Patient - Definitions - HL7 FHIR Implementation Guide: Example IG Release 1 - US Realm

HL7 FHIR Implementation Guide: Example IG Release 1 - US Realm | STU1, published by My Organization. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/rmrlangford/Botswana-Training and changes regularly. See the Directory of published versions

Resource Profile: HIVPatient - Detailed Descriptions

Active as of 2023-09-25

Definitions for the hiv-patient resource profile.

Differential Elements Table
Key Elements Table
Snapshot Elements Table

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

0. Patient
LOINC Code
2. Patient.extension
LOINC Code
Slicing	This element introduces a set of slices on `Patient.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
4. Patient.extension:citizenship
Slice Name	citizenship
Control	0..1
Type	Extension(Patient Citizenship) (Complex Extension)
Must Support	true
6. Patient.extension:nationality
Slice Name	nationality
Control	0..1
Type	Extension(Patient Nationality) (Complex Extension)
Must Support	true
8. Patient.identifier
Note	This is a business identifier, not a resource identifier (see discussion)
Control	2..?
LOINC Code
Slicing	This element introduces a set of slices on `Patient.identifier`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ system
10. Patient.identifier:OmangID
Slice Name	OmangID
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
12. Patient.identifier:OmangID.extension
Control	1..?
14. Patient.identifier:OmangID.extension:OID
Slice Name	OID
Control	1..1
Type	Extension(Omang ID) (Complex Extension)
16. Patient.identifier:OmangID.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/omang
18. Patient.identifier:OmangID.value
Control	1..?
Pattern Value	Omang ID is split into two.
20. Patient.identifier:MRN
Slice Name	MRN
Note	This is a business identifier, not a resource identifier (see discussion)
Control	1..1
22. Patient.identifier:MRN.extension
Control	1..?
24. Patient.identifier:MRN.extension:MRNID
Slice Name	MRNID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
26. Patient.identifier:MRN.type
28. Patient.identifier:MRN.type.coding
30. Patient.identifier:MRN.type.coding.system
Pattern Value	http://terminology.hl7.org/CodeSystem/v2-0203
32. Patient.identifier:MRN.type.coding.code
Pattern Value	MR
34. Patient.identifier:MRN.type.coding.display
Pattern Value	Medical record number
36. Patient.identifier:MRN.type.text
Pattern Value	Patient folder number
38. Patient.identifier:MRN.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/mrn
40. Patient.identifier:MRN.value
Control	1..?
Pattern Value	MRN ID can be issued by many different systems.
42. Patient.identifier:PPN
Slice Name	PPN
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
44. Patient.identifier:PPN.extension
Control	1..?
46. Patient.identifier:PPN.extension:PASSID
Slice Name	PASSID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
48. Patient.identifier:PPN.type
50. Patient.identifier:PPN.type.coding
52. Patient.identifier:PPN.type.coding.system
Pattern Value	http://terminology.hl7.org/CodeSystem/v2-0203
54. Patient.identifier:PPN.type.coding.code
Pattern Value	PPN
56. Patient.identifier:PPN.type.coding.display
Pattern Value	Passport number
58. Patient.identifier:PPN.type.text
Pattern Value	Passport number
60. Patient.identifier:PPN.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/passport
62. Patient.identifier:PPN.value
Control	1..?
Pattern Value	A patient can have multiple passport IDs.
64. Patient.identifier:RefugeeID
Slice Name	RefugeeID
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
66. Patient.identifier:RefugeeID.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/refugee
68. Patient.identifier:RefugeeID.value
Control	1..?
70. Patient.identifier:BirthCertificateID
Slice Name	BirthCertificateID
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
72. Patient.identifier:BirthCertificateID.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/birth-certificate
74. Patient.identifier:BirthCertificateID.value
Control	1..?
76. Patient.identifier:Biometric
Slice Name	Biometric
Note	This is a business identifier, not a resource identifier (see discussion)
Control	1..1
78. Patient.identifier:Biometric.extension
Control	1..?
80. Patient.identifier:Biometric.extension:BiometricID
Slice Name	BiometricID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
82. Patient.identifier:Biometric.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/biometric
84. Patient.identifier:Biometric.value
Control	1..?
Pattern Value	Biometric ID can be issued by many different systems.
86. Patient.identifier:Residence
Slice Name	Residence
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
88. Patient.identifier:Residence.extension
Control	1..?
90. Patient.identifier:Residence.extension:ResidenceID
Slice Name	ResidenceID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
92. Patient.identifier:Residence.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/residence
94. Patient.identifier:Residence.value
Control	1..?
Pattern Value	A patient can have multiple residence IDs.
96. Patient.identifier:Foreign
Slice Name	Foreign
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
98. Patient.identifier:Foreign.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/foreign
100. Patient.identifier:Foreign.value
Control	1..?
102. Patient.identifier:Drivers
Slice Name	Drivers
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
104. Patient.identifier:Drivers.system
Control	1..?
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/drivers
106. Patient.identifier:Drivers.value
Control	1..?
108. Patient.name
110. Patient.name.use
Control	1..?
112. Patient.name.family
Control	1..?
114. Patient.name.given
Control	1..?
116. Patient.gender
Control	1..?
LOINC Code
118. Patient.birthDate
Control	1..?
