PackagesCanonicalsLogsProblems
    Packages
    BCPatientSummary.Draft@0.0.1-draft
    http://hl7.org/fhir/StructureDefinition/Patient
{
  "description": "Base StructureDefinition for Patient Resource",
  "_filename": "Patient.json",
  "package_name": "BCPatientSummary.Draft",
  "date": "2019-02-28T20:28:38.06275+00:00",
  "derivation": "specialization",
  "meta": {
    "lastUpdated": "2019-02-28T20:28:39.0983383+00:00"
  },
  "publisher": "Island Health",
  "fhirVersion": "3.0.1",
  "purpose": "Tracking patient is the center of the healthcare process.",
  "name": "Patient",
  "mapping": [ {
    "uri": "http://hl7.org/v3",
    "name": "RIM Mapping",
    "identity": "rim"
  }, {
    "uri": "http://hl7.org/v3/cda",
    "name": "CDA (R2)",
    "identity": "cda"
  }, {
    "uri": "http://hl7.org/fhir/w5",
    "name": "W5 Mapping",
    "identity": "w5"
  }, {
    "uri": "http://hl7.org/v2",
    "name": "HL7 v2 Mapping",
    "identity": "v2"
  }, {
    "uri": "http://loinc.org",
    "name": "LOINC code for the element",
    "identity": "loinc"
  } ],
  "abstract": false,
  "copyright": "Island Health 2018",
  "type": "Patient",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": "Patient",
  "package_version": "0.0.1-draft",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger": 5
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "pa"
  } ],
  "status": "draft",
  "id": "9e0b8157-dfff-4b00-8095-b81545c35c36",
  "kind": "resource",
  "url": "http://hl7.org/fhir/StructureDefinition/Patient",
  "identifier": [ {
    "use": "official"
  } ],
  "version": "0.1",
  "differential": {
    "element": [ {
      "id": "Patient",
      "path": "Patient",
      "alias": [ "SubjectOfCare Client Resident" ],
      "short": "Information about an individual or animal receiving health care services",
      "mapping": [ {
        "map": "Patient[classCode=PAT]",
        "identity": "rim"
      }, {
        "map": "ClinicalDocument.recordTarget.patientRole",
        "identity": "cda"
      }, {
        "map": "administrative.individual",
        "identity": "w5"
      } ],
      "definition": "Demographics and other administrative information about an individual or animal receiving care or other health-related services."
    }, {
      "id": "Patient.meta.lastUpdated",
      "path": "Patient.meta.lastUpdated",
      "defaultValueInstant": "2018-03-15T00:00:00-07:00"
    }, {
      "id": "Patient.Identifier",
      "path": "Patient.identifier",
      "type": [ {
        "code": "Identifier",
        "profile": "Patient"
      } ],
      "short": "An identifier for this patient",
      "mapping": [ {
        "map": "PID-3",
        "identity": "v2"
      }, {
        "map": "id",
        "identity": "rim"
      }, {
        "map": ".id",
        "identity": "cda"
      }, {
        "map": "id",
        "identity": "w5"
      } ],
      "isSummary": true,
      "definition": "An identifier for this patient.",
      "requirements": "Patients are almost always assigned specific numerical identifiers."
