Purpose

The SHINNY Patient Profile inherits from the US Core Patient profile. It sets minimum expectations for the Patient resource. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile.

Usage

The patient profile is required for all SHINNY HRSN bundles.

An extension is included for both patient pronouns and gender identity with SHINNY valuesets defined for each of these. In addition, an extension has been added to explicitly capture the patient's middle name.

Three patient identifiers are defined using slices. These include the medical record number MR (MR), the Medicare identifier CMS (MA), and the social security number SSN (SS).

Parent Child Relationships

Within the PatientExample instance, an example of a relationship between a parent and a child is shown using the contact.relationship element. This example can be used for situations where two members of the same family are receiving a service. The FHIR valueset is extensible and in this example we are using the HL7 Terminology CodeSystem: relationship.

Race and Ethnicity

Due to the values defined by US Core for Ethnicity and Race, the situation where this information is unknown for a patient must be handled differently for each of these elements, as described below.

The values for Ethnicity found here do not include an option for "unknown", so a value should not be included when this information is unknown.

Conversely, the values for Race found here include both "Unknown" and "Asked but no answer", so either of these values can be used when appropriate.

Language

Note that within the SHINNYLanguageVS value set there are two different links to language standards. Within the FHIR documentation, currently there is no way of navitaging directly to the complete list of "All Languages", which can be found here.

It's also important to note there are two language attributes within the patient resource. The "language" attribute within all resources describes the language of the FHIR IG itself. For the SHIN-NY IG, this should always be "en" for English. The communication.language is described as, "The language which can be used to communicate with the patient about his or her health." For this attribute, any of the languages found in the list of "All Languages", referenced above, can be used.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Patient		0..*	USCorePatientProfile	Information about an individual or animal receiving health care services
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension				Content/Rules for all slices
extension:race	S	0..1	(Complex)	US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
extension:ethnicity	S	0..1	(Complex)	US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
extension:birthsex	S	0..1	code	Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
extension:pronouns		0..*	CodeableConcept	SHINNY Personal Pronouns URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-personal-pronouns Binding: SHINNYPersonalPronounsVS (preferred): PersonalPronouns
extension:genderIdentity		0..*	CodeableConcept	SHINNYGenderIdentityExtension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-gender-identity Binding: Gender Identity (extensible): GenderIdentity
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	An identifier for this patient Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible)
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
identifier:MR	SΣ	1..1	Identifier	An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MR
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CMS	SΣ	1..1	Identifier	An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
identifier:SSN	SΣ	0..1	Identifier	An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SS
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..1	HumanName	A name associated with the patient Constraints: us-core-8
Slices for extension				Content/Rules for all slices
extension:middle-name		0..1	string	SHINNY Name Extension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/middle-name Binding Description: (extensible) ⚠: middle name
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
family	SΣC	1..1	string	Family name (often called 'Surname')
given	SΣC	1..1	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
telecom	SΣ	0..*	ContactPoint	A contact detail for the individual
system	SΣC	1..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	The actual contact point details
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
gender	SΣ	1..1	code	male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	1..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	An address for the individual
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..*	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
period	SΣ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication	S	0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Patient.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier.type	extensible	SHINNYIdentiferTypeVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:MR.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:MR.type	extensible	Pattern Value: MR http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:CMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:CMS.type	extensible	Pattern Value: MA http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:SSN.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:SSN.type	extensible	Pattern Value: SS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 From the FHIR Standard
Patient.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system From the FHIR Standard
Patient.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use From the FHIR Standard
Patient.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender From the FHIR Standard
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 From the FHIR Standard
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-8	error	Patient.name	Either Patient.name.given and/or Patient.name.family SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