LOINC Code
120. Patient.address
Control	1..?
LOINC Code
122. Patient.address.type
Control	1..?
124. Patient.address.line
Must Support	true
126. Patient.address.city
Control	1..?
128. Patient.address.district
Control	1..?
130. Patient.address.country
Control	1..?
132. Patient.maritalStatus
Control	1..?
LOINC Code
134. Patient.contact
Must Support	true
LOINC Code
136. Patient.contact.relationship
Control	1..1
LOINC Code
138. Patient.contact.name
140. Patient.contact.name.family
Control	1..?
142. Patient.contact.name.given
Control	1..?
144. Patient.contact.telecom
Must Support	true
LOINC Code

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

0. Patient
Definition	Demographics and other administrative information about an individual or animal receiving care or other health-related services.
Short	Information about an individual or animal receiving health care services
Control	0..*
Is Modifier	false
Must Support	false
Summary	false
Alternate Names	SubjectOfCare Client Resident
Invariants	dom-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().ofType(canonical) \| %resource.descendants().ofType(uri) \| %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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.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.
Short	A 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 its narrative along with other profiles, value sets, etc.
Control	0..1
Type	uri
Is Modifier	true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Patient.contained
Definition	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short	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.
Control	0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type	Resource
Is Modifier	false
Must Support	false
Summary	false
Alternate Names	inline resources, anonymous resources, contained resources
6. 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 managable, 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.
Short	ExtensionAdditional 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.
Control	0..*
Type	Extension
Is Modifier	false
Must Support	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing	This element introduces a set of slices on `Patient.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
8. Patient.extension:citizenship
Slice Name	citizenship
Definition	The patient's legal status as citizen of a country.
Short	Nation(s) where the patient claims citizenship
Control	0..1
Type	Extension(Patient Citizenship) (Complex Extension)
Is Modifier	false
Must Support	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
LOINC Code
10. Patient.extension:nationality
Slice Name	nationality
Definition	The nationality of the patient.
Short	Nationality
Control	0..1
Type	Extension(Patient Nationality) (Complex Extension)
Is Modifier	false
Must Support	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
LOINC Code
12. 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 managable, 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).
Short	Extensions 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.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support	false
Summary	true
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 Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
14. Patient.identifier
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	20..*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing	This element introduces a set of slices on `Patient.identifier`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ system
16. Patient.identifier:OmangID
Slice Name	OmangID
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Patient.identifier:OmangID.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 managable, 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.
Short	ExtensionAdditional 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.
Control	10..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
20. Patient.identifier:OmangID.extension:OID
Slice Name	OID
Definition	Omang ID
Short	Omang ID
Control	1..1
Type	Extension(Omang ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
LOINC Code
22. Patient.identifier:OmangID.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Patient.identifier:OmangID.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/omang
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Patient.identifier:OmangID.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	Omang ID is split into two.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Patient.identifier:MRN
Slice Name	MRN
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	10..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Patient.identifier:MRN.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 managable, 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.
Short	ExtensionAdditional 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.
Control	10..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
32. Patient.identifier:MRN.extension:MRNID
Slice Name	MRNID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
LOINC Code
34. Patient.identifier:MRN.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. Patient.identifier:MRN.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/mrn
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. Patient.identifier:MRN.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	MRN ID can be issued by many different systems.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. Patient.identifier:PPN
Slice Name	PPN
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. Patient.identifier:PPN.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 managable, 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.
Short	ExtensionAdditional 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.
Control	10..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
44. Patient.identifier:PPN.extension:PASSID
Slice Name	PASSID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
LOINC Code
46. Patient.identifier:PPN.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. Patient.identifier:PPN.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/passport
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
50. Patient.identifier:PPN.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	A patient can have multiple passport IDs.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. Patient.identifier:RefugeeID
Slice Name	RefugeeID
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. Patient.identifier:RefugeeID.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. Patient.identifier:RefugeeID.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/refugee
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. Patient.identifier:RefugeeID.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. Patient.identifier:BirthCertificateID
Slice Name	BirthCertificateID
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
62. Patient.identifier:BirthCertificateID.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. Patient.identifier:BirthCertificateID.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/birth-certificate
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. Patient.identifier:BirthCertificateID.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
68. Patient.identifier:Biometric
Slice Name	Biometric
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	10..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
70. Patient.identifier:Biometric.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 managable, 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.
Short	ExtensionAdditional 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.
Control	10..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
72. Patient.identifier:Biometric.extension:BiometricID
Slice Name	BiometricID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
LOINC Code
74. Patient.identifier:Biometric.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
76. Patient.identifier:Biometric.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/biometric
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. Patient.identifier:Biometric.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	Biometric ID can be issued by many different systems.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. Patient.identifier:Residence
Slice Name	Residence
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
82. Patient.identifier:Residence.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 managable, 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.
Short	ExtensionAdditional 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.
