DSTU2

This page is part of the FHIR Specification (v0.0.82: (v1.0.2: DSTU 1). 2). 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

5.1.8 5.1.11 Resource Patient - Formal Definitions Detailed Descriptions

Formal definitions Detailed Descriptions for the elements in the Patient resource.

Summary true Patient.active Definition Whether this patient record is in active use. 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. Summary true Comments Default is true. If a record is inactive, and linked to an active record, then future patient/person/record updates should occur on the other patient.
Patient
Definition

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

Control 1..1
Requirements

Tracking patient is the center of the healthcare process.

Alternate Names SubjectOfCare Client Resident
Patient.identifier
Definition

An identifier that applies to for this person as a patient.

Note This is a business identifer, not a resource identifier (see discussion )
Control 0..*
Type Identifier
Requirements

Patients are almost always assigned specific numerical identifiers.

Summary true
Patient.name Patient.active
Definition

Whether this patient record is in active use.

Control 0..1
Type boolean
Is Modifier true
Default Value true
Requirements

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

Summary true
Comments

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

Patient.name
Definition

A name associated with the individual.

Control 0..*
Type HumanName
Requirements

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

Summary true
Comments Person

A patient may have multiple names with different uses or applicable periods.For periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

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 Contact ContactPoint
Requirements

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

Summary true
Comments Person

A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address may not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

Patient.gender
Definition

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

Control 0..1
Binding AdministrativeGender: ( See http://hl7.org/fhir/vs/administrative-gender The gender of a person used for administrative purposes. ( Required )
Type CodeableConcept code
Requirements

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

Summary true
Comments

The gender may 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 M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, 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, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error.

Patient.birthDate
Definition

The date and time of birth for the individual.

Control 0..1
Type dateTime date
Requirements

Age of the individual drives many clinical processes. Next to the common use case of capturing someone birth date, also in some common cases time is registered.

Summary true
Comments

At least an estimated year should be provided as a guess if the real dob DOB is unknown. unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternaty/infant care systems).

LOINC Code 21112-8
Patient.deceased[x]
Definition

Indicates if the individual is deceased or not.

Control 0..1
Type 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.

Summary true
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.

Patient.address
Definition

Addresses for the individual.

Control 0..*
Type Address
Requirements

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

Summary true
Comments Person

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

Patient.maritalStatus
Definition

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

Control 0..1
Binding MaritalStatus: ( Marital Status Codes: See http://hl7.org/fhir/vs/marital-status The domestic partnership status of a person. ( Required )
Type CodeableConcept
Requirements

Most, if not all systems capture it.

Summary true Patient.multipleBirth[x]
Definition

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

Control 0..1
Type 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.

Summary true Patient.photo
Definition

Image of the person. 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.

Patient.contact
Definition

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

Control 0..*
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
Inv-1 pat-1 : SHALL at least contain a contact's details or a reference to an organization (xpath: f:name or f:telecom or f:address or f:organization)
Patient.contact.relationship
Definition

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

Control 0..*
Binding ContactRelationship: ( PatientContactRelationship: See http://hl7.org/fhir/vs/patient-contact-relationship The nature of the relationship between a patient and a contact person for that patient. ( Extensible )
Type CodeableConcept
Requirements

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

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.

Patient.contact.telecom
Definition

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

Control 0..*
Type Contact ContactPoint
Requirements

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

Comments Person

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.

Patient.contact.address
Definition

Address for the contact person.

Control 0..1
Type Address
Requirements

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

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 AdministrativeGender: ( See http://hl7.org/fhir/vs/administrative-gender The gender of a person used for administrative purposes. ( Required )
Type CodeableConcept code
Requirements

Needed to address the person correctly.

Patient.contact.organization
Definition

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

Control 0..1
Type Resource Reference ( Organization )
Requirements

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

Invariants Affect this element
Inv-1 pat-1 : SHALL at least contain a contact's details or a reference to an organization (xpath: f:name or f:telecom or f:address or f:organization)
Patient.animal 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
Patient.animal
Definition

This element has a value if the patient is known to be an animal.

Control 0..1
Is Modifier true
Requirements

Many clinical systems are extended to care for animal patients as well as human.

Summary true
Comments

The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject non-human patient declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

Patient.animal.species
Definition

Identifies the high level taxonomic categorization of the kind of animal.

Control 1..1
Binding AnimalSpecies: ( See http://hl7.org/fhir/vs/animal-species The species of an animal. ( Example )
Type CodeableConcept
Requirements

Need to know what kind of animal.

Summary true
Comments

If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).

Patient.animal.breed
Definition

Identifies the detailed categorization of the kind of animal.

Control 0..1
Binding AnimalBreed: ( AnimalBreeds: See http://hl7.org/fhir/vs/animal-breeds The breed of an animal. ( Example )
Type CodeableConcept
Requirements

May need to know the specific kind within the species.

Summary true
Comments

Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.

Patient.animal.genderStatus
Definition

Indicates the current state of the animal's reproductive organs.

Control 0..1
Binding AnimalGenderStatus: ( GenderStatus: See http://hl7.org/fhir/vs/animal-genderstatus The state of the animal's reproductive organs. ( Example )
Type CodeableConcept
Requirements

Gender status can affect housing and animal behavior.

Summary true
Patient.communication
Definition

Languages which may be used to communicate with the patient about his or her health.

Control 0..*
Binding Language: see IETF language tag Type CodeableConcept Requirements

If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.

Comments

If no language is specified, this *implies* 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.

Patient.careProvider 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 Language : Required : IETF language tag (A human language.)
Type CodeableConcept
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.

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
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.

Patient.careProvider
Definition

Patient's nominated care provider.

Control 0..*
Type Resource Reference ( Organization | Practitioner )
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles.

This is not to be used to record Care Teams, these should be recorded on either the CarePlan or EpisodeOfCare resources.

To Do Need to rationalize this with circleOfCare from CarePlan.
Patient.managingOrganization
Definition

Organization that is the custodian of the patient record.

Control 0..1
Type Resource Reference ( Organization )
Requirements

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

Summary true
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).

Patient.link
Definition

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

Control 0..*
Is Modifier true
Requirements

There are multiple usecases: *

  • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers. Summary true
Comments

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

Patient.link.other
Definition

The other patient resource that the link refers to.

Control 1..1
Type Resource Reference ( Patient )
Is Modifier true
Summary true Patient.link.type
Definition

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

Control 1..1
Binding LinkType: The type of link between this patient resource and another patient resource. (see http://hl7.org/fhir/link-type for values) ( Required )
Type code
Is Modifier true
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