    }, {
      "path": "Patient.active",
      "requirements": "Need to be able to mark a patient record as not to be used because it was created in error.",
      "definition": "Whether this patient record is in active use.",
      "isModifier": true,
      "short": "Whether this patient's record is in active use",
      "mapping": [ {
        "map": "statusCode",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      }, {
        "map": "status",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "boolean"
      } ],
      "defaultValueBoolean": true,
      "max": "1",
      "id": "Patient.boolean",
      "comment": "Default is true. If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient\n\nThis element is labeled as a modifier because when the patient record is marked as not active it is not expected to be used/referenced without being changed back to active.",
      "isSummary": true
    }, {
      "path": "Patient.name",
      "requirements": "Need to be able to track the patient by multiple names. Examples are your official name and a partner name.",
      "definition": "A name associated with the individual.",
      "short": "A name associated with the patient",
      "mapping": [ {
        "map": "PID-5, PID-9",
        "identity": "v2"
      }, {
        "map": "name",
        "identity": "rim"
      }, {
        "map": ".patient.name",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "HumanName"
      } ],
      "id": "Patient.HumanName",
      "comment": "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.",
      "isSummary": true
    }, {
      "path": "Patient.telecom",
      "requirements": "People have (primary) ways to contact them in some way such as phone, email.",
      "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",
      "mapping": [ {
        "map": "PID-13, PID-14, PID-40",
        "identity": "v2"
      }, {
        "map": "telecom",
        "identity": "rim"
      }, {
        "map": ".telecom",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "ContactPoint"
      } ],
      "id": "Patient.ContactPoint",
      "comment": "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 may 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).",
      "isSummary": true
    }, {
      "path": "Patient.gender",
      "requirements": "Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.",
      "definition": "Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.",
      "short": "male | female | other | unknown",
      "mapping": [ {
        "map": "PID-8",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender",
        "identity": "rim"
      }, {
        "map": ".patient.administrativeGenderCode",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "AdministrativeGender"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "The gender of a person used for administrative purposes.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/administrative-gender"
        }
      },
      "max": "1",
      "id": "Patient.code",
      "comment": "The gender may 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 M and F, though the vast majority of systems and contexts only support M and F.  Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, 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, chromosonal and other gender aspects.  For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a \"hard\" error.",
      "isSummary": true
    }, {
      "path": "Patient.birthDate",
      "requirements": "Age of the individual drives many clinical processes.",
      "definition": "The date of birth for the individual.",
      "short": "The date of birth for the individual",
      "mapping": [ {
        "map": "PID-7",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime",
        "identity": "rim"
      }, {
        "map": ".patient.birthTime",
        "identity": "cda"
      }, {
        "map": "21112-8",
        "identity": "loinc"
      } ],
      "type": [ {
        "code": "date"
      } ],
      "max": "1",
      "id": "Patient.date",
      "comment": "At least an estimated year should be provided as a guess if the real DOB is unknown  There is a standard extension \"patient-birthTime\" available that should be used where Time is required (such as in maternaty/infant care systems).",
      "isSummary": true
    }, {
      "path": "Patient.deceased[x]",
      "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.",
      "definition": "Indicates if the individual is deceased or not.",
      "isModifier": true,
      "short": "Indicates if the individual is deceased or not",
      "mapping": [ {
        "map": "PID-30  (bool) and PID-29 (datetime)",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "boolean"
      }, {
        "code": "dateTime"
      } ],
      "max": "1",
      "id": "Patient.boolean",
      "comment": "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.\n\nThis 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.",
      "isSummary": true
    }, {
      "path": "Patient.address",
      "requirements": "May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.",
      "definition": "Addresses for the individual.",
      "short": "Addresses for the individual",
      "mapping": [ {
        "map": "PID-11",
        "identity": "v2"
      }, {
        "map": "addr",
        "identity": "rim"
      }, {
        "map": ".addr",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "Address"
      } ],
      "id": "Patient.Address",
      "comment": "Patient may have multiple addresses with different uses or applicable periods.",
      "isSummary": true
    }, {
      "path": "Patient.maritalStatus",
      "requirements": "Most, if not all systems capture it.",
      "definition": "This field contains a patient's most recent marital (civil) status.",
      "short": "Marital (civil) status of a patient",
      "mapping": [ {
        "map": "PID-16",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN]/maritalStatusCode",
        "identity": "rim"
      }, {
        "map": ".patient.maritalStatusCode",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MaritalStatus"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "The domestic partnership status of a person.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/marital-status"
        }
      },
      "max": "1",
      "id": "Patient.CodeableConcept"
    }, {
      "path": "Patient.multipleBirth[x]",
      "requirements": "For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.",
      "definition": "Indicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer).",
      "short": "Whether patient is part of a multiple birth",
      "mapping": [ {
        "map": "PID-24 (bool), PID-25 (integer)",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd,  player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "boolean"
      }, {
        "code": "integer"
      } ],
      "max": "1",
      "id": "Patient.boolean",
      "comment": "Where the valueInteger is provided, the number is the birth number in the sequence.\nE.g. The middle birth in tripplets would be valueInteger=2 and the third born would have valueInteger=3\nIf a bool value was provided for this tripplets examle, then all 3 patient records would have valueBool=true (the ordering is not indicated)."
