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 in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: DeIdentifiedUDSPlusPatient - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 2

Definitions for the de-identified-uds-plus-patient resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Patient
Definition

The UDS+ profile is based on the **FHIR Patient resource and establishes the core elements, extensions, vocabularies and value sets for representing patients for UDS+ program.

ShortDe-Identified UDS Plus Patient
2. Patient.id
Definition

De-dentified patient identifier.

ShortThe de-identified patient identifier created by the health center to send data to HRSA.
Must Supporttrue
4. Patient.text
ShortCannot include any text in the resource as part of the de-identified data.
Control0..0
Must Supportfalse
6. Patient.contained
ShortCannot include any contained resources in the resource as part of the de-identified data.
Control0..0
Must Supportfalse
8. Patient.extension:uds-plus-race
Slice Nameuds-plus-race
Control1..1
TypeExtension(UDS Plus Race Extension) (Complex Extension)
Must Supporttrue
10. Patient.extension:uds-plus-ethnicty
Slice Nameuds-plus-ethnicty
Control1..1
TypeExtension(UDS Plus Ethnicity Extension) (Complex Extension)
Must Supporttrue
12. Patient.extension:uds-plus-birthsex
Slice Nameuds-plus-birthsex
Control1..1
TypeExtension(UDS Plus Birth Sex Extension) (Extension Type: code)
Must Supporttrue
14. Patient.extension:uds-plus-age-extension
Slice Nameuds-plus-age-extension
ShortAge of the Patient computed using birthDate and the reporting period reference
Control1..1
TypeExtension(UDS Plus Age Extension) (Extension Type: Quantity)
Must Supporttrue
16. Patient.extension:uds-plus-gender-identity-extension
Slice Nameuds-plus-gender-identity-extension
ShortGender Identity of the pateient
Control0..1
TypeExtension(UDS Plus Gender Identity Extension) (Extension Type: CodeableConcept)
Must Supporttrue
18. Patient.extension:uds-plus-agriculture-worker-status
Slice Nameuds-plus-agriculture-worker-status
ShortAgriculture Status of the patient
Control0..1
TypeExtension(UDS Plus Agriculture Worker Status Extension) (Extension Type: code)
Must Supporttrue
20. Patient.extension:uds-plus-housing-status
Slice Nameuds-plus-housing-status
ShortHousing Status of the patient
Control0..1
TypeExtension(UDS Plus Housing Status Extension) (Extension Type: code)
Must Supporttrue
22. Patient.extension:uds-plus-veteran-status
Slice Nameuds-plus-veteran-status
ShortVeteran Status of the patient
Control0..1
TypeExtension(UDS Plus Veteran Status Extension) (Extension Type: boolean)
Must Supporttrue
24. Patient.identifier
ShortCannot include any identifier in the resource as part of the de-identified data.
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..0
Must Supportfalse
26. Patient.name
ShortCannot include any name in the resource as part of the de-identified data.
Control0..0
Must Supportfalse
28. Patient.telecom
ShortCannot include any telecom information in the resource as part of the de-identified data.
Control0..0
Must Supportfalse
30. Patient.birthDate
ShortCannot include any date of birth information in the resource as part of the de-identified data.
Control0..0
Must Supportfalse
LOINC Code
32. Patient.deceased[x]
ShortIndicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only.
Control0..1
TypeChoice of: dateTime, boolean
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Must Support TypesChoice of: dateTime, boolean
Invariantsuds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. ($this is dateTime implies $this.toString().length() = 4)
34. Patient.address
ShortIncluded only to support zip code
Control1..1
Must Supporttrue
36. Patient.address.text
ShortText cannot be included in the profile
Control0..0
Must Supportfalse
38. Patient.address.line
ShortStreet names cannot be included in the profile
Control0..0
Must Supportfalse
40. Patient.address.postalCode
ShortZipCode must be included in the profile
Control1..1
Must Supporttrue
Invariantsuds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. ($this.matches('[0-9]{3}00|00000'))
42. Patient.address.postalCode.extension:dataAbsentReason
Slice NamedataAbsentReason
ShortReason why the data is not present
Control0..1
TypeExtension(Data Absent Reason) (Extension Type: code)
Must Supporttrue
44. Patient.address.postalCode.extension:dataAbsentReason.value[x]
Control1..?
Typecode
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
46. Patient.maritalStatus
ShortCannot include information not required for UDS+
Control0..0
Must Supportfalse
48. Patient.multipleBirth[x]
ShortCannot include information not required for UDS+
Control0..0
Must Supportfalse
50. Patient.photo
ShortCannot include information not required for UDS+
Control0..0
Must Supportfalse
52. Patient.contact
ShortCannot include information not required for UDS+
Control0..0
Must Supportfalse
54. Patient.communication
56. Patient.communication.language
ShortLanguage must be included in the profile
Control1..1
BindingUnless not suitable, these codes SHALL be taken from Language codes with language and optionally a region modifier
(extensible to http://hl7.org/fhir/us/core/ValueSet/simple-language)