This structure is derived from USCorePatientProfile

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Patient			USCorePatientProfile
id	S	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	S	1..1	SHINNYMeta	Metadata about the resource
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension				Content/Rules for all slices
extension:pronouns		0..*	CodeableConcept	SHINNY Personal Pronouns URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-personal-pronouns Binding: SHINNYPersonalPronounsVS (preferred): PersonalPronouns
extension:genderIdentity		0..*	CodeableConcept	SHINNYGenderIdentityExtension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-gender-identity Binding: Gender Identity (extensible): GenderIdentity
Slices for identifier		2..*	Identifier	An identifier for this patient Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
type	S	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible)
identifier:MR		1..1	Identifier	An identifier for this patient
type		1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MR
assigner	S	1..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CMS		1..1	Identifier	An identifier for this patient
type		1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA
identifier:SSN		0..1	Identifier	An identifier for this patient
type		1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SS
name		1..1	HumanName	A name associated with the patient
Slices for extension				Content/Rules for all slices
extension:middle-name		0..1	string	SHINNY Name Extension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/middle-name Binding Description: (extensible) ⚠: middle name
family		1..1	string	Family name (often called 'Surname')
given		1..1	string	Given names (not always 'first'). Includes middle names
birthDate		1..1	date	The date of birth for the individual
contact
relationship		0..*	CodeableConcept	The kind of relationship Binding: SHINNYRelationshipVS (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Patient.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Patient.identifier.type	extensible	SHINNYIdentiferTypeVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.contact.relationship	extensible	SHINNYRelationshipVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYRelationshipVS From this IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Patient		0..*	USCorePatientProfile	Information about an individual or animal receiving health care services
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:race	S	0..1	(Complex)	US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
extension:ethnicity	S	0..1	(Complex)	US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
extension:birthsex	S	0..1	code	Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
extension:pronouns		0..*	CodeableConcept	SHINNY Personal Pronouns URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-personal-pronouns Binding: SHINNYPersonalPronounsVS (preferred): PersonalPronouns
extension:genderIdentity		0..*	CodeableConcept	SHINNYGenderIdentityExtension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-gender-identity Binding: Gender Identity (extensible): GenderIdentity
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	An identifier for this patient Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible)
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:MR	SΣ	1..1	Identifier	An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MR
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CMS	SΣ	1..1	Identifier	An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:SSN	SΣ	0..1	Identifier	An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SS
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..1	HumanName	A name associated with the patient Constraints: us-core-8
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:middle-name		0..1	string	SHINNY Name Extension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/middle-name Binding Description: (extensible) ⚠: middle name
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	Σ	0..1	string	Text representation of the full name
family	SΣC	1..1	string	Family name (often called 'Surname')
given	SΣC	1..1	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	Σ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	Time period when name was/is in use
telecom	SΣ	0..*	ContactPoint	A contact detail for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	1..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	The actual contact point details
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
gender	SΣ	1..1	code	male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	1..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	An address for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..*	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	SΣ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
maritalStatus		0..1	CodeableConcept	Marital (civil) status of a patient Binding: Marital Status Codes (extensible): The domestic partnership status of a person.
multipleBirth[x]		0..1		Whether patient is part of a multiple birth
multipleBirthBoolean			boolean
multipleBirthInteger			integer
photo		0..*	Attachment	Image of the patient
contact	C	0..*	BackboneElement	A contact party (e.g. guardian, partner, friend) for the patient Constraints: pat-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
relationship		0..*	CodeableConcept	The kind of relationship Binding: SHINNYRelationshipVS (extensible)
name		0..1	HumanName	A name associated with the contact person
telecom		0..*	ContactPoint	A contact detail for the person
address		0..1	Address	Address for the contact person
gender		0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
organization	C	0..1	Reference(Organization)	Organization that is associated with the contact
period		0..1	Period	The period during which this contact person or organization is valid to be contacted relating to this patient
