HRSA 2024 Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+) FHIR IG
2.0.0 - STU2 Release 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 (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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.


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.

Control30..*
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.
    Control0..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-sex
    Slice Nameuds-plus-sex
    Definition

    Indicates the sex of the Patient

    ShortIndicates the sex of the Patient.
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(UDS Plus 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())
    20. 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())
    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 $this.toString().length() = 4)
    uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 ($this is dateTime implies $this.toString() >= '1900')
    uds-plus-pat-1b: All dateTime data elements should have valid year < 2030 ($this is dateTime implies $this.toString() <= '2030')
    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.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.

    ShortExtension cannot be included in AddressAdditional 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
    Must Supportfalse
    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
    • 46. 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()))
      48. 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()))
      50. 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()))
      52. 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. If the extended ZipCode format is used the resulting format should be #####-####. ($this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$'))
      54. 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
      This element is affected by the following invariants: ele-1
      TypeExtension(Why value is missing) (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())
      56. 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())
      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
      • 58. 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
        60. 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
        BindingThe codes SHALL be taken from For codes, see DataAbsentReason
        (required to http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1)

        Used to specify why the normally expected content of the data element is missing.

        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()))
        62. Patient.address.period
        Definition

        Time period when address was/is in use.

        ShortAddress period cannot be included in the profileTime period when address was/is in use
        Control0..1
        TypePeriod
        Is Modifierfalse
        Must Supportfalse
        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()))
        64. 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()))
        66. 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()))
        68. 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()))
        70. 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())
        73. 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()))
        75. 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())
        77. 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()))
        79. 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()))
        81. 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()))
        83. 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
        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
        Control0..1
        TypeExtension(UDS Plus Birth Sex Extension) (Extension Type: code)
        Must Supporttrue
        14. Patient.extension:uds-plus-sex
        Slice Nameuds-plus-sex
        Control0..1
        TypeExtension(UDS Plus Sex Extension) (Extension Type: code)
        Must Supporttrue
        16. 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
        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 $this.toString().length() = 4)
        uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 ($this is dateTime implies $this.toString() >= '1900')
        uds-plus-pat-1b: All dateTime data elements should have valid year < 2030 ($this is dateTime implies $this.toString() <= '2030')
        34. Patient.address
        ShortIncluded only to support zip code
        Control1..1
        Must Supporttrue
        36. Patient.address.extension
        ShortExtension cannot be included in Address
        Control0..0
        Must Supportfalse
        38. Patient.address.text
        ShortText cannot be included in the profile
        Control0..0
        Must Supportfalse
        40. Patient.address.line
        ShortStreet names cannot be included in the profile
        Control0..0
        Must Supportfalse
        42. Patient.address.postalCode
        ShortZipCode must be included in the profile
        Control1..1
        Must Supporttrue
        Invariantsuds-plus-patient-1: De-identified Zipcodes can contain first 3 digits followed by 00 in the last two digits or have to be masked with 00000. If the extended ZipCode format is used the resulting format should be #####-####. ($this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$'))
        44. Patient.address.postalCode.extension:dataAbsentReason
        Slice NamedataAbsentReason
        ShortReason why the data is not present
        Control0..1
        TypeExtension(Why value is missing) (Extension Type: code)
        Must Supporttrue
        46. 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
        48. Patient.address.period
        ShortAddress period cannot be included in the profile
        Control0..1
        Must Supportfalse
        50. Patient.maritalStatus
        ShortCannot include information not required for UDS+
        Control0..0
        Must Supportfalse
        52. Patient.multipleBirth[x]
        ShortCannot include information not required for UDS+
        Control0..0
        Must Supportfalse
        54. Patient.photo
        ShortCannot include information not required for UDS+
        Control0..0
        Must Supportfalse
        56. Patient.contact
        ShortCannot include information not required for UDS+
        Control0..0
        Must Supportfalse
        58. Patient.communication
        60. 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
        62. Patient.generalPractitioner
        ShortCannot include information not required for UDS+
        Control0..0
        Must Supportfalse
        64. Patient.managingOrganization
        ShortCannot include information not required for UDS+
        Control0..0
        Must Supportfalse
        66. 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.

        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
        Control3..*
        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.
          Control0..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-sex
          Slice Nameuds-plus-sex
          Definition

          Indicates the sex of the Patient

          ShortIndicates the sex of the Patient.
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(UDS Plus 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())
          24. 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())
          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 $this.toString().length() = 4)
          uds-plus-pat-1a: All dateTime data elements should have valid year > 1900 ($this is dateTime implies $this.toString() >= '1900')
          uds-plus-pat-1b: All dateTime data elements should have valid year < 2030 ($this is dateTime implies $this.toString() <= '2030')
          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

          An Extension

          ShortExtension cannot be included in Address
          Control0..0
          TypeExtension
          Is Modifierfalse
          Must Supportfalse
          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.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. If the extended ZipCode format is used the resulting format should be #####-####. ($this.matches('^[0-9]{3}[0]{2}(-[0-9]{4})?$'))
            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
              This element is affected by the following invariants: ele-1
              TypeExtension(Why value is missing) (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
              Typestring
              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
                BindingThe codes SHALL be taken from DataAbsentReason
                (required to http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1)

                Used to specify why the normally expected content of the data element is missing.

                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.

                ShortAddress period cannot be included in the profile
                Control0..1
                TypePeriod
                Is Modifierfalse
                Must Supportfalse
                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()))