Generated Narrative: StructureDefinition plugin-patient Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Patient 0..* NlcorePatient Patient #xD; identifier S 1..* Identifier PatientIdentificationNumber #xD; Slices for identifier Content/Rules for all slices #xD; identifier:patientnummer S 1..1 Identifier Patiëntnummer zoals door zorgverleners gebruikt en getoond in het EPD Required Pattern: At least the following #xD; type 1..1 CodeableConcept Description of identifier Fixed Value: (Complex) #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: MR #xD; type 1..1 CodeableConcept Description of identifier #xD; value 1..1 string Patiëntnummer #xD; identifier:zorgttp S 0..1 Identifier Identifier zoals uitgegeven door ZorgTTP #xD; name S 0..* HumanName NameInformation / PayerName #xD; Slices for name Content/Rules for all slices #xD; name:nameInformation S 0..2 NlcoreNameInformation NameInformation #xD; family S 0..1 string Family name (often called 'Surname') #xD; gender S 0..1 code Gender #xD; birthDate S 0..1 date DateOfBirth #xD; deceased[x] S 0..1 boolean, dateTime Indicates if the individual is deceased or not #xD; Slices for deceased[x] Content/Rules for all slices #xD; deceased[x]:deceasedDateTime S 0..1 dateTime DateOfDeath #xD; address #xD; use S 0..1 code AddressType #xD; postalCode S 0..1 string Postcode #xD; country S 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code) #xD; multipleBirth[x] S 0..1 boolean, integer Whether patient is part of a multiple birth #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
Maturity Level: 1 Draft. Describes the Patient resource as used by the Dutch PLUGIN project. Inherits from [nl-core-Patient](https://simplifier.net/nictiz-r4-zib2020/nlcorepatient). Open issues see [Github](https://github.com/orgs/plugin-healthcare/projects/7/views/8?filterQuery=fhir-profile%3APluginPatient).
Used by permission of the PLUGIN team, all rights reserved Creative Commons License
Demographics and other administrative information about an individual or animal receiving care or other health-related services.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Due to the nature of the nationality core extension (which allows for a period to be placed next to the nationality and thus allows for different nationalities over time), the cardinality of the extension is left at `0..*` instead of the zib cardinality of `0..1`.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Code representing nationality of patient.
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/extensibility.html) for a list).
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
The patient’s identification number. In transfer situations, use of the social security number (BSN) must comply with the Use of Social Security Numbers in Healthcare Act (Wbsn-z). In other situations, other number systems can be used, such as internal hospital patient numbers for example.
Patients are almost always assigned specific numerical identifiers.
Patiëntnummer zoals door zorgverleners gebruikt en getoond in het EPD
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Identifier zoals uitgegeven door ZorgTTP
Whether this patient's record is in active use
Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Need to be able to mark a patient record as not to be used because it was created in error.
This resource is generally assumed to be active if no value is provided for the active element
This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid
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.
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
This slice represents the person's official name information, including given names, last name and possibly the partner's last name.
This `.name` element accomodates the official parts of a Dutch name according to common international usage and optionally to the [zib NameInformation v1.1 (2020)](https://zibs.nl/wiki/NameInformation-v1.1(2020EN)). An official Dutch name is represented in FHIR as an ordinary international name, optionally augmented using extensions to specify how the last name is built up according to the Dutch rules if conformance to the zib is required. See the guidance on `.family` and on `.extension:nameUsage` for more information. Systems that need to work in a Dutch context SHOULD support the extensions as specified in `.given`, `.family` and `.extension:nameUsage`. In addition, systems SHOULD use the core elements according to the FHIR specifications to provide compatibility outside Dutch contexts. This means that: * If parts of the name are specified using one or more of the structured elements, the `.text` element SHOULD be populated with a rendered version of the full name. * If parts of the family name are specified using the extensions in `.family`, the `.family` element SHOULD be populated with the full family name. **Note 1**: The zib cannot be represented straightforward in FHIR. Especially note the guidance on `.given` on how to map the FirstNames and Initials concepts, and on `.prefix`/`.suffix` on how to map the Titles concept. **Note 2**: This element should only contain a person's _official_ names. The GivenName concept is represented in another `.name` element with `.name.use` = _usual_. **Note 3**: The examples illustrate how the zib is mapped to FHIR.
If a prefix for a family name is specified, the family name is expected as well
family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty().not() implies family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty().not()
If the prefix for a partner family name is specified, the partner family name is expected as well
family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix').empty().not() implies family.extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-name').empty().not()
If parts of the name are specified using one or more of the structured elements, the `.text` element SHOULD be populated with a rendered version of the full name. This ensures compatibility with common FHIR usage.
(family.exists() or given.extension.where(url = 'http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').where(value != 'IN').exists()) implies text.hasValue()
A code that represents the preferred display order of the components of this human name.
This concept indicates the last name or order of last names with which the person is to be addressed.
Use ConceptMap NaamgebruikCodelijst-to-HumanNameAssemblyOrder to translate terminology from the functional model to profile terminology in ValueSet HumanNameAssemblyOrder.
usual | official | temp | nickname | anonymous | old | maiden
Applications can assume that a name is current unless it explicitly says that it is temporary or old.
Allows the appropriate name for a particular context of use to be selected from among a set of names.
This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one
XPN.7, but often indicated by which field contains the name
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
A representation of the full name, including given names and the family name. When implementing zib NameInformation, this representation should include the FirstNames or Initials and the family name constructed according to the NameUsage concept.