communication	S	0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
preferred		0..1	boolean	Language preference indicator
generalPractitioner		0..*	Reference(Organization | Practitioner | PractitionerRole)	Patient's nominated primary care provider
managingOrganization	Σ	0..1	Reference(Organization)	Organization that is the custodian of the patient record
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Patient.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier.type	extensible	SHINNYIdentiferTypeVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:MR.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:MR.type	extensible	Pattern Value: MR http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:CMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:CMS.type	extensible	Pattern Value: MA http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:SSN.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:SSN.type	extensible	Pattern Value: SS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 From the FHIR Standard
Patient.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system From the FHIR Standard
Patient.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use From the FHIR Standard
Patient.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender From the FHIR Standard
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 From the FHIR Standard
Patient.address.type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 From the FHIR Standard
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Patient.maritalStatus	extensible	Marital Status Codes http://hl7.org/fhir/ValueSet/marital-status From the FHIR Standard
Patient.contact.relationship	extensible	SHINNYRelationshipVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYRelationshipVS From this IG
Patient.contact.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 From the FHIR Standard
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
pat-1	error	Patient.contact	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()
us-core-8	error	Patient.name	Either Patient.name.given and/or Patient.name.family SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Patient		0..*	USCorePatientProfile	Information about an individual or animal receiving health care services
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension				Content/Rules for all slices
extension:race	S	0..1	(Complex)	US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
extension:ethnicity	S	0..1	(Complex)	US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
extension:birthsex	S	0..1	code	Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
extension:pronouns		0..*	CodeableConcept	SHINNY Personal Pronouns URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-personal-pronouns Binding: SHINNYPersonalPronounsVS (preferred): PersonalPronouns
extension:genderIdentity		0..*	CodeableConcept	SHINNYGenderIdentityExtension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-gender-identity Binding: Gender Identity (extensible): GenderIdentity
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	An identifier for this patient Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible)
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
identifier:MR	SΣ	1..1	Identifier	An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MR
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CMS	SΣ	1..1	Identifier	An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
identifier:SSN	SΣ	0..1	Identifier	An identifier for this patient
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SS
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..1	HumanName	A name associated with the patient Constraints: us-core-8
Slices for extension				Content/Rules for all slices
extension:middle-name		0..1	string	SHINNY Name Extension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/middle-name Binding Description: (extensible) ⚠: middle name
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
family	SΣC	1..1	string	Family name (often called 'Surname')
given	SΣC	1..1	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
telecom	SΣ	0..*	ContactPoint	A contact detail for the individual
system	SΣC	1..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	The actual contact point details
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
gender	SΣ	1..1	code	male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	1..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	An address for the individual
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..*	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
period	SΣ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication	S	0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Patient.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier.type	extensible	SHINNYIdentiferTypeVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:MR.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:MR.type	extensible	Pattern Value: MR http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:CMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:CMS.type	extensible	Pattern Value: MA http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:SSN.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:SSN.type	extensible	Pattern Value: SS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 From the FHIR Standard
Patient.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system From the FHIR Standard
Patient.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use From the FHIR Standard
Patient.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender From the FHIR Standard
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 From the FHIR Standard
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-8	error	Patient.name	Either Patient.name.given and/or Patient.name.family SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

