HRSA 2024 Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+) FHIR IG
2.0.0 - STU2 Release 1 - Standard for Trial-Use

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## Resource Profile: De-Identified UDS Plus Patient

Official URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/de-identified-uds-plus-patient | Version: 2.0.0
Standards status: Trial-use | Maturity Level: 2 | Computable Name: DeIdentifiedUDSPlusPatient

This Patient profile represents a Patient availing HRSA services.

### Introduction

This profile is used to represent de-identified patient information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance the following data elements have to be removed or de-identified

- Patient Name

- Address that is more specific than a state

  - First 3 digits of Zipcodes can be included if the population of all zipcodes starting with the same 3 digits are > 20000 people and the last 2 digits should be masked with "00", in all other cases, the zipcodes have to be masked to 00000.
- All dates should not have a precision of more than the year. This means month and day cannot be included.
- Demographics including birthdate, deceased indicator
- Patient contact details such as telephone numbers, fax, email, URLs,
- Patient personal identifiers such as SSN, Drivers License,
- Business identifiers such as MRNs, certificate numbers, Account numbers
- Biometrics such as fingerprints, photos

In FHIR Resources, text elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Patient resource text element may contain information such as the full name and Date of Birth. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Age Computation

The Data Submitter has to compute the age based as of December 31st of the previous year for inclusion in the UDS+ report.

Id Generation

The original patient resource id should not be included in the De-identified patient instance. Instead a new id should be created and provided as part of the FHIR resource. This Data Submitter should be capable of using the generated id to relink the data to the original patient. All resource references to the Patient submitted as part of the UDS+ report should refer to newly generated de-identified id.

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

- deceased[x] when the data type used is dateTime.

Usage of Data Absent Reason Extension

For the UDS+ reporting, the patient data is de-identified and in the process zip codes may be masked to a value of "00000". In these cases the dataAbsentReason extension must be added to identify that the data is "masked". If the zip code is not known, a value of "00000" must be sent with a dataAbsentReason of "unknown". If the zip code is outside the country, a value of "00000" must be sent with a dataAbsentReason of "unsupported".

Race and Ethnicity Additional Constraints

US Core allows Race and Ethnicity to be described as only text or rolled up to the OMB categories, however for UDS+ reporting detailed race and ethnicity have to be captured and reported as part of the profile. If the reported race and ethncity values are not null flavors then detailed values are mandatory.

Birth Sex vs Sex

Healthcenters are enouraged to use the uds-plus-sex-extension to capture the sex of the patient. This is in alignment with the CMS Sex codes and the UDS Manual. However, this change was implemented recently and in order to allow Healthcenters and their vendors who have already tested the 2024 reporting changes the uds-plus-birthsex-extension can be used to convey sex in the patient profile. The uds-plus-birthsex-extension is also enhanced to allow the SNOMED sex codes in addition to the HL7 AdministrativeGender codes that were previously allowed. The cardinality is relaxed from 1..1 to 0..1 but one of either uds-plus-sex or uds-plus-birthsex-extension should be present.

Birth Sex/Sex Null Flavors

NullFlavors are allowed to be sent for this reporting cycle even though they are not in the valueset. The NullFlavor support will be removed in future versions of the IG.

Examples Examples of identifiable data and its corresponding de-identifiable data is present in Reporting Guidance.

Usage:

- Refer to this Resource Profile: De-Identified UDS Plus Income, De-Identified UDS Plus RelatedPerson, De-Identified UDS Plus AdverseEvent, De-Identified UDS Plus AllergyIntolerance... Show 10 more, De-Identified UDS Plus Clinical Result Observation, De-Identified UDS Plus Coverage, De-Identified UDS Plus Diagnosis, De-Identified UDS Plus Encounter, De-Identified UDS Plus Immunization, De-Identified UDS Plus MedicationRequest, De-Identified UDS Plus MedicationStatement, De-Identified UDS Plus Observation, De-Identified UDS Plus Procedure and De-Identified UDS Plus ServiceRequest
- Examples for this Resource Profile: Patient/de-identified-age89-example, Patient/de-identified-example and Patient/de-identified-smallpop-example