The set of languages that the patient uses

Must Supporttrue
58. Patient.generalPractitioner
ShortCannot include information not required for UDS+
Control0..0
Must Supportfalse
60. Patient.managingOrganization
ShortCannot include information not required for UDS+
Control0..0
Must Supportfalse
62. Patient.link
ShortCannot include information not required for UDS+
Control0..0
Must Supportfalse

Guidance on how to interpret the contents of this table can be found here

0. Patient
Definition

The UDS+ profile is based on the **FHIR Patient resource and establishes the core elements, extensions, vocabularies and value sets for representing patients for UDS+ program.


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

ShortDe-Identified UDS Plus PatientInformation about an individual or animal receiving health care services
Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesSubjectOfCare Client Resident
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Patient.id
Definition

De-dentified patient identifier.


The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortThe de-identified patient identifier created by the health center to send data to HRSA.Logical id of this artifact
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.

Control0..1
Typeidstring
Is Modifierfalse
Must Supporttrue
Summarytrue
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.

ShortA set of rules under which this content was created
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.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-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.

ShortCannot include any text in the resource as part of the de-identified data.Text summary of the resource, for human interpretation
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.

Control0..01
TypeNarrative
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. 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.

ShortCannot include any contained resources in the resource as part of the de-identified data.Contained, inline 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.

Control0..0*
TypeResource
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
10. Patient.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. 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.

ShortExtensionAdditional content defined by implementations
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.

Control40..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-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())
SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 12. Patient.extension:uds-plus-race
    Slice Nameuds-plus-race
    Definition

    Indicates the race of the Patient

    ShortIndicates the race of the Patient.
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Race Extension) (Complex Extension)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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:uds-plus-ethnicty
    Slice Nameuds-plus-ethnicty
    Definition

    Indicates the ethnicity of the Patient

    ShortIndicates the ethnicity of the Patient.
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Ethnicity Extension) (Complex Extension)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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.extension:uds-plus-birthsex
    Slice Nameuds-plus-birthsex
    Definition

    Indicates the birth sex of the Patient

    ShortIndicates the birth sex of the Patient.
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Birth Sex Extension) (Extension Type: code)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. Patient.extension:uds-plus-age-extension
    Slice Nameuds-plus-age-extension
    Definition

    Indicates the age of the Patient computed based on date of birth at a specific time

    ShortAge of the Patient computed using birthDate and the reporting period reference
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Age Extension) (Extension Type: Quantity)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    20. Patient.extension:uds-plus-gender-identity-extension
    Slice Nameuds-plus-gender-identity-extension
    Definition

    Indicates the gender identity of the Patient at a specific time

    ShortGender Identity of the pateient
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Gender Identity Extension) (Extension Type: CodeableConcept)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    22. Patient.extension:uds-plus-agriculture-worker-status
    Slice Nameuds-plus-agriculture-worker-status
    Definition

    Indicates the agriculture worker status of the patient.

    ShortAgriculture Status of the patient
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Agriculture Worker Status Extension) (Extension Type: code)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    24. Patient.extension:uds-plus-housing-status
    Slice Nameuds-plus-housing-status
    Definition

    Indicates the housing status of the Patient at a specific time

    ShortHousing Status of the patient
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Housing Status Extension) (Extension Type: code)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    26. Patient.extension:uds-plus-veteran-status
    Slice Nameuds-plus-veteran-status
    Definition

    Indicates the Veteran status of the Patient, populate with true when the patient is a veteran

    ShortVeteran Status of the patient
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus Veteran Status Extension) (Extension Type: boolean)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    28. 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).

    ShortExtensions that cannot be ignored
    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.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    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 Namesextensions, user content
    Invariantsele-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())
    30. Patient.identifier
    Definition

    An identifier for this patient.

    ShortCannot include any identifier in the resource as part of the de-identified data.An identifier for this patient
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..0*
    TypeIdentifier
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Patients are almost always assigned specific numerical identifiers.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. 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.