    }, {
      "id": "Patient.Attachment",
      "path": "Patient.photo",
      "type": [ {
        "code": "Attachment"
      } ],
      "short": "Image of the patient",
      "mapping": [ {
        "map": "OBX-5 - needs a profile",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "definition": "Image of the patient.",
      "requirements": "Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too."
    }, {
      "constraint": [ {
        "key": "pat-1",
        "human": "SHALL at least contain a contact's details or a reference to an organization",
        "xpath": "exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization)",
        "severity": "error",
        "expression": "name.exists() or telecom.exists() or address.exists() or organization.exists()"
      } ],
      "path": "Patient.contact",
      "requirements": "Need to track people you can contact about the patient.",
      "definition": "A contact party (e.g. guardian, partner, friend) for the patient.",
      "short": "A contact party (e.g. guardian, partner, friend) for the patient",
      "mapping": [ {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
        "valueString": "Contact"
      } ],
      "id": "Patient.BackboneElement",
      "comment": "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."
    }, {
      "id": "Patient.BackboneElement.CodeableConcept",
      "path": "Patient.contact.relationship",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "The kind of relationship",
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "ContactRelationship"
        } ],
        "description": "The nature of the relationship between a patient and a contact person for that patient.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/v2-0131"
        }
      },
      "mapping": [ {
        "map": "NK1-7, NK1-3",
        "identity": "v2"
      }, {
        "map": "code",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "definition": "The nature of the relationship between the patient and the contact person.",
      "requirements": "Used to determine which contact person is the most relevant to approach, depending on circumstances."
    }, {
      "id": "Patient.BackboneElement.HumanName",
      "max": "1",
      "path": "Patient.contact.name",
      "type": [ {
        "code": "HumanName"
      } ],
      "short": "A name associated with the contact person",
      "mapping": [ {
        "map": "NK1-2",
        "identity": "v2"
      }, {
        "map": "name",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "definition": "A name associated with the contact person.",
      "requirements": "Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person."
    }, {
      "id": "Patient.BackboneElement.ContactPoint",
      "path": "Patient.contact.telecom",
      "type": [ {
        "code": "ContactPoint"
      } ],
      "short": "A contact detail for the person",
      "comment": "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.",
      "mapping": [ {
        "map": "NK1-5, NK1-6, NK1-40",
        "identity": "v2"
      }, {
        "map": "telecom",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "definition": "A contact detail for the person, e.g. a telephone number or an email address.",
      "requirements": "People have (primary) ways to contact them in some way such as phone, email."
    }, {
      "id": "Patient.BackboneElement.Address",
      "max": "1",
      "path": "Patient.contact.address",
      "type": [ {
        "code": "Address"
      } ],
      "short": "Address for the contact person",
      "mapping": [ {
        "map": "NK1-4",
        "identity": "v2"
      }, {
        "map": "addr",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "definition": "Address for the contact person.",
      "requirements": "Need to keep track where the contact person can be contacted per postal mail or visited."