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | De-Identified UDS Plus Patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
id | S Σ | 0..1 | id | The de-identified patient identifier created by the health center to send data to HRSA.
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension |  | 3..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-race | S | 1..1 | (Complex) | Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-ethnicty | S | 1..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-birthsex | S | 0..1 | code | Indicates the Birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Sex Codes (extensible): The set of codes to be used for UDS+ reporting. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension Binding: CMS Sex (extensible): The set of sex codes to be used for UDS+ reporting. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-age-extension | S | 1..1 | Quantity | Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-agriculture-worker-status | S | 0..1 | code | Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-housing-status | S | 0..1 | code | Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-veteran-status | S | 0..1 | boolean | Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use ele-1: All FHIR elements must have a @value or children
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. ele-1: All FHIR elements must have a @value or children uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 uds-plus-pat-1b: All dateTime data elements should have valid year < 2030
deceasedDateTime |  |  | dateTime |
deceasedBoolean |  |  | boolean |
address | S Σ | 1..1 | Address | Included only to support zip code ele-1: All FHIR elements must have a @value or children
extension |  | 0..0 |  |
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. ele-1: All FHIR elements must have a @value or children Example General: home
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile ele-1: All FHIR elements must have a @value or children 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. If the extended ZipCode format is used the resulting format should be #####-####. Example General: 9132
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing. ele-1: All FHIR elements must have a @value or children
period | Σ | 0..1 | Period | Address period cannot be included in the profile ele-1: All FHIR elements must have a @value or children Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses ele-1: All FHIR elements must have a @value or children
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Patient.address.use | required | AddressUse `http://hl7.org/fhir/ValueSet/address-use|4.0.1` from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x] | required | DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1` from the FHIR Standard
Patient.communication.language | extensible | LanguageCodesWithLanguageAndOptionallyARegionModifier `http://hl7.org/fhir/us/core/ValueSet/simple-language`
Patient.link.type | required | LinkType `http://hl7.org/fhir/ValueSet/link-type|4.0.1` from the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Patient | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
uds-plus-pat-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4 |
uds-plus-pat-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 : $this is dateTime implies $this.toString() >= '1900' |
uds-plus-pat-1b | error | Patient.deceased[x] | All dateTime data elements should have valid year < 2030 : $this is dateTime implies $this.toString() <= '2030' |
uds-plus-patient-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. : $this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$') |

This structure is derived from Patient

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | De-Identified UDS Plus Patient
id | S | 0..1 | id | The de-identified patient identifier created by the health center to send data to HRSA.
text |  | 0..0 |  |
contained |  | 0..0 |  |
Slices for extension |  |  |  | Content/Rules for all slices
extension:uds-plus-race | S | 1..1 | (Complex) | Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
extension:uds-plus-ethnicty | S | 1..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
extension:uds-plus-birthsex | S | 0..1 | code | Indicates the Birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Sex Codes (extensible): The set of codes to be used for UDS+ reporting.
extension:uds-plus-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension Binding: CMS Sex (extensible): The set of sex codes to be used for UDS+ reporting.
extension:uds-plus-age-extension | S | 1..1 | Quantity | Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
extension:uds-plus-agriculture-worker-status | S | 0..1 | code | Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
extension:uds-plus-housing-status | S | 0..1 | code | Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
extension:uds-plus-veteran-status | S | 0..1 | boolean | Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
identifier |  | 0..0 |  |
name |  | 0..0 |  |
telecom |  | 0..0 |  |
birthDate |  | 0..0 |  |
deceased[x] | S C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 uds-plus-pat-1b: All dateTime data elements should have valid year < 2030
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S | 1..1 | Address | Included only to support zip code
extension |  | 0..0 |  |
text |  | 0..0 |  |
line |  | 0..0 |  |
postalCode | S C | 1..1 | string | ZipCode must be included in the profile 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. If the extended ZipCode format is used the resulting format should be #####-####.
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x] | S | 1..1 | code | Value of extension
period |  | 0..1 | Period | Address period cannot be included in the profile
maritalStatus |  | 0..0 |  |
multipleBirth[x] |  | 0..0 |  |
photo |  | 0..0 |  |
contact |  | 0..0 |  |
communication |  |  |  |
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
generalPractitioner |  | 0..0 |  |
managingOrganization |  | 0..0 |  |
link |  | 0..0 |  |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
Patient.communication.language | extensible | LanguageCodesWithLanguageAndOptionallyARegionModifier `http://hl7.org/fhir/us/core/ValueSet/simple-language`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
uds-plus-pat-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4 |
uds-plus-pat-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 : $this is dateTime implies $this.toString() >= '1900' |
uds-plus-pat-1b | error | Patient.deceased[x] | All dateTime data elements should have valid year < 2030 : $this is dateTime implies $this.toString() <= '2030' |
uds-plus-patient-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. : $this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$') |