    ShortWhether this patient's record is in active use
    Comments

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

    Control0..1
    Typeboolean
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

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

    Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. Patient.name
    Definition

    A name associated with the individual.

    ShortCannot include any name in the resource as part of the de-identified data.A name associated with the patient
    Comments

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

    Control0..0*
    TypeHumanName
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    36. Patient.telecom
    Definition

    A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

    ShortCannot include any telecom information in the resource as part of the de-identified data.A contact detail for the individual
    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).

    Control0..0*
    TypeContactPoint
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    38. Patient.birthDate
    Definition

    The date of birth for the individual.

    ShortCannot include any date of birth information in the resource as part of the de-identified data.The date of birth for the individual
    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).

    Control0..01
    Typedate
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Age of the individual drives many clinical processes.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    LOINC Code21112-8
    40. Patient.deceased[x]
    Definition

    Indicates if the individual is deceased or not.

    ShortIndicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only.Indicates if the individual is deceased or not
    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.

    Control0..1
    TypeChoice of: dateTime, boolean
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Must Support TypesChoice of: dateTime, boolean
    Summarytrue
    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.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. ($this is dateTime implies $this.toString().length() = 4)
    42. Patient.address
    Definition

    An address for the individual.

    ShortIncluded only to support zip codeAn address for the individual
    Comments

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

    Control10..1*
    TypeAddress
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. Patient.address.use
    Definition

    The purpose of this address.

    Shorthome | work | temp | old | billing - purpose of this address
    Comments

    Applications can assume that an address is current unless it explicitly says that it is temporary or old.

    Control0..1
    BindingThe codes SHALL be taken from AddressUsehttp://hl7.org/fhir/ValueSet/address-use|4.0.1
    (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

    The use of an address.

    Typecode
    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Allows an appropriate address to be chosen from a list of many.

    Example<br/><b>General</b>:home
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    46. Patient.address.text
    Definition

    Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

    ShortText cannot be included in the profileText representation of the address
    Comments

    Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

    Control0..01
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    A renderable, unencoded form.

    Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. Patient.address.line
    Definition

    This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

    ShortStreet names cannot be included in the profileStreet name, number, direction & P.O. Box etc.
    Control0..0*
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Example<br/><b>General</b>:137 Nowhere Street
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. Patient.address.postalCode
    Definition

    A postal code designating a region defined by the postal service.

    ShortZipCode must be included in the profilePostal code for area
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Alternate NamesZip
    Example<br/><b>General</b>:9132
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. ($this.matches('[0-9]{3}00|00000'))
    52. Patient.address.postalCode.extension:dataAbsentReason
    Slice NamedataAbsentReason
    Definition

    Provides a reason why the expected value or elements in the element that is extended are missing.

    ShortReason why the data is not present
    Control0..1
    TypeExtension(Data Absent Reason) (Extension Type: code)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-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())
    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())
    54. Patient.address.postalCode.extension:dataAbsentReason.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional content defined by implementations
    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.

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-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())
    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())
    SlicingThis element introduces a set of slices on Patient.address.postalCode.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 56. Patient.address.postalCode.extension:dataAbsentReason.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/StructureDefinition/data-absent-reason
      58. Patient.address.postalCode.extension:dataAbsentReason.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      This element is affected by the following invariants: ext-1
      BindingThe codes SHALL be taken from For codes, see DataAbsentReason
      (required to http://hl7.org/fhir/ValueSet/data-absent-reason)
      Typecode, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. Patient.maritalStatus
      Definition

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

      ShortCannot include information not required for UDS+Marital (civil) status of a patient
      Control0..01
      BindingUnless not suitable, these codes SHALL be taken from Marital Status Codeshttp://hl7.org/fhir/ValueSet/marital-status
      (extensible to http://hl7.org/fhir/ValueSet/marital-status)

      The domestic partnership status of a person.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      Most, if not all systems capture it.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      62. Patient.multipleBirth[x]
      Definition

      Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

      ShortCannot include information not required for UDS+Whether patient is part of a multiple birth
      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).

      Control0..01
      TypeChoice of: boolean, integer
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Requirements

      For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. Patient.photo
      Definition

      Image of the patient.

      ShortCannot include information not required for UDS+Image of the patient
      Comments

      Guidelines:

      • Use id photos, not clinical photos.
      • Limit dimensions to thumbnail.
      • Keep byte count low to ease resource updates.
      Control0..0*
      TypeAttachment
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. Patient.contact
      Definition

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

      ShortCannot include information not required for UDS+A contact party (e.g. guardian, partner, friend) for 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.