    }, {
      "path": "Patient.contact.gender",
      "requirements": "Needed to address the person correctly.",
      "definition": "Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.",
      "short": "male | female | other | unknown",
      "mapping": [ {
        "map": "NK1-15",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "AdministrativeGender"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "The gender of a person used for administrative purposes.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/administrative-gender"
        }
      },
      "max": "1",
      "id": "Patient.BackboneElement.code"
    }, {
      "path": "Patient.contact.organization",
      "requirements": "For guardians or business related contacts, the organization is relevant.",
      "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",
      "mapping": [ {
        "map": "NK1-13, NK1-30, NK1-31, NK1-32, NK1-41",
        "identity": "v2"
      }, {
        "map": "scoper",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
      } ],
      "max": "1",
      "id": "Patient.BackboneElement.Reference",
      "condition": [ "pat-1" ]
    }, {
      "id": "Patient.BackboneElement.Period",
      "max": "1",
      "path": "Patient.contact.period",
      "type": [ {
        "code": "Period"
      } ],
      "short": "The period during which this contact person or organization is valid to be contacted relating to this patient",
      "mapping": [ {
        "map": "effectiveTime",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "definition": "The period during which this contact person or organization is valid to be contacted relating to this patient."
    }, {
      "path": "Patient.animal",
      "requirements": "Many clinical systems are extended to care for animal patients as well as human.",
      "definition": "This patient is known to be an animal.",
      "isModifier": true,
      "short": "This patient is known to be an animal (non-human)",
      "mapping": [ {
        "map": "player[classCode=ANM]",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
        "valueString": "Animal"
      } ],
      "max": "1",
      "id": "Patient.BackboneElement",
      "comment": "The animal element is labeled \"Is Modifier\" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records.   The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required.  (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).",
      "isSummary": true
    }, {
      "path": "Patient.animal.species",
      "requirements": "Need to know what kind of animal.",
      "min": 1,
      "definition": "Identifies the high level taxonomic categorization of the kind of animal.",
      "short": "E.g. Dog, Cow",
      "mapping": [ {
        "map": "PID-35",
        "identity": "v2"
      }, {
        "map": "code",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "example",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "AnimalSpecies"
        } ],
        "description": "The species of an animal.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/animal-species"
        }
      },
      "max": "1",
      "id": "Patient.BackboneElement.CodeableConcept",
      "comment": "If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification.  It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species.  (The common example is that the word \"Hereford\" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for \"Hereford Cattle Breed\" does.).",
      "isSummary": true
    }, {
      "path": "Patient.animal.breed",
      "requirements": "May need to know the specific kind within the species.",
      "definition": "Identifies the detailed categorization of the kind of animal.",
      "short": "E.g. Poodle, Angus",
      "mapping": [ {
        "map": "PID-37",
        "identity": "v2"
      }, {
        "map": "playedRole[classCode=GEN]/scoper[classCode=ANM, determinerCode=KIND]/code",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "example",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "AnimalBreed"
        } ],
        "description": "The breed of an animal.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/animal-breeds"
        }
      },
      "max": "1",
      "id": "Patient.BackboneElement.CodeableConcept",
      "comment": "Breed MAY be used to provide further taxonomic or non-taxonomic classification.  It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.",
      "isSummary": true
    }, {
      "path": "Patient.animal.genderStatus",
      "requirements": "Gender status can affect housing and animal behavior.",
      "definition": "Indicates the current state of the animal's reproductive organs.",
      "short": "E.g. Neutered, Intact",
      "mapping": [ {
        "map": "N/A",
        "identity": "v2"
      }, {
        "map": "genderStatusCode",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "example",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "AnimalGenderStatus"
        } ],
        "description": "The state of the animal's reproductive organs.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/animal-genderstatus"
        }
      },
      "max": "1",
      "id": "Patient.BackboneElement.CodeableConcept",
      "isSummary": true
    }, {
      "id": "Patient.BackboneElement",
      "path": "Patient.communication",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "short": "A list of Languages which may be used to communicate with the patient about his or her health",
      "comment": "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.",
      "mapping": [ {
        "map": "LanguageCommunication",
        "identity": "rim"
      }, {
        "map": "patient.languageCommunication",
        "identity": "cda"
      } ],
      "definition": "Languages which may be used to communicate with the patient about his or her health.",
      "requirements": "If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest."