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | De-Identified UDS Plus Patient
id | S Σ | 0..1 | id | The de-identified patient identifier created by the health center to send data to HRSA.
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  | 3..* | Extension | Extension Slice: Unordered, Open by value:url
extension:uds-plus-race | S | 1..1 | (Complex) | Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
extension:uds-plus-ethnicty | S | 1..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
extension:uds-plus-birthsex | S | 0..1 | code | Indicates the Birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Sex Codes (extensible): The set of codes to be used for UDS+ reporting.
extension:uds-plus-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension Binding: CMS Sex (extensible): The set of sex codes to be used for UDS+ reporting.
extension:uds-plus-age-extension | S | 1..1 | Quantity | Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
extension:uds-plus-agriculture-worker-status | S | 0..1 | code | Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
extension:uds-plus-housing-status | S | 0..1 | code | Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
extension:uds-plus-veteran-status | S | 0..1 | boolean | Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use
gender | Σ | 0..1 | code | male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 uds-plus-pat-1b: All dateTime data elements should have valid year < 2030
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S Σ | 1..1 | Address | Included only to support zip code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile 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. If the extended ZipCode format is used the resulting format should be #####-####. Example General: 9132
id |  | 0..1 | string | xml:id (or equivalent in JSON)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
value |  | 0..1 | string | Primitive value for string Max Length:1048576
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code)
period | Σ | 0..1 | Period | Address period cannot be included in the profile Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
preferred |  | 0..1 | boolean | Language preference indicator
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Patient.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` from the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Patient.gender | required | AdministrativeGender `http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1` from the FHIR Standard
Patient.address.use | required | AddressUse `http://hl7.org/fhir/ValueSet/address-use|4.0.1` from the FHIR Standard
Patient.address.type | required | AddressType `http://hl7.org/fhir/ValueSet/address-type|4.0.1` from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x] | required | DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1` from the FHIR Standard
Patient.contact.relationship | extensible | PatientContactRelationship `http://hl7.org/fhir/ValueSet/patient-contactrelationship` from the FHIR Standard
Patient.contact.gender | required | AdministrativeGender `http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1` from the FHIR Standard
Patient.communication.language | extensible | LanguageCodesWithLanguageAndOptionallyARegionModifier `http://hl7.org/fhir/us/core/ValueSet/simple-language`
Patient.link.type | required | LinkType `http://hl7.org/fhir/ValueSet/link-type|4.0.1` from the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Patient | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
uds-plus-pat-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4 |
uds-plus-pat-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 : $this is dateTime implies $this.toString() >= '1900' |
uds-plus-pat-1b | error | Patient.deceased[x] | All dateTime data elements should have valid year < 2030 : $this is dateTime implies $this.toString() <= '2030' |
uds-plus-patient-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. : $this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$') |

This structure is derived from Patient

Summary

Mandatory: 5 elements(2 nested mandatory elements)
Must-Support: 15 elements
Prohibited: 16 elements

