HRSA 2023 Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+) FHIR IG
1.1.0 - STU1 Release 1.1 - Standard for Trial-Use International flag

This page is part of the HRSA Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+ or uds-plus) FHIR IG (v1.1.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: US Core Patient Example - JSON Representation

Page standards status: Informative

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{
  "resourceType" : "Patient",
  "id" : "example",
  "meta" : {
    "extension" : [
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/instance-name",
        "valueString" : "Patient Example"
      },
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/instance-description",
        "valueMarkdown" : "This is a patient example for the *US Core Patient Profile*."
      }
    ],
    "profile" : [
      🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Amy V. Baxter </b> female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (USUAL))</p></div>"
  },
  "extension" : [
    {
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2106-3",
            "display" : "White"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1002-5",
            "display" : "American Indian or Alaska Native"
          }
        },
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2028-9",
            "display" : "Asian"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "1586-7",
            "display" : "Shoshone"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2036-2",
            "display" : "Filipino"
          }
        },
        {
          "url" : "text",
          "valueString" : "Mixed"
        }
      ],
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
    },
    {
      "extension" : [
        {
          "url" : "ombCategory",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2135-2",
            "display" : "Hispanic or Latino"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2184-0",
            "display" : "Dominican"
          }
        },
        {
          "url" : "detailed",
          "valueCoding" : {
            "system" : "urn:oid:2.16.840.1.113883.6.238",
            "code" : "2148-5",
            "display" : "Mexican"
          }
        },
        {
          "url" : "text",
          "valueString" : "Hispanic or Latino"
        }
      ],
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
      "valueCode" : "F"
    },
    {
      "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
            "code" : "ASKU",
            "display" : "asked but unknown"
          }
        ],
        "text" : "asked but unknown"
      }
    }
  ],
  "identifier" : [
    {
      "use" : "usual",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MR",
            "display" : "Medical Record Number"
          }
        ],
        "text" : "Medical Record Number"
      },
      "system" : "http://hospital.smarthealthit.org",
      "value" : "1032702"
    }
  ],
  "active" : true,
  "name" : [
    {
      "use" : "old",
      "family" : "Shaw",
      "given" : [
        "Amy",
        "V."
      ],
      "period" : {
        "start" : "2016-12-06",
        "end" : "2020-07-22"
      }
    },
    {
      "family" : "Baxter",
      "given" : [
        "Amy",
        "V."
      ],
      "suffix" : [
        "PharmD"
      ],
      "period" : {
        "start" : "2020-07-22"
      }
    }
  ],
  "telecom" : [
    {
      "system" : "phone",
      "value" : "555-555-5555",
      "use" : "home"
    },
    {
      "system" : "email",
      "value" : "amy.shaw@example.com"
    }
  ],
  "gender" : "female",
  "birthDate" : "1987-02-20",
  "address" : [
    {
      "use" : "old",
      "line" : [
        "49 Meadow St"
      ],
      "city" : "Alstead",
      "state" : "NH",
      "postalCode" : "03602",
      "country" : "US",
      "period" : {
        "start" : "2016-12-06",
        "end" : "2020-07-22"
      }
    },
    {
      "line" : [
        "183 Mountain View St"
      ],
      "city" : "Alstead",
      "state" : "NH",
      "postalCode" : "03602",
      "country" : "US",
      "period" : {
        "start" : "2020-07-22"
      }
    }
  ]
}