Control	10..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
84. Patient.identifier:Residence.extension:ResidenceID
Slice Name	ResidenceID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
LOINC Code
86. Patient.identifier:Residence.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
88. Patient.identifier:Residence.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/residence
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
90. Patient.identifier:Residence.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	A patient can have multiple residence IDs.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
92. Patient.identifier:Foreign
Slice Name	Foreign
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
94. Patient.identifier:Foreign.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
96. Patient.identifier:Foreign.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/foreign
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
98. Patient.identifier:Foreign.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
100. Patient.identifier:Drivers
Slice Name	Drivers
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
102. Patient.identifier:Drivers.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use\|5.0.0 Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
104. Patient.identifier:Drivers.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	10..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/drivers
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
106. Patient.identifier:Drivers.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	10..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
108. 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.
Short	Whether 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.
Control	0..1
Type	boolean
Is Modifier	true 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 Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	Need to be able to mark a patient record as not to be used because it was created in error.
Meaning if Missing	This resource is generally assumed to be active if no value is provided for the active element
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
110. Patient.gender
Definition	Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Short	male \| 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.
Control	10..1
Binding	The codes SHALL be taken from AdministrativeGenderhttp://hl7.org/fhir/ValueSet/administrative-gender\|5.0.0 The gender of a person used for administrative purposes.
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	Needed for identification of the individual, in combination with (at least) name and birth date.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
112. Patient.birthDate
Definition	The date of birth for the individual.
Short	The date of birth for the individual
Comments	Partial dates are allowed if the specific date of birth 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).
Control	10..1
Type	date
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	Age of the individual drives many clinical processes.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
LOINC Code	21112-8
114. Patient.deceased[x]
Definition	Indicates if the individual is deceased or not.
Short	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.
Control	0..1
Type	Choice of: boolean, dateTime
[x] Note	See Choice of Data Types for further information about how to use [x]
Is Modifier	true 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 Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
116. Patient.address
Definition	An address for the individual.
Short	An address for the individual
Comments	Patient may have multiple addresses with different uses or applicable periods.
Control	10..*
Type	Address
Is Modifier	false
Must Support	false
Summary	true
Requirements	May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
118. Patient.address.use
Definition	The purpose of this address.
Short	home \| 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.
Control	0..1
Binding	The codes SHALL be taken from AddressUsehttp://hl7.org/fhir/ValueSet/address-use\|5.0.0 The use of an address (home / work / etc.).
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows an appropriate address to be chosen from a list of many.
Example	<br/><b>General</b>:home
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
120. 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.
Short	postal \| 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).
Control	10..1
Binding	The codes SHALL be taken from AddressTypehttp://hl7.org/fhir/ValueSet/address-type\|5.0.0 The type of an address (physical / postal).
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:both
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
122. 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.
Short	Street name, number, direction & P.O. Box etc.
Control	0..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	true
Summary	true
Example	<br/><b>General</b>:137 Nowhere Street
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
124. Patient.address.city
Definition	The name of the city, town, suburb, village or other community or delivery center.
Short	Name of city, town etc.
Control	10..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	Municpality
Example	<br/><b>General</b>:Erewhon
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
126. Patient.address.district
Definition	The name of the administrative area (county).
Short	District 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.
Control	10..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	County
Example	<br/><b>General</b>:Madison
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
128. Patient.address.country
Definition	Country - a nation as commonly understood or generally accepted.
Short	Country (e.g. may be ISO 3166 2 or 3 letter code)
Comments	ISO 3166 2- or 3- letter codes MAY be used in place of a human readable country name.
Control	10..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
130. Patient.maritalStatus
Definition	This field contains a patient's most recent marital (civil) status.
Short	Marital (civil) status of a patient
Control	10..1
Binding	Unless not suitable, these codes SHALL be taken from MaritalStatusCodeshttp://hl7.org/fhir/ValueSet/marital-status The domestic partnership status of a person.
Type	CodeableConcept
Is Modifier	false
Must Support	false
Summary	false
Requirements	Most, if not all systems capture it.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
132. Patient.contact
Definition	A contact party (e.g. guardian, partner, friend) for the patient.
Short	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.
Control	0..*
Type	BackboneElement
Is Modifier	false
Must Support	true
Summary	false
Requirements	Need to track people you can contact about the patient.
Invariants	ele-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())
134. Patient.contact.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 managable, 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).
Short	Extensions 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.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary	true
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 Names	extensions, user content, modifiers
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
136. Patient.contact.relationship
Definition	The nature of the relationship between the patient and the contact person.
Short	The kind of relationship
Control	10..1*
Binding	Unless not suitable, these codes SHALL be taken from PatientContactRelationshiphttp://hl7.org/fhir/ValueSet/patient-contactrelationship The nature of the relationship between a patient and a contact person for that patient.
Type	CodeableConcept
Is Modifier	false
Must Support	false
Summary	false
Requirements	Used to determine which contact person is the most relevant to approach, depending on circumstances.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
138. Patient.contact.telecom
Definition	A contact detail for the person, e.g. a telephone number or an email address.
Short	A contact detail for the person
Comments	Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
Control	0..* This element is affected by the following invariants: pat-1
Type	ContactPoint
Is Modifier	false
Must Support	true
Summary	false
Requirements	People have (primary) ways to contact them in some way such as phone, email.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
140. Patient.link
Definition	Link to a Patient or RelatedPerson resource that concerns the same actual individual.
Short	Link to a Patient or RelatedPerson resource that concerns the same actual individual
Comments	There is no assumption that linked patient records have mutual links.
Control	0..*
Type	BackboneElement
Is Modifier	true 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 Support	false
Summary	true
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.