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|4.0.1

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | De-Identified UDS Plus Patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
id | S Σ | 0..1 | id | The de-identified patient identifier created by the health center to send data to HRSA.
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension |  | 3..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-race | S | 1..1 | (Complex) | Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-ethnicty | S | 1..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-birthsex | S | 0..1 | code | Indicates the Birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Sex Codes (extensible): The set of codes to be used for UDS+ reporting. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension Binding: CMS Sex (extensible): The set of sex codes to be used for UDS+ reporting. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-age-extension | S | 1..1 | Quantity | Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-agriculture-worker-status | S | 0..1 | code | Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-housing-status | S | 0..1 | code | Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:uds-plus-veteran-status | S | 0..1 | boolean | Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use ele-1: All FHIR elements must have a @value or children
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. ele-1: All FHIR elements must have a @value or children uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 uds-plus-pat-1b: All dateTime data elements should have valid year < 2030
deceasedDateTime |  |  | dateTime |
deceasedBoolean |  |  | boolean |
address | S Σ | 1..1 | Address | Included only to support zip code ele-1: All FHIR elements must have a @value or children
extension |  | 0..0 |  |
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. ele-1: All FHIR elements must have a @value or children Example General: home
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile ele-1: All FHIR elements must have a @value or children 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. If the extended ZipCode format is used the resulting format should be #####-####. Example General: 9132
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing. ele-1: All FHIR elements must have a @value or children
period | Σ | 0..1 | Period | Address period cannot be included in the profile ele-1: All FHIR elements must have a @value or children Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses ele-1: All FHIR elements must have a @value or children
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Patient.address.use | required | AddressUse `http://hl7.org/fhir/ValueSet/address-use|4.0.1` from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x] | required | DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1` from the FHIR Standard
Patient.communication.language | extensible | LanguageCodesWithLanguageAndOptionallyARegionModifier `http://hl7.org/fhir/us/core/ValueSet/simple-language`
Patient.link.type | required | LinkType `http://hl7.org/fhir/ValueSet/link-type|4.0.1` from the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Patient | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
uds-plus-pat-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4 |
uds-plus-pat-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 : $this is dateTime implies $this.toString() >= '1900' |
uds-plus-pat-1b | error | Patient.deceased[x] | All dateTime data elements should have valid year < 2030 : $this is dateTime implies $this.toString() <= '2030' |
uds-plus-patient-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. : $this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$') |

Differential View

This structure is derived from Patient

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | De-Identified UDS Plus Patient
id | S | 0..1 | id | The de-identified patient identifier created by the health center to send data to HRSA.
text |  | 0..0 |  |
contained |  | 0..0 |  |
Slices for extension |  |  |  | Content/Rules for all slices
extension:uds-plus-race | S | 1..1 | (Complex) | Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
extension:uds-plus-ethnicty | S | 1..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
extension:uds-plus-birthsex | S | 0..1 | code | Indicates the Birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Sex Codes (extensible): The set of codes to be used for UDS+ reporting.
extension:uds-plus-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension Binding: CMS Sex (extensible): The set of sex codes to be used for UDS+ reporting.
extension:uds-plus-age-extension | S | 1..1 | Quantity | Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
extension:uds-plus-agriculture-worker-status | S | 0..1 | code | Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
extension:uds-plus-housing-status | S | 0..1 | code | Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
extension:uds-plus-veteran-status | S | 0..1 | boolean | Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
identifier |  | 0..0 |  |
name |  | 0..0 |  |
telecom |  | 0..0 |  |
birthDate |  | 0..0 |  |
deceased[x] | S C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 uds-plus-pat-1b: All dateTime data elements should have valid year < 2030
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S | 1..1 | Address | Included only to support zip code
extension |  | 0..0 |  |
text |  | 0..0 |  |
line |  | 0..0 |  |
postalCode | S C | 1..1 | string | ZipCode must be included in the profile 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. If the extended ZipCode format is used the resulting format should be #####-####.
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x] | S | 1..1 | code | Value of extension
period |  | 0..1 | Period | Address period cannot be included in the profile
maritalStatus |  | 0..0 |  |
multipleBirth[x] |  | 0..0 |  |
photo |  | 0..0 |  |
contact |  | 0..0 |  |
communication |  |  |  |
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
generalPractitioner |  | 0..0 |  |
managingOrganization |  | 0..0 |  |
link |  | 0..0 |  |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
Patient.communication.language | extensible | LanguageCodesWithLanguageAndOptionallyARegionModifier `http://hl7.org/fhir/us/core/ValueSet/simple-language`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
uds-plus-pat-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4 |
uds-plus-pat-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 : $this is dateTime implies $this.toString() >= '1900' |
uds-plus-pat-1b | error | Patient.deceased[x] | All dateTime data elements should have valid year < 2030 : $this is dateTime implies $this.toString() <= '2030' |
uds-plus-patient-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. : $this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$') |

