) 
      Organization that is associated with the contact --></organization>
 </contact>
 <animal>  <!-- 0..1 If this patient is an animal (non-human) § -->
  <species><!-- 1..1 CodeableConcept E.g. Dog, Cow § --></species>
  <breed><!-- 0..1 CodeableConcept E.g. Poodle, Angus § --></breed>
  <genderStatus><!-- 0..1 CodeableConcept E.g. Neutered, Intact § --></genderStatus>
 </animal>
 <communication><!-- 0..* CodeableConcept Languages which may be used to communicate with the patient about his or her health --></communication>
 <careProvider><!-- 0..* Resource(Organization|Practitioner) 
     Patient's nominated care provider --></careProvider>
 <managingOrganization><!-- 0..1 Resource(Organization) 
     Organization that is the custodian of the patient record § --></managingOrganization>
 <link>  <!-- 0..* Link to another patient resource that concerns the same actual person § -->
  <other><!-- 1..1 Resource(Patient) The other patient resource that the link refers to § --></other>
  <type value="[code]"/><!-- 1..1 replace | refer | seealso - type of link § -->
 </link>
 <active value="[boolean]"/><!-- 0..1 Whether this patient's record is in active use § -->
</Patient>

Alternate definitions: Schema / Schematron , Resource Profile

5.1.2.1 Terminology Bindings

5.1.2.2 Constraints

• Inv-1 : On Patient.contact: SHALL at least contain a contact's details or a reference to an organization (xpath on f:Patient/f:contact: f:name or f:telecom or f:address or f:organization )

Notes:

• multipleBirth can be either expressed as a boolean (just indicating whether the patient is part of a multiple birth) or as an integer, indicating the actual birth order.
• Patient records may only be in one of two statuses: in use (active=true) and not in use (active=false). A normal record is active, i.e. it is in use. Active is set to 'false' when a record is created as a duplicate or in error. A record does not need to be linked to be inactivated.
• The link element is used to assert that two or more Patient resources are both about the same actual person. See below for further discussion
• There should be only one preferred language (Language.preference = true) per mode of expression.
• The Contact for a Patient has an element organization , this is for use with guardians or business related contacts where just the organization is relevant.

5.1.3 Patient id's and Patient resource id's

A Patient record's Resource Id can never change. For this reason the identifiers with which humans are concerned (often called MRN - Medical Record Number, or UR - Unit Record) should not be used for the resource's id, since MRN's may change, i.e. as a result of having duplicate records of the same person. Instead they should be represented in the Patient.identifier list where they can be managed. This is also useful for the case of institutions that have acquired multiple numbers because of mergers of patient record systems over time.

5.1.4 Linking Patients

The link element is used to assert that patient resources refer to the same person. This element is used to support three distinct scenario's where multiple records of the same person exist:

5.1.4.1 Duplicate Patient records

Managing Patient registration is a well known difficult problem. Around 2% of registrations are in error, mostly duplicate records. Sometimes the duplicate record is caught fairly quickly and retired before much data is accumulated. In other cases, substantial amounts of data may accumulate. By using a link of type 'replace', the record containing such a link is marked as a duplicate and the link points forward to a record that should be used instead. Note that the record pointed to may in its turn have been identified as created in error and forward to yet another Patient resource. Records that replace another record, do not point back to the replaced record.

5.1.4.2 Patient record in a Patient index

A Patient record may be present in a system that acts as a Patient Index: it maintains a (summary of) patient data and a list of one or more servers that it are known to hold a more comprehensive and/or authorative record of the same patient. The link type 'refer' is used denote such a link. Note that linked records may contain contradictory information. The record referred to does not point back to the referring record.

5.1.4.3 Distributed Patient record

In a distributed architecture, multiple systems keep separate patient records concerning the same person. These records are not considered duplicates, but contain a distributed, potentially overlapping view of the patient's data. Each such record may have its own focus or maintaining organization and there need not be a sense of one record being more complete or more authorative than another. In such cases, links of type 'seealso' can be used to point to other patient records. It is not a requirement that such links are bilateral.

5.1.5 Merging records

This specification does not specify merge functionality: if multiple patient records are found to be duplicates, they can be linked together, as described above. These links merely express the relationship between records, and in the case of a replacement link, indicate a "master" record. This specification does not mandate that FHIR servers migrate information between such records on finding such a link. Note:

• Health information administrators may call the process "merging", but it is often implemented as "linking" at the record level
• Servers are allowed to implement merging/record migration even though it is not mandated.

5.1.6 Search Parameters

Search parameters for this resource. The standard parameters also apply. See Searching for more information about searching in REST, messaging, and services.