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
142. Patient.link.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 managable, 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).
Short	Extensions 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.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary	true
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 Names	extensions, user content, modifiers
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
144. Patient.link.other
Definition	Link to a Patient or RelatedPerson resource that concerns the same actual individual.
Short	The other patient or related person resource that the link refers to
Comments	Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
Control	1..1
Type	Reference(Patient, RelatedPerson)
Is Modifier	false
Must Support	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
146. Patient.link.type
Definition	The type of link between this patient resource and another patient resource.
Short	replaced-by \| replaces \| refer \| seealso
Control	1..1
Binding	The codes SHALL be taken from LinkTypehttp://hl7.org/fhir/ValueSet/link-type\|5.0.0 The type of link between this patient resource and another Patient resource, or Patient/RelatedPerson when using the `seealso` code
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Invariants	ele-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	Demographics and other administrative information about an individual or animal receiving care or other health-related services.
Short	Information about an individual or animal receiving health care services
Control	0..*
Is Modifier	false
Must Support	false
Summary	false
Alternate Names	SubjectOfCare Client Resident
Invariants	dom-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().ofType(canonical) \| %resource.descendants().ofType(uri) \| %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short	Logical id of this artifact
Comments	Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
Control	0..1
Type	id
Is Modifier	false
Must Support	false
Summary	true
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.
Short	Metadata about the resource
Control	0..1
Type	Meta
Is Modifier	false
Must Support	false
Summary	true
Invariants	ele-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.
Short	A 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 its narrative along with other profiles, value sets, etc.
Control	0..1
Type	uri
Is Modifier	true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Invariants	ele-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.
Short	Language 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).
Control	0..1
Binding	The codes SHALL be taken from AllLanguages: IETF language tag for a human language
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	false
Invariants	ele-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.
Short	Text summary of the resource, for human interpretation
Comments	Contained resources do not have a 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.
Control	0..1 This element is affected by the following invariants: dom-6
Type	Narrative
Is Modifier	false
Must Support	false
Summary	false
Alternate Names	narrative, html, xhtml, display
Invariants	ele-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, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short	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.
Control	0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type	Resource
Is Modifier	false
Must Support	false
Summary	false
Alternate Names	inline resources, anonymous resources, contained resources
14. Patient.extension
Definition	An Extension
Short	Extension
Control	0..*
Type	Extension
Is Modifier	false
Must Support	false
Summary	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
16. Patient.extension:citizenship
Slice Name	citizenship
Definition	The patient's legal status as citizen of a country.
Short	Nation(s) where the patient claims citizenship
Control	0..1
Type	Extension(Patient Citizenship) (Complex Extension)
Is Modifier	false
Must Support	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
18. Patient.extension:nationality
Slice Name	nationality
Definition	The nationality of the patient.
Short	Nationality
Control	0..1
Type	Extension(Patient Nationality) (Complex Extension)
Is Modifier	false
Must Support	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
20. 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 managable, 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.
Short	Extensions 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.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support	false
Summary	true
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 Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
22. Patient.identifier
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	2..*
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing	This element introduces a set of slices on `Patient.identifier`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ system
24. Patient.identifier:OmangID
Slice Name	OmangID
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. Patient.identifier:OmangID.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
28. Patient.identifier:OmangID.extension
Definition	An Extension
Short	Extension
Control	1..*
Type	Extension
Is Modifier	false
Summary	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
30. Patient.identifier:OmangID.extension:OID
Slice Name	OID
Definition	Omang ID
Short	Omang ID
Control	1..1
Type	Extension(Omang ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
32. Patient.identifier:OmangID.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. Patient.identifier:OmangID.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. Patient.identifier:OmangID.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/omang
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
38. Patient.identifier:OmangID.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	Omang ID is split into two.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. Patient.identifier:OmangID.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. Patient.identifier:OmangID.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
44. Patient.identifier:MRN
Slice Name	MRN
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	1..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
46. Patient.identifier:MRN.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
48. Patient.identifier:MRN.extension
Definition	An Extension
Short	Extension
Control	1..*
Type	Extension
Is Modifier	false
Summary	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
50. Patient.identifier:MRN.extension:MRNID
Slice Name	MRNID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
52. Patient.identifier:MRN.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. Patient.identifier:MRN.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
56. Patient.identifier:MRN.type.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
58. Patient.identifier:MRN.type.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.type.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
60. Patient.identifier:MRN.type.coding
Definition	A reference to a code defined by a terminology system.
Short	Code defined by a terminology system
Comments	Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Control	0..*
Type	Coding
Is Modifier	false
Summary	true
Requirements	Allows for alternative encodings within a code system, and translations to other code systems.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. Patient.identifier:MRN.type.coding.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
64. Patient.identifier:MRN.type.coding.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.type.coding.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
66. Patient.identifier:MRN.type.coding.system
Definition	The identification of the code system that defines the meaning of the symbol in the code.
Short	Identity of the terminology system
Comments	The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should be an absolute reference to some definition that establishes the system clearly and unambiguously.
Control	0..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Need to be unambiguous about the source of the definition of the symbol.