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Patient |  | 0..* | Patient | De-Identified UDS Plus Patient
id | S Σ | 0..1 | id | The de-identified patient identifier created by the health center to send data to HRSA.
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  | 3..* | Extension | Extension Slice: Unordered, Open by value:url
extension:uds-plus-race | S | 1..1 | (Complex) | Indicates the race of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
extension:uds-plus-ethnicty | S | 1..1 | (Complex) | Indicates the ethnicity of the Patient. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity profiled by http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
extension:uds-plus-birthsex | S | 0..1 | code | Indicates the Birth sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension Binding: Uds Plus Sex Codes (extensible): The set of codes to be used for UDS+ reporting.
extension:uds-plus-sex | S | 0..1 | code | Indicates the sex of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension Binding: CMS Sex (extensible): The set of sex codes to be used for UDS+ reporting.
extension:uds-plus-age-extension | S | 1..1 | Quantity | Age of the Patient computed using birthDate and the reporting period reference URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
extension:uds-plus-agriculture-worker-status | S | 0..1 | code | Agriculture Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status Binding: Uds Plus Agriculture Worker Status Codes (extensible)
extension:uds-plus-housing-status | S | 0..1 | code | Housing Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension Binding: Uds Plus Housing Status Codes (extensible)
extension:uds-plus-veteran-status | S | 0..1 | boolean | Veteran Status of the patient URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
active | ?!Σ | 0..1 | boolean | Whether this patient's record is in active use
gender | Σ | 0..1 | code | male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
deceased[x] | ?!S Σ C | 0..1 |  | Indicates if the Patient is deceased, it can be either a Boolean or a Date with a precision of year only. uds-plus-pat-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 uds-plus-pat-1b: All dateTime data elements should have valid year < 2030
deceasedDateTime |  |  | dateTime S |
deceasedBoolean |  |  | boolean S |
address | S Σ | 1..1 | Address | Included only to support zip code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | S Σ C | 1..1 | string | ZipCode must be included in the profile 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. If the extended ZipCode format is used the resulting format should be #####-####. Example General: 9132
id |  | 0..1 | string | xml:id (or equivalent in JSON)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason | S | 0..1 | (Complex) | Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] | S | 1..1 | code | Value of extension Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
value |  | 0..1 | string | Primitive value for string Max Length:1048576
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code)
period | Σ | 0..1 | Period | Address period cannot be included in the profile Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication |  | 0..* | BackboneElement | A language which may be used to communicate with the patient about his or her health
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
language | S | 1..1 | CodeableConcept | Language must be included in the profile Binding: Language codes with language and optionally a region modifier (extensible): The set of languages that the patient uses
preferred |  | 0..1 | boolean | Language preference indicator
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Patient.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` from the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Patient.gender | required | AdministrativeGender `http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1` from the FHIR Standard
Patient.address.use | required | AddressUse `http://hl7.org/fhir/ValueSet/address-use|4.0.1` from the FHIR Standard
Patient.address.type | required | AddressType `http://hl7.org/fhir/ValueSet/address-type|4.0.1` from the FHIR Standard
Patient.address.postalCode.extension:dataAbsentReason.value[x] | required | DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1` from the FHIR Standard
Patient.contact.relationship | extensible | PatientContactRelationship `http://hl7.org/fhir/ValueSet/patient-contactrelationship` from the FHIR Standard
Patient.contact.gender | required | AdministrativeGender `http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1` from the FHIR Standard
Patient.communication.language | extensible | LanguageCodesWithLanguageAndOptionallyARegionModifier `http://hl7.org/fhir/us/core/ValueSet/simple-language`
Patient.link.type | required | LinkType `http://hl7.org/fhir/ValueSet/link-type|4.0.1` from the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Patient | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Patient | 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 | error | Patient | 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 | error | Patient | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Patient | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
uds-plus-pat-1 | error | Patient.deceased[x] | All dateTime data elements should be truncated to a year only for de-identified resources. : $this is dateTime implies $this.toString().length() = 4 |
uds-plus-pat-1a | error | Patient.deceased[x] | All dateTime data elements should have valid year > 1900 : $this is dateTime implies $this.toString() >= '1900' |
uds-plus-pat-1b | error | Patient.deceased[x] | All dateTime data elements should have valid year < 2030 : $this is dateTime implies $this.toString() <= '2030' |
uds-plus-patient-1 | error | Patient.address.postalCode | De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. : $this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$') |

This structure is derived from Patient

Summary

Mandatory: 5 elements(2 nested mandatory elements)
Must-Support: 15 elements
Prohibited: 16 elements

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-race-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-ethnicity-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-birthsex-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-sex-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-age-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/udsplus-agriculture-worker-status
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-housing-status-extension
- http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-veteran-status-extension
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|4.0.1

Maturity: 2

Other representations of profile: CSV, Excel, Schematron