      Control0..0*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      Need to track people you can contact about the patient.

      Invariantsele-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())
      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())
      69. Patient.communication
      Definition

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

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

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      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.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      71. 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).

      ShortExtensions that cannot be ignored even if unrecognized
      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      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 Namesextensions, user content, modifiers
      Invariantsele-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())
      73. 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.

      ShortLanguage must be included in the profileThe language which can be used to communicate with the patient about his or her health
      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.

      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from The codes SHOULD be taken from Language codes with language and optionally a region modifierhttp://hl7.org/fhir/ValueSet/languages
      (extensible to http://hl7.org/fhir/us/core/ValueSet/simple-language)

      The set of languages that the patient uses


      A human language.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      75. Patient.generalPractitioner
      Definition

      Patient's nominated care provider.

      ShortCannot include information not required for UDS+Patient's nominated primary care provider
      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.

      Control0..0*
      TypeReference(Organization, Practitioner, PractitionerRole)
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate NamescareProvider
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      77. Patient.managingOrganization
      Definition

      Organization that is the custodian of the patient record.

      ShortCannot include information not required for UDS+Organization that is the custodian of the patient record
      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).

      Control0..01
      TypeReference(Organization)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      79. Patient.link
      Definition

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

      ShortCannot include information not required for UDS+Link to another patient resource that concerns the same actual person
      Comments

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

      Control0..0*
      TypeBackboneElement
      Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
      Must Supportfalse
      Summarytrue
      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.
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. Patient
      Definition

      The UDS+ profile is based on the **FHIR Patient resource and establishes the core elements, extensions, vocabularies and value sets for representing patients for UDS+ program.

      ShortDe-Identified UDS Plus Patient
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Alternate NamesSubjectOfCare Client Resident
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. Patient.id
      Definition

      De-dentified patient identifier.

      ShortThe de-identified patient identifier created by the health center to send data to HRSA.
      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.

      Control0..1
      Typeid
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      4. 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.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. 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.

      ShortA set of rules under which this content was created
      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.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. Patient.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      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).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. 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.

      ShortCannot include any text in the resource as part of the de-identified data.
      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.

      Control0..0
      TypeNarrative
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. 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.

      ShortCannot include any contained resources in the resource as part of the de-identified data.
      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.

      Control0..0
      TypeResource
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. Patient.extension
      Definition

      An Extension

      ShortExtension
      Control4..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      SlicingThis element introduces a set of slices on Patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Patient.extension:uds-plus-race
        Slice Nameuds-plus-race
        Definition

        Indicates the race of the Patient

        ShortIndicates the race of the Patient.
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Race Extension) (Complex Extension)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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())
        18. Patient.extension:uds-plus-ethnicty
        Slice Nameuds-plus-ethnicty
        Definition

        Indicates the ethnicity of the Patient

        ShortIndicates the ethnicity of the Patient.
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Ethnicity Extension) (Complex Extension)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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())
        20. Patient.extension:uds-plus-birthsex
        Slice Nameuds-plus-birthsex
        Definition

        Indicates the birth sex of the Patient

        ShortIndicates the birth sex of the Patient.
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Birth Sex Extension) (Extension Type: code)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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())
        22. Patient.extension:uds-plus-age-extension
        Slice Nameuds-plus-age-extension
        Definition

        Indicates the age of the Patient computed based on date of birth at a specific time

        ShortAge of the Patient computed using birthDate and the reporting period reference
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Age Extension) (Extension Type: Quantity)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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())
        24. Patient.extension:uds-plus-gender-identity-extension
        Slice Nameuds-plus-gender-identity-extension
        Definition

        Indicates the gender identity of the Patient at a specific time

        ShortGender Identity of the pateient
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Gender Identity Extension) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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())
        26. Patient.extension:uds-plus-agriculture-worker-status
        Slice Nameuds-plus-agriculture-worker-status
        Definition

        Indicates the agriculture worker status of the patient.

        ShortAgriculture Status of the patient
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Agriculture Worker Status Extension) (Extension Type: code)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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.extension:uds-plus-housing-status
        Slice Nameuds-plus-housing-status
        Definition

        Indicates the housing status of the Patient at a specific time

        ShortHousing Status of the patient
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Housing Status Extension) (Extension Type: code)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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())
        30. Patient.extension:uds-plus-veteran-status
        Slice Nameuds-plus-veteran-status
        Definition

        Indicates the Veteran status of the Patient, populate with true when the patient is a veteran

        ShortVeteran Status of the patient
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(UDS Plus Veteran Status Extension) (Extension Type: boolean)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-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())
        32. 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).