Differential View

This structure is derived from USCorePatientProfile

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Patient			USCorePatientProfile
id	S	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	S	1..1	SHINNYMeta	Metadata about the resource
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension				Content/Rules for all slices
extension:pronouns		0..*	CodeableConcept	SHINNY Personal Pronouns URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-personal-pronouns Binding: SHINNYPersonalPronounsVS (preferred): PersonalPronouns
extension:genderIdentity		0..*	CodeableConcept	SHINNYGenderIdentityExtension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-gender-identity Binding: Gender Identity (extensible): GenderIdentity
Slices for identifier		2..*	Identifier	An identifier for this patient Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
type	S	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible)
identifier:MR		1..1	Identifier	An identifier for this patient
type		1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MR
assigner	S	1..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CMS		1..1	Identifier	An identifier for this patient
type		1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA
identifier:SSN		0..1	Identifier	An identifier for this patient
type		1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SS
name		1..1	HumanName	A name associated with the patient
Slices for extension				Content/Rules for all slices
extension:middle-name		0..1	string	SHINNY Name Extension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/middle-name Binding Description: (extensible) ⚠: middle name
family		1..1	string	Family name (often called 'Surname')
given		1..1	string	Given names (not always 'first'). Includes middle names
birthDate		1..1	date	The date of birth for the individual
contact
relationship		0..*	CodeableConcept	The kind of relationship Binding: SHINNYRelationshipVS (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Patient.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Patient.identifier.type	extensible	SHINNYIdentiferTypeVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.contact.relationship	extensible	SHINNYRelationshipVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYRelationshipVS From this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Patient		0..*	USCorePatientProfile	Information about an individual or animal receiving health care services
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:race	S	0..1	(Complex)	US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
extension:ethnicity	S	0..1	(Complex)	US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
extension:birthsex	S	0..1	code	Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth
extension:pronouns		0..*	CodeableConcept	SHINNY Personal Pronouns URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-personal-pronouns Binding: SHINNYPersonalPronounsVS (preferred): PersonalPronouns
extension:genderIdentity		0..*	CodeableConcept	SHINNYGenderIdentityExtension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-gender-identity Binding: Gender Identity (extensible): GenderIdentity
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	An identifier for this patient Slice: Unordered, Open by pattern:type
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible)
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:MR	SΣ	1..1	Identifier	An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MR
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	SΣ	1..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CMS	SΣ	1..1	Identifier	An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:SSN	SΣ	0..1	Identifier	An identifier for this patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier. It MUST contain a single instance of MR (Medical record number) Binding: SHINNYIdentiferTypeVS (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SS
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!Σ	0..1	boolean	Whether this patient's record is in active use
name	SΣC	1..1	HumanName	A name associated with the patient Constraints: us-core-8
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:middle-name		0..1	string	SHINNY Name Extension URL: http://shinny.org/us/ny/hrsn/StructureDefinition/middle-name Binding Description: (extensible) ⚠: middle name
use	?!Σ	0..1	code	usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name.
text	Σ	0..1	string	Text representation of the full name
family	SΣC	1..1	string	Family name (often called 'Surname')
given	SΣC	1..1	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name
prefix	Σ	0..*	string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name
suffix	Σ	0..*	string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	Time period when name was/is in use
telecom	SΣ	0..*	ContactPoint	A contact detail for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	1..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	SΣ	1..1	string	The actual contact point details
use	?!SΣ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required)
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
gender	SΣ	1..1	code	male | female | other | unknown Binding: AdministrativeGender (required)
birthDate	SΣ	1..1	date	The date of birth for the individual
deceased[x]	?!Σ	0..1		Indicates if the individual is deceased or not
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	An address for the individual
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..*	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	SΣ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
maritalStatus		0..1	CodeableConcept	Marital (civil) status of a patient Binding: Marital Status Codes (extensible): The domestic partnership status of a person.
multipleBirth[x]		0..1		Whether patient is part of a multiple birth
multipleBirthBoolean			boolean
multipleBirthInteger			integer
photo		0..*	Attachment	Image of the patient
contact	C	0..*	BackboneElement	A contact party (e.g. guardian, partner, friend) for the patient Constraints: pat-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
relationship		0..*	CodeableConcept	The kind of relationship Binding: SHINNYRelationshipVS (extensible)
name		0..1	HumanName	A name associated with the contact person
telecom		0..*	ContactPoint	A contact detail for the person
address		0..1	Address	Address for the contact person
gender		0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
organization	C	0..1	Reference(Organization)	Organization that is associated with the contact
period		0..1	Period	The period during which this contact person or organization is valid to be contacted relating to this patient
communication	S	0..*	BackboneElement	A language which may be used to communicate with the patient about his or her health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language	S	1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible)
preferred		0..1	boolean	Language preference indicator
generalPractitioner		0..*	Reference(Organization | Practitioner | PractitionerRole)	Patient's nominated primary care provider
managingOrganization	Σ	0..1	Reference(Organization)	Organization that is the custodian of the patient record
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
other	Σ	1..1	Reference(Patient | RelatedPerson)	The other patient or related person resource that the link refers to
type	Σ	1..1	code	replaced-by | replaces | refer | seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Patient.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS From this IG
Patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier.type	extensible	SHINNYIdentiferTypeVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:MR.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:MR.type	extensible	Pattern Value: MR http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:CMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:CMS.type	extensible	Pattern Value: MA http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.identifier:SSN.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Patient.identifier:SSN.type	extensible	Pattern Value: SS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYIdentiferTypeVS From this IG
Patient.name.use	required	NameUse http://hl7.org/fhir/ValueSet/name-use|4.0.1 From the FHIR Standard
Patient.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system From the FHIR Standard
Patient.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use From the FHIR Standard
Patient.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender From the FHIR Standard
Patient.address.use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 From the FHIR Standard
Patient.address.type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 From the FHIR Standard
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Patient.maritalStatus	extensible	Marital Status Codes http://hl7.org/fhir/ValueSet/marital-status From the FHIR Standard
Patient.contact.relationship	extensible	SHINNYRelationshipVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYRelationshipVS From this IG
Patient.contact.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 From the FHIR Standard
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier http://hl7.org/fhir/us/core/ValueSet/simple-language
Patient.link.type	required	LinkType http://hl7.org/fhir/ValueSet/link-type|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
pat-1	error	Patient.contact	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()
us-core-8	error	Patient.name	Either Patient.name.given and/or Patient.name.family SHALL be present or a Data Absent Reason Extension SHALL be present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()

This structure is derived from USCorePatientProfile

Summary

Mandatory: 9 elements
Must-Support: 4 elements

Structures

This structure refers to these other structures:

• SHINNYMeta (http://shinny.org/us/ny/hrsn/StructureDefinition/SHINNYMeta)

Extensions

This structure refers to these extensions:

• http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-personal-pronouns
• http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-gender-identity
• http://shinny.org/us/ny/hrsn/StructureDefinition/middle-name

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Patient.identifier