Pattern Value	http://terminology.hl7.org/CodeSystem/v2-0203
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
68. Patient.identifier:MRN.type.coding.version
Definition	The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Short	Version of the system - if relevant
Comments	Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
Note	This is a business versionId, not a resource version id (see discussion)
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. Patient.identifier:MRN.type.coding.code
Definition	A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Short	Symbol in syntax defined by the system
Control	0..1 This element is affected by the following invariants: cod-1
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Need to refer to a particular code in the system.
Pattern Value	MR
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
72. Patient.identifier:MRN.type.coding.display
Definition	A representation of the meaning of the code in the system, following the rules of the system.
Short	Representation defined by the system
Control	0..1 This element is affected by the following invariants: cod-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Pattern Value	Medical record number
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
74. Patient.identifier:MRN.type.coding.userSelected
Definition	Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short	If this coding was chosen directly by the user
Comments	Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
Control	0..1
Type	boolean
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. Patient.identifier:MRN.type.text
Definition	A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Short	Plain text representation of the concept
Comments	Very often the text is the same as a displayName of one of the codings.
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Pattern Value	Patient folder number
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
78. Patient.identifier:MRN.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/mrn
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
80. Patient.identifier:MRN.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	MRN ID can be issued by many different systems.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
82. Patient.identifier:MRN.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
84. Patient.identifier:MRN.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
86. Patient.identifier:PPN
Slice Name	PPN
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
88. Patient.identifier:PPN.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
90. Patient.identifier:PPN.extension
Definition	An Extension
Short	Extension
Control	1..*
Type	Extension
Is Modifier	false
Summary	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
92. Patient.identifier:PPN.extension:PASSID
Slice Name	PASSID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
94. Patient.identifier:PPN.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
96. Patient.identifier:PPN.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
98. Patient.identifier:PPN.type.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
100. Patient.identifier:PPN.type.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.type.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
102. Patient.identifier:PPN.type.coding
Definition	A reference to a code defined by a terminology system.
Short	Code defined by a terminology system
Comments	Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Control	0..*
Type	Coding
Is Modifier	false
Summary	true
Requirements	Allows for alternative encodings within a code system, and translations to other code systems.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
104. Patient.identifier:PPN.type.coding.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
106. Patient.identifier:PPN.type.coding.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.type.coding.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
108. Patient.identifier:PPN.type.coding.system
Definition	The identification of the code system that defines the meaning of the symbol in the code.
Short	Identity of the terminology system
Comments	The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should be an absolute reference to some definition that establishes the system clearly and unambiguously.
Control	0..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Need to be unambiguous about the source of the definition of the symbol.
Pattern Value	http://terminology.hl7.org/CodeSystem/v2-0203
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
110. Patient.identifier:PPN.type.coding.version
Definition	The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Short	Version of the system - if relevant
Comments	Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
Note	This is a business versionId, not a resource version id (see discussion)
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. Patient.identifier:PPN.type.coding.code
Definition	A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Short	Symbol in syntax defined by the system
Control	0..1 This element is affected by the following invariants: cod-1
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Need to refer to a particular code in the system.
Pattern Value	PPN
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
114. Patient.identifier:PPN.type.coding.display
Definition	A representation of the meaning of the code in the system, following the rules of the system.
Short	Representation defined by the system
Control	0..1 This element is affected by the following invariants: cod-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Pattern Value	Passport number
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
116. Patient.identifier:PPN.type.coding.userSelected
Definition	Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short	If this coding was chosen directly by the user
Comments	Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
Control	0..1
Type	boolean
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
118. Patient.identifier:PPN.type.text
Definition	A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Short	Plain text representation of the concept
Comments	Very often the text is the same as a displayName of one of the codings.
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Pattern Value	Passport number
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
120. Patient.identifier:PPN.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/passport
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
122. Patient.identifier:PPN.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	A patient can have multiple passport IDs.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
124. Patient.identifier:PPN.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
126. Patient.identifier:PPN.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
128. Patient.identifier:RefugeeID
Slice Name	RefugeeID
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
130. Patient.identifier:RefugeeID.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
132. Patient.identifier:RefugeeID.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
134. Patient.identifier:RefugeeID.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
136. Patient.identifier:RefugeeID.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
138. Patient.identifier:RefugeeID.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/refugee
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
140. Patient.identifier:RefugeeID.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
142. Patient.identifier:RefugeeID.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
144. Patient.identifier:RefugeeID.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
146. Patient.identifier:BirthCertificateID
Slice Name	BirthCertificateID
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
148. Patient.identifier:BirthCertificateID.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
150. Patient.identifier:BirthCertificateID.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
152. Patient.identifier:BirthCertificateID.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
154. Patient.identifier:BirthCertificateID.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
156. Patient.identifier:BirthCertificateID.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/birth-certificate
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
158. Patient.identifier:BirthCertificateID.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
160. Patient.identifier:BirthCertificateID.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
162. Patient.identifier:BirthCertificateID.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
164. Patient.identifier:Biometric
Slice Name	Biometric
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	1..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
166. Patient.identifier:Biometric.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
168. Patient.identifier:Biometric.extension
Definition	An Extension
Short	Extension
Control	1..*
Type	Extension
Is Modifier	false
Summary	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
170. Patient.identifier:Biometric.extension:BiometricID
Slice Name	BiometricID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
172. Patient.identifier:Biometric.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
174. Patient.identifier:Biometric.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
176. Patient.identifier:Biometric.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/biometric
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
178. Patient.identifier:Biometric.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	Biometric ID can be issued by many different systems.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
180. Patient.identifier:Biometric.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
182. Patient.identifier:Biometric.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
184. Patient.identifier:Residence
Slice Name	Residence
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
186. Patient.identifier:Residence.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
188. Patient.identifier:Residence.extension
Definition	An Extension
Short	Extension
Control	1..*
Type	Extension
Is Modifier	false
Summary	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
190. Patient.identifier:Residence.extension:ResidenceID
Slice Name	ResidenceID
Definition	Parent Extension for ID
Short	Parent Extension for ID
Control	1..*
Type	Extension(Parent Extension for ID) (Complex Extension)
Is Modifier	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
192. Patient.identifier:Residence.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
194. Patient.identifier:Residence.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
196. Patient.identifier:Residence.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/residence
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
198. Patient.identifier:Residence.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Pattern Value	A patient can have multiple residence IDs.