    }, {
      "path": "Patient.communication.language",
      "requirements": "Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.",
      "min": 1,
      "definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
      "short": "The language which can be used to communicate with the patient about his or her health",
      "mapping": [ {
        "map": "PID-15, LAN-2",
        "identity": "v2"
      }, {
        "map": "player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code",
        "identity": "rim"
      }, {
        "map": ".languageCode",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
          "valueReference": {
            "reference": "http://hl7.org/fhir/ValueSet/all-languages"
          }
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "Language"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A human language.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/languages"
        }
      },
      "max": "1",
      "id": "Patient.BackboneElement.CodeableConcept",
      "comment": "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."
    }, {
      "path": "Patient.communication.preferred",
      "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.",
      "definition": "Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).",
      "short": "Language preference indicator",
      "mapping": [ {
        "map": "PID-15",
        "identity": "v2"
      }, {
        "map": "preferenceInd",
        "identity": "rim"
      }, {
        "map": ".preferenceInd",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "boolean"
      } ],
      "max": "1",
      "id": "Patient.BackboneElement.boolean",
      "comment": "This language is specifically identified for communicating healthcare information."
    }, {
      "id": "Patient.Reference",
      "path": "Patient.generalPractitioner",
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner"
      } ],
      "alias": [ "careProvider" ],
      "short": "Patient's nominated primary care provider",
      "comment": "This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles.\n\nIt 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.",
      "mapping": [ {
        "map": "PD1-4",
        "identity": "v2"
      }, {
        "map": "subjectOf.CareEvent.performer.AssignedEntity",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "definition": "Patient's nominated care provider."
    }, {
      "path": "Patient.managingOrganization",
      "requirements": "Need to know who recognizes this patient record, manages and updates it.",
      "definition": "Organization that is the custodian of the patient record.",
      "short": "Organization that is the custodian of the patient record",
      "mapping": [ {
        "map": "scoper",
        "identity": "rim"
      }, {
        "map": ".providerOrganization",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
      } ],
      "max": "1",
      "id": "Patient.Reference",
      "comment": "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).",
      "isSummary": true
    }, {
      "path": "Patient.link",
      "requirements": "There are multiple usecases: \n\n* Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers.",
      "definition": "Link to another patient resource that concerns the same actual patient.",
      "isModifier": true,
      "short": "Link to another patient resource that concerns the same actual person",
      "mapping": [ {
        "map": "outboundLink",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "id": "Patient.BackboneElement",
      "comment": "There is no assumption that linked patient records have mutual links. \n\nThis element is labelled as a modifier because it may 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'.",
      "isSummary": true
    }, {
      "path": "Patient.link.other",
      "min": 1,
      "definition": "The other patient resource that the link refers to.",
      "short": "The other patient or related person resource that the link refers to",
      "mapping": [ {
        "map": "PID-3, MRG-1",
        "identity": "v2"
      }, {
        "map": "id",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
      } ],
      "max": "1",
      "id": "Patient.BackboneElement.Reference",
      "comment": "Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.",
      "isSummary": true
    }, {
      "path": "Patient.link.type",
      "min": 1,
      "definition": "The type of link between this patient resource and another patient resource.",
      "short": "replaced-by | replaces | refer | seealso - type of link",
      "mapping": [ {
        "map": "typeCode",
        "identity": "rim"
      }, {
        "map": "n/a",
        "identity": "cda"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "LinkType"
        } ],
        "description": "The type of link between this patient resource and another patient resource.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/link-type"
        }
      },
      "max": "1",
      "id": "Patient.BackboneElement.code",
      "isSummary": true
    } ]
  },
  "contact": [ {
    "telecom": [ {
      "value": "http://hl7.org/fhir",
      "system": "url"
    } ]
  }, {
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/pafm/index.cfm",
      "system": "url"
    } ]
  } ],
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}