        ShortExtensions that cannot be ignored
        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        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 Namesextensions, user content
        Invariantsele-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())
        34. Patient.identifier
        Definition

        An identifier for this patient.

        ShortCannot include any identifier in the resource as part of the de-identified data.
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..0
        TypeIdentifier
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Patients are almost always assigned specific numerical identifiers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. 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.

        ShortWhether this patient's record is in active use
        Comments

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

        Control0..1
        Typeboolean
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

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

        Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Patient.name
        Definition

        A name associated with the individual.

        ShortCannot include any name in the resource as part of the de-identified data.
        Comments

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

        Control0..0
        TypeHumanName
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Patient.telecom
        Definition

        A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

        ShortCannot include any telecom information in the resource as part of the de-identified data.
        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).

        Control0..0
        TypeContactPoint
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Patient.gender
        Definition

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

        Shortmale | female | other | unknown
        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.

        Control0..1
        BindingThe codes SHALL be taken from AdministrativeGender
        (required to http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1)

        The gender of a person used for administrative purposes.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Needed for identification of the individual, in combination with (at least) name and birth date.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Patient.birthDate
        Definition

        The date of birth for the individual.

        ShortCannot include any date of birth information in the resource as part of the de-identified data.
        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).

        Control0..0
        Typedate
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Age of the individual drives many clinical processes.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        LOINC Code21112-8
        46. Patient.deceased[x]
        Definition

        Indicates if the individual is deceased or not.

        ShortIndicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only.
        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.

        Control0..1
        TypeChoice of: dateTime, boolean
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifiertrue because This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Must Support TypesChoice of: dateTime, boolean
        Summarytrue
        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.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. ($this is dateTime implies $this.toString().length() = 4)
        48. Patient.address
        Definition

        An address for the individual.

        ShortIncluded only to support zip code
        Comments

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

        Control1..1
        TypeAddress
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Patient.address.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        52. Patient.address.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.

        ShortAdditional content defined by implementations
        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-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())
        SlicingThis element introduces a set of slices on Patient.address.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 54. Patient.address.use
          Definition

          The purpose of this address.

          Shorthome | work | temp | old | billing - purpose of this address
          Comments

          Applications can assume that an address is current unless it explicitly says that it is temporary or old.

          Control0..1
          BindingThe codes SHALL be taken from AddressUse
          (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

          The use of an address.

          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Allows an appropriate address to be chosen from a list of many.

          Example<br/><b>General</b>:home
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. Patient.address.type
          Definition

          Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

          Shortpostal | physical | both
          Comments

          The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

          Control0..1
          BindingThe codes SHALL be taken from AddressType
          (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1)

          The type of an address (physical / postal).

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Example<br/><b>General</b>:both
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. Patient.address.text
          Definition

          Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

          ShortText cannot be included in the profile
          Comments

          Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

          Control0..0
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Requirements

          A renderable, unencoded form.

          Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. Patient.address.line
          Definition

          This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

          ShortStreet names cannot be included in the profile
          Control0..0
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Example<br/><b>General</b>:137 Nowhere Street
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          62. Patient.address.city
          Definition

          The name of the city, town, suburb, village or other community or delivery center.

          ShortName of city, town etc.
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Alternate NamesMunicpality
          Example<br/><b>General</b>:Erewhon
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          64. Patient.address.district
          Definition

          The name of the administrative area (county).

          ShortDistrict name (aka county)
          Comments

          District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Alternate NamesCounty
          Example<br/><b>General</b>:Madison
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          66. Patient.address.state
          Definition

          Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

          ShortSub-unit of country (abbreviations ok)
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Alternate NamesProvince, Territory
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. Patient.address.postalCode
          Definition

          A postal code designating a region defined by the postal service.

          ShortZipCode must be included in the profile
          Control1..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Alternate NamesZip
          Example<br/><b>General</b>:9132
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          uds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. ($this.matches('[0-9]{3}00|00000'))
          70. Patient.address.postalCode.id
          Definition

          unique id for the element within a resource (for internal references)

          Shortxml:id (or equivalent in JSON)
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          72. Patient.address.postalCode.extension
          Definition

          An Extension

          ShortExtension
          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-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())
          SlicingThis element introduces a set of slices on Patient.address.postalCode.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 74. Patient.address.postalCode.extension:dataAbsentReason
            Slice NamedataAbsentReason
            Definition

            Provides a reason why the expected value or elements in the element that is extended are missing.