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
200. Patient.identifier:Residence.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
202. Patient.identifier:Residence.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
204. Patient.identifier:Foreign
Slice Name	Foreign
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
206. Patient.identifier:Foreign.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
208. Patient.identifier:Foreign.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
210. Patient.identifier:Foreign.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
212. Patient.identifier:Foreign.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
214. Patient.identifier:Foreign.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/foreign
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
216. Patient.identifier:Foreign.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
218. Patient.identifier:Foreign.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
220. Patient.identifier:Foreign.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
222. Patient.identifier:Drivers
Slice Name	Drivers
Definition	An identifier for this patient.
Short	An identifier for this patient
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..1
Type	Identifier
Is Modifier	false
Must Support	false
Summary	true
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
224. Patient.identifier:Drivers.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
226. Patient.identifier:Drivers.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.identifier.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
228. Patient.identifier:Drivers.use
Definition	The purpose of this identifier.
Short	usual \| official \| temp \| secondary \| old (If known)
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control	0..1
Binding	The codes SHALL be taken from IdentifierUse: Identifies the purpose for this identifier, if known .
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
230. Patient.identifier:Drivers.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short	Description of identifier
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control	0..1
Binding	Unless not suitable, these codes SHALL be taken from IdentifierTypeCodes: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Type	CodeableConcept
Is Modifier	false
Summary	true
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
232. Patient.identifier:Drivers.system
Definition	Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short	The namespace for the identifier value
Comments	Identifier.system is always case sensitive.
Control	1..1
Type	uri
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Pattern Value	http://openhie.org/fhir/botswana-training/identifier/drivers
Example	<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
234. Patient.identifier:Drivers.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short	The value that is unique
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control	1..1 This element is affected by the following invariants: ident-1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:123456
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
236. Patient.identifier:Drivers.period
Definition	Time period during which identifier is/was valid for use.
Short	Time period when id is/was valid for use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
238. Patient.identifier:Drivers.assigner
Definition	Organization that issued/manages the identifier.
Short	Organization that issued id (may be just text)
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
240. 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.
Short	Whether 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.
Control	0..1
Type	boolean
Is Modifier	true 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 Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	Need to be able to mark a patient record as not to be used because it was created in error.
Meaning if Missing	This resource is generally assumed to be active if no value is provided for the active element
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
242. Patient.name
Definition	A name associated with the individual.
Short	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. Animal names may be communicated as given names, and optionally may include a family name.
Control	0..*
Type	HumanName
Is Modifier	false
Must Support	false
Summary	true
Requirements	Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
244. Patient.name.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
246. Patient.name.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.name.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
248. Patient.name.use
Definition	Identifies the purpose for this name.
Short	usual \| official \| temp \| nickname \| anonymous \| old \| maiden
Comments	Applications can assume that a name is current unless it explicitly says that it is temporary or old.
Control	1..1
Binding	The codes SHALL be taken from NameUse: The use of a human name.
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate name for a particular context of use to be selected from among a set of names.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
250. Patient.name.text
Definition	Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
Short	Text representation of the full name
Comments	Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	A renderable, unencoded form.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
252. Patient.name.family
Definition	The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.
Short	Family name (often called 'Surname')
Comments	Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).
Control	1..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	surname
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
254. Patient.name.given
Definition	Given name.
Short	Given names (not always 'first'). Includes middle names
Comments	If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
Control	1..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	first name, middle name
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
256. Patient.name.prefix
Definition	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.
Short	Parts that come before the name
Control	0..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
258. Patient.name.suffix
Definition	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.
Short	Parts that come after the name
Control	0..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
260. Patient.name.period
Definition	Indicates the period of time when this name was valid for the named person.
Short	Time period when name was/is in use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Requirements	Allows names to be placed in historical context.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
262. Patient.telecom
Definition	A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Short	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).
Control	0..*
Type	ContactPoint
Is Modifier	false
Must Support	false
Summary	true
Requirements	People have (primary) ways to contact them in some way such as phone, email.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
264. Patient.gender
Definition	Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Short	male \| 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.
Control	1..1
Binding	The codes SHALL be taken from AdministrativeGender: The gender of a person used for administrative purposes.
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	Needed for identification of the individual, in combination with (at least) name and birth date.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
266. Patient.birthDate
Definition	The date of birth for the individual.
