description: 'A Group resource representing members who have opted out of Provider Access API data sharing. **Intended use:** this profile is offered as a payer-internal FHIR-based scaffolding pattern that implementers MAY adopt when their existing platform (legacy system, vendor product, internal API) cannot itself act as the authoritative reference source for opt-out determinations. Implementers whose existing systems can answer opt-out queries authoritatively are not required to use this profile. **Secondary use:** the same profile serves as the wire-format target profile for the `ConsentConstrainedMembers` output of the `$provider-member-match` operation; a ConsentConstrainedMembers Group returned by that operation conforms to this profile regardless of the mechanism the payer uses internally to determine opt-out status. **Privacy default — SHOULD suppress when opt-out status is sensitive.** Where a payer determines that disclosing opt-out status to a requesting provider would itself constitute a disclosure the member did not authorize (whether under applicable state privacy law, the member''s stated preference, or the payer''s privacy policy), the payer **SHOULD** suppress the `ConsentConstrainedMembers` output of `$provider-member-match` and instead include the affected members in the `NonMatchedMembers` Group; this makes the response indistinguishable to the requester between a true no-match and a matched-but-opted-out outcome. The internal-tracking use of this profile is unaffected by that choice. **Distinguishing master-list instances from operation-emitted response instances.** Both the payer-internal master opt-out list and the response Group emitted by `$provider-member-match` conform to this profile, so a payer storing both must distinguish them at query time. The recommended discriminator is `Group.identifier`: the payer SHOULD assign master-list instances a `Group.identifier` with a payer-defined `system` URI such as `https://{payer}/fhir/identifier/master-opt-out-list` (and a stable `value`), while operation-emitted response instances either omit `Group.identifier` or use a distinct system URI such as `https://{payer}/fhir/identifier/match-result`. Payers that prefer a tag-based discriminator MAY instead use `Group.meta.tag` with a payer-defined coding. `Group.code` is **not** a reliable discriminator here because it is fixed-pattern to `PdexMultiMemberMatchResultCS#consentconstraint` on every conformant instance (see FHIR-56493). The Payer is the managing organization, and Group.member entries reference the patients who have exercised their right to opt-out, either broadly or for specific purposes or providers.'
package_name: hl7.fhir.us.davinci-pdex
derivation: constraint
name: MemberOptOut
type: Group
elements:
  type:
    short: Type of group (members)
    mustSupport: true
    pattern: {type: Code, value: person}
    index: 2
  member:
    short: Members who have opted out
    mustSupport: true
    index: 18
    elements:
      entity:
        type: Reference
        short: Member/patient who has opted out
        mustSupport: true
        refers: ['http://hl7.org/fhir/StructureDefinition/Patient']
        index: 19
        extensions:
          optOutDetails: {url: 'http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/opt-out-details', min: 0, max: 1, type: Extension, short: Details of the member's opt-out, index: 20}
        elements:
          extension:
            type: Extension
            short: Details of the member's opt-out
            url: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/opt-out-details
            index: 20
            slicing:
              slices:
                optOutDetails:
                  match: {}
                  schema: {type: Extension, short: Details of the member's opt-out, url: 'http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/opt-out-details', index: 20}
                  min: 0
                  max: 1
      inactive: {short: Whether the opt-out is currently active, index: 21}
  characteristic:
    short: Opt-out characteristics and scope
    mustSupport: true
    index: 7
    extensions:
      optOutReason: {url: 'http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/opt-out-reason', min: 0, max: 1, type: Extension, short: Reason for the opt-out, index: 9}
    elements:
      extension:
        index: 8
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            optOutReason:
              match: {url: null}
              schema: {type: Extension, short: Reason for the opt-out, url: 'http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/opt-out-reason', index: 9}
              min: 0
              max: 1
      code:
        short: Identifies this as a consent constraint group
        mustSupport: true
        pattern:
          type: CodeableConcept
          value:
            coding:
            - {code: consentconstraint, system: 'http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PdexMultiMemberMatchResultCS', display: Consent Constraint}
        index: 10
        elements:
          coding:
            binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pdex/ValueSet/PDexMultiMemberMatchResultVS'}
            index: 11
      value:
        short: The type of opt-out
        mustSupport: true
        choices: [valueCodeableConcept]
        index: 13
      valueCodeableConcept: {type: CodeableConcept, short: The type of opt-out, mustSupport: true, choiceOf: value, index: 14}
      exclude:
        short: This is an include, not an exclude
        pattern: {type: Boolean, value: false}
        index: 15
      period:
        short: Period during which the opt-out is effective
        mustSupport: true
        index: 16
        elements:
          start: {short: Opt-out effective date, mustSupport: true, index: 17}
  active:
    short: Opt-out group is active
    mustSupport: true
    pattern: {type: Boolean, value: true}
    index: 1
  code:
    short: Kind of group (opt-out)
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pdex/ValueSet/PDexMultiMemberMatchResultVS'}
    mustSupport: true
    pattern:
      type: CodeableConcept
      value:
        coding:
        - {code: consentconstraint, system: 'http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PdexMultiMemberMatchResultCS', display: Consent Constraint}
    index: 4
  identifier: {short: Unique identifier for the opt-out group, mustSupport: true, index: 0}
  quantity: {short: Number of members who have opted out, mustSupport: true, index: 5}
  managingEntity:
    type: Reference
    short: The Payer managing this opt-out group
    mustSupport: true
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    index: 6
  actual:
    short: This is an actual collection of members
    mustSupport: true
    pattern: {type: Boolean, value: true}
    index: 3
package_version: 2.2.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-opt-out
base: http://hl7.org/fhir/StructureDefinition/Group
version: 2.2.0