            ShortReason why the data is not present
            Control0..1
            TypeExtension(Data Absent Reason) (Extension Type: code)
            Is Modifierfalse
            Must Supporttrue
            Invariantsele-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())
            76. Patient.address.postalCode.extension:dataAbsentReason.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            This element is affected by the following invariants: ele-1
            Typeid
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            78. Patient.address.postalCode.extension:dataAbsentReason.extension
            Definition

            An Extension

            ShortExtension
            Control0..0
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-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())
            SlicingThis element introduces a set of slices on Patient.address.postalCode.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 80. Patient.address.postalCode.extension:dataAbsentReason.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Shortidentifies the meaning of the extension
              Comments

              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

              Control1..1
              Typeuri
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Fixed Valuehttp://hl7.org/fhir/StructureDefinition/data-absent-reason
              82. Patient.address.postalCode.extension:dataAbsentReason.value[x]
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              ShortValue of extension
              Control1..1
              This element is affected by the following invariants: ext-1
              BindingThe codes SHALL be taken from DataAbsentReason
              (required to http://hl7.org/fhir/ValueSet/data-absent-reason)
              Typecode
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              84. Patient.address.postalCode.value
              Definition

              The actual value

              ShortPrimitive value for string
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Max Length:1048576
              86. Patient.address.country
              Definition

              Country - a nation as commonly understood or generally accepted.

              ShortCountry (e.g. can be ISO 3166 2 or 3 letter code)
              Comments

              ISO 3166 3 letter codes can be used in place of a human readable country name.

              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              88. Patient.address.period
              Definition

              Time period when address was/is in use.

              ShortTime period when address was/is in use
              Control0..1
              TypePeriod
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows addresses to be placed in historical context.

              Example<br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              90. Patient.maritalStatus
              Definition

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

              ShortCannot include information not required for UDS+
              Control0..0
              BindingUnless not suitable, these codes SHALL be taken from Marital Status Codes
              (extensible to http://hl7.org/fhir/ValueSet/marital-status)

              The domestic partnership status of a person.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Most, if not all systems capture it.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              92. Patient.multipleBirth[x]
              Definition

              Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

              ShortCannot include information not required for UDS+
              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).

              Control0..0
              TypeChoice of: boolean, integer
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Requirements

              For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              94. Patient.photo
              Definition

              Image of the patient.

              ShortCannot include information not required for UDS+
              Comments

              Guidelines:

              • Use id photos, not clinical photos.
              • Limit dimensions to thumbnail.
              • Keep byte count low to ease resource updates.
              Control0..0
              TypeAttachment
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              96. Patient.contact
              Definition

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

              ShortCannot include information not required for UDS+
              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.

              Control0..0
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Need to track people you can contact about the patient.

              Invariantsele-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())
              108. Patient.communication
              Definition

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

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

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              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.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              110. 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.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              112. 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.

              ShortAdditional content defined by implementations
              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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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())
              114. 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).

              ShortExtensions that cannot be ignored even if unrecognized
              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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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 Namesextensions, user content, modifiers
              Invariantsele-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())
              116. 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.

              ShortLanguage must be included in the profile
              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.

              Control1..1
              BindingUnless not suitable, these codes SHALL be taken from Language codes with language and optionally a region modifier
              (extensible to http://hl7.org/fhir/us/core/ValueSet/simple-language)

              The set of languages that the patient uses

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              118. Patient.communication.preferred
              Definition

              Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

              ShortLanguage preference indicator
              Comments

              This language is specifically identified for communicating healthcare information.

              Control0..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              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.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              120. Patient.generalPractitioner
              Definition

              Patient's nominated care provider.

              ShortCannot include information not required for UDS+
              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.

              Control0..0
              TypeReference(Organization, Practitioner, PractitionerRole)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Alternate NamescareProvider
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              122. Patient.managingOrganization
              Definition

              Organization that is the custodian of the patient record.

              ShortCannot include information not required for UDS+
              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).

              Control0..0
              TypeReference(Organization)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              124. Patient.link
              Definition

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

              ShortCannot include information not required for UDS+
              Comments

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

              Control0..0
              TypeBackboneElement
              Is Modifiertrue because This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
              Must Supportfalse
              Summarytrue
              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.
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))