Short	The date of birth for the individual
Comments	Partial dates are allowed if the specific date of birth 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).
Control	1..1
Type	date
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	Age of the individual drives many clinical processes.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
LOINC Code	21112-8
268. Patient.deceased[x]
Definition	Indicates if the individual is deceased or not.
Short	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.
Control	0..1
Type	Choice of: boolean, dateTime
[x] Note	See Choice of Data Types for further information about how to use [x]
Is Modifier	true 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 Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Requirements	The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
270. Patient.address
Definition	An address for the individual.
Short	An address for the individual
Comments	Patient may have multiple addresses with different uses or applicable periods.
Control	1..*
Type	Address
Is Modifier	false
Must Support	false
Summary	true
Requirements	May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
272. 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.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
274. Patient.address.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.address.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
276. Patient.address.use
Definition	The purpose of this address.
Short	home \| 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.
Control	0..1
Binding	The codes SHALL be taken from AddressUse: The use of an address (home / work / etc.).
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows an appropriate address to be chosen from a list of many.
Example	<br/><b>General</b>:home
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
278. 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.
Short	postal \| 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).
Control	1..1
Binding	The codes SHALL be taken from AddressType: The type of an address (physical / postal).
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Example	<br/><b>General</b>:both
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
280. 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.
Short	Text 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.
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	A renderable, unencoded form.
Example	<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
282. 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.
Short	Street name, number, direction & P.O. Box etc.
Control	0..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	true
Summary	true
Example	<br/><b>General</b>:137 Nowhere Street
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
284. Patient.address.city
Definition	The name of the city, town, suburb, village or other community or delivery center.
Short	Name of city, town etc.
Control	1..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	Municpality
Example	<br/><b>General</b>:Erewhon
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
286. Patient.address.district
Definition	The name of the administrative area (county).
Short	District 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.
Control	1..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	County
Example	<br/><b>General</b>:Madison
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
288. 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).
Short	Sub-unit of country (abbreviations ok)
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	Province, Territory
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
290. Patient.address.postalCode
Definition	A postal code designating a region defined by the postal service.
Short	Postal code for area
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	Zip
Example	<br/><b>General</b>:9132
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
292. Patient.address.country
Definition	Country - a nation as commonly understood or generally accepted.
Short	Country (e.g. may be ISO 3166 2 or 3 letter code)
Comments	ISO 3166 2- or 3- letter codes MAY be used in place of a human readable country name.
Control	1..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
294. Patient.address.period
Definition	Time period when address was/is in use.
Short	Time period when address was/is in use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Requirements	Allows addresses to be placed in historical context.
Example	<br/><b>General</b>:<valuePeriod xmlns="http://hl7.org/fhir"><br/>  <start value="2010-03-23"/><br/>  <end value="2010-07-01"/><br/></valuePeriod><br/>
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
296. Patient.maritalStatus
Definition	This field contains a patient's most recent marital (civil) status.
Short	Marital (civil) status of a patient
Control	1..1
Binding	Unless not suitable, these codes SHALL be taken from MaritalStatusCodes: The domestic partnership status of a person.
Type	CodeableConcept
Is Modifier	false
Must Support	false
Summary	false
Requirements	Most, if not all systems capture it.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
298. Patient.multipleBirth[x]
Definition	Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Short	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).
Control	0..1
Type	Choice of: boolean, integer
[x] Note	See Choice of Data Types for further information about how to use [x]
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	false
Requirements	For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
300. Patient.photo
Definition	Image of the patient.
Short	Image of the patient
Comments	Guidelines:
Control	0..*
Type	Attachment
Is Modifier	false
Must Support	false
Summary	false
Requirements	Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
302. Patient.contact
Definition	A contact party (e.g. guardian, partner, friend) for the patient.
Short	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.
Control	0..*
Type	BackboneElement
Is Modifier	false
Must Support	true
Summary	false
Requirements	Need to track people you can contact about the patient.
Invariants	ele-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()`)
304. Patient.contact.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	string
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
306. Patient.contact.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
308. Patient.contact.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 managable, 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.
Short	Extensions 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.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary	true
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 Names	extensions, user content, modifiers
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
310. Patient.contact.relationship
Definition	The nature of the relationship between the patient and the contact person.
Short	The kind of relationship
Control	1..1
Binding	Unless not suitable, these codes SHALL be taken from PatientContactRelationship: The nature of the relationship between a patient and a contact person for that patient.
Type	CodeableConcept
Is Modifier	false
Must Support	false
Summary	false
Requirements	Used to determine which contact person is the most relevant to approach, depending on circumstances.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
312. Patient.contact.name
Definition	A name associated with the contact person.
Short	A name associated with the contact person
Control	0..1 This element is affected by the following invariants: pat-1
Type	HumanName
Is Modifier	false
Must Support	false
Summary	false
Requirements	Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
314. Patient.contact.name.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	id
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
316. Patient.contact.name.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Patient.contact.name.extension`. The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: value @ url
318. Patient.contact.name.use
Definition	Identifies the purpose for this name.
Short	usual \| official \| temp \| nickname \| anonymous \| old \| maiden
Comments	Applications can assume that a name is current unless it explicitly says that it is temporary or old.
Control	0..1
Binding	The codes SHALL be taken from NameUse: The use of a human name.
Type	code
Is Modifier	true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	Allows the appropriate name for a particular context of use to be selected from among a set of names.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
320. Patient.contact.name.text
Definition	Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
Short	Text representation of the full name
Comments	Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
Control	0..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Requirements	A renderable, unencoded form.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
322. Patient.contact.name.family
Definition	The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.
Short	Family name (often called 'Surname')
Comments	Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).
Control	1..1
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	surname
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
324. Patient.contact.name.given
Definition	Given name.
Short	Given names (not always 'first'). Includes middle names
Comments	If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
Control	1..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Alternate Names	first name, middle name
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
326. Patient.contact.name.prefix
Definition	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.
Short	Parts that come before the name
Control	0..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
328. Patient.contact.name.suffix
Definition	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.
Short	Parts that come after the name
Control	0..*
Type	string
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
330. Patient.contact.name.period
Definition	Indicates the period of time when this name was valid for the named person.
Short	Time period when name was/is in use
Control	0..1
Type	Period
Is Modifier	false
Summary	true
Requirements	Allows names to be placed in historical context.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
332. Patient.contact.telecom
Definition	A contact detail for the person, e.g. a telephone number or an email address.
Short	A contact detail for the person
Comments	Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
Control	0..* This element is affected by the following invariants: pat-1
Type	ContactPoint
Is Modifier	false
Must Support	true
Summary	false
Requirements	People have (primary) ways to contact them in some way such as phone, email.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
334. Patient.contact.address
Definition	Address for the contact person.
Short	Address for the contact person
Control	0..1 This element is affected by the following invariants: pat-1
Type	Address
Is Modifier	false
Must Support	false
Summary	false
Requirements	Need to keep track where the contact person can be contacted per postal mail or visited.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
336. Patient.contact.gender
Definition	Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Short	male \| female \| other \| unknown
Control	0..1
Binding	The codes SHALL be taken from AdministrativeGender: The gender of a person used for administrative purposes.
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	false
Requirements	Needed to address the person correctly.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
338. Patient.contact.organization
Definition	Organization on behalf of which the contact is acting or for which the contact is working.
Short	Organization that is associated with the contact
Control	0..1 This element is affected by the following invariants: pat-1
Type	Reference(Organization)
Is Modifier	false
Must Support	false
Summary	false
Requirements	For guardians or business related contacts, the organization is relevant.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
340. Patient.contact.period
Definition	The period during which this contact person or organization is valid to be contacted relating to this patient.
Short	The period during which this contact person or organization is valid to be contacted relating to this patient
Control	0..1
Type	Period
Is Modifier	false
Must Support	false
Summary	false
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
342. Patient.communication
Definition	A language which may be used to communicate with the patient about his or her health.
Short	A 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.
Control	0..*
Type	BackboneElement
Is Modifier	false
Must Support	false
Summary	false
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.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
344. 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.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	string
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
346. 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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
348. 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 managable, 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.
Short	Extensions 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.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary	true
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 Names	extensions, user content, modifiers
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
350. 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-AU" for Australian English.
Short	The 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.
Control	1..1
Binding	The codes SHALL be taken from AllLanguages: IETF language tag for a human language
Type	CodeableConcept
Is Modifier	false
Must Support	false
Summary	false
Requirements	Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
352. Patient.communication.preferred
Definition	Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Short	Language preference indicator
Comments	This language is specifically identified for communicating healthcare information.
Control	0..1
Type	boolean
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	false
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.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
354. Patient.generalPractitioner
Definition	Patient's nominated care provider.
Short	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.
Control	0..*
Type	Reference(Organization, Practitioner, PractitionerRole)
Is Modifier	false
Must Support	false
Summary	false
Alternate Names	careProvider
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
356. Patient.managingOrganization
Definition	Organization that is the custodian of the patient record.
Short	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).
Control	0..1
Type	Reference(Organization)
Is Modifier	false
Must Support	false
Summary	true
Requirements	Need to know who recognizes this patient record, manages and updates it.
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
358. Patient.link
Definition	Link to a Patient or RelatedPerson resource that concerns the same actual individual.
Short	Link to a Patient or RelatedPerson resource that concerns the same actual individual
Comments	There is no assumption that linked patient records have mutual links.
Control	0..*
Type	BackboneElement
Is Modifier	true 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 Support	false
Summary	true
Requirements	There are multiple use cases:
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
360. Patient.link.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1 This element is affected by the following invariants: ele-1
Type	string
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
362. Patient.link.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 managable, 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.
Short	Additional 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.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
364. Patient.link.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 managable, 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.
Short	Extensions 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.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary	true
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 Names	extensions, user content, modifiers
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
366. Patient.link.other
Definition	Link to a Patient or RelatedPerson resource that concerns the same actual individual.
Short	The other patient or related person resource that the link refers to
Comments	Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
Control	1..1
Type	Reference(Patient, RelatedPerson)
Is Modifier	false
Must Support	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
368. Patient.link.type
Definition	The type of link between this patient resource and another patient resource.
Short	replaced-by \| replaces \| refer \| seealso
Control	1..1
Binding	The codes SHALL be taken from LinkType: The type of link between this patient resource and another Patient resource, or Patient/RelatedPerson when using the `seealso` code
Type	code
Is Modifier	false
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
Must Support	false
Summary	true
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)