FirstNames (implicit, main mapping is on .given)
Initials (implicit, main mapping is on .given)
NameUsage (implicit, main mapping is on extension:nameUsage)
Prefix (implicit, main mapping is on .family.extension:prefix)
LastName (implicit, main mapping is on .family.extension:lastName)
PartnerPrefix (implicit, main mapping is on .family.extension:partnerPrefix)
PartnerLastName (implicit, main mapping is on .family.extension:partnerLastName)
The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.
When implementing zib NameInformation, this representation should be constrcuted from the Prefix, LastName, PartnerPrefix and/or PartnerLastName concepts according to the NameUsage concept.
If parts of the family name are specified using the extensions in .family, the .family element SHOULD be populated with the full family name as well. This ensures compatibility with common FHIR usage.
(extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').exists() or extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').exists() or extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-prefix').exists() or extension('http://hl7.org/fhir/StructureDefinition/humanname-partner-name').exists()) implies $this.hasValue()
unique id for the element within a resource (for internal references)
Voorvoegsel derived from person's own surname
The prefix portion (e.g. voorvoegsel) of the family name that is derived from the person's own surname, as distinguished from any portion that is derived from the surname of the person's partner or spouse.
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
Portion derived from person's own surname
The portion of the family name that is derived from the person's own surname, as distinguished from any portion that is derived from the surname of the person's partner or spouse.
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Voorvoegsel derived from person's partner's surname
The prefix portion (e.g. voorvoegsel) of the family name that is derived from the person's partner's surname, as distinguished from any portion that is derived from the surname of the person's own.
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to identify it as a separate sub-component.
Portion derived from person's partner's surname
The portion of the family name that is derived from the person's partner's surname, as distinguished from any portion that is derived from the surname of the person's own name.
One of a person’s official first names or the initial if the full name is not known.
This element can be used to represent full given names or initials. `extension:givenOrInitial` SHALL be used on each repretition to specifiy if it's a full name (_BR_) or an initial (_IN_). ## Zib compatibility Tthis element is used to represent the FirstNames and Initials concepts of zib NameInformation, but the FHIR implementation deviates from the zib model. The zib defines these concepts as a list of official first names (as a single string) and a list of initials (as a single string), both optional. They both represent the official name(s) of a person and thus represent the same concept. In FHIR however, each first name is either a complete name or an initial, but not both. In addition, each name may be defined separately. Therefore, the zib concepts are implemented here in the following way: * Systems SHOULD use a `.given` element for each official first name that they know of (either as a full name or an initial), in order of appearance (as specified by FHIR). * Each of these elements: * SHOULD be populated with the complete name if it is known, or with the initial if no more information is available. * As noted, it SHALL be augmented with `extension:givenOrInitial`. Initials should thus not be communicated for each complete first name that is known, in contrast to what is specified by the zib. Receiving systems can recreate initials from the full names if needed. If a system _does_ however only have a list of official first names and a separate list of official initials, without knowing the relationship between these two, only the full names SHOULD be communicated, while an additional `.name` instance MAY be used to communicate the initials. It is expected that the second instance just contains the initials and no other information from the zib. Receiving systems MAY ignore the second instance. **Note 1:** The GivenName concept should not be included here but in a separate `.name` instance where `.use` = _usual_. **Note 2**: As specified by FHIR, multiple official first names MAY be combined in a single `.given` element (separated by spaces), as long as the `.given` elements can be concatenated to form the full first name representation, and the 'extension:givenOrInitial` is used to mark the element as containing either full names or the initials. This pattern is strongly discouraged as it is hard to determine if the value pertains multiple names or a single combined name containing spaces.
Given Names appear in the correct order for presenting the name
LS | AC | NB | PR | HON | BR | AD | SP | MID | CL | IN | VV
A set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type.
Used to indicate additional information about the name part and how it should be used.
Noble and scientific titles. These can assist in formulating oral and formal addresing titles.
The zib concept 'titles' is mapped to elements `HumanName.prefix` and `HumanName.suffix`. Semantically this mapping is not complete: the zib uses a single concept that contains all the required information about noble and scientific titles, while FHIR captures the same information in a structured way. **Export:** Systems are expected to transform as much as possible to the FHIR datamodel and thereby to be as explicit as possible. Note that in order to mark the type of a prefix, you can use the FHIR standard extension for ISO 21090 EN Qualifiers. Examples include the use of the qualifier _HON_ to indicate honorific prefixes and _AC_ for academic prefixes. If it is not possible to breakup the zib concept titles to positioned prefixes and suffixes, the prefix element is used to store all information. **Import:** Systems need to expect and be resilient for a broader range of information stored in the prefix element than stated by it's definition.
Prefixes appear in the correct order for presenting the name
Suffixes appear in the correct order for presenting the name
Indicates the period of time when this name was valid for the named person.
Allows names to be placed in historical context.
This slice represents the name information normally used to address the person.
This `.name` element represents the Dutch given name ("roepnaam") according to the [zib NameInformation v1.1 (2020)](https://zibs.nl/wiki/NameInformation-v1.1(2020EN)). **Note 1**: This element should only contain a person's _unofficial_ name. The official names are represented in one or more other `.name` elements with `.name.use` = _official_. **Note 2**: The examples illustrate how the zib is mapped to FHIR.
Patient’s telephone number(s) or e-mail address(es).
The cardinality mismatch between the zib (`0..1`) and FHIR (`0..*`) is explained by the containers TelephoneNumbers (`0..*`) and EmailAddresses (`0..*`) inside the ContactInformation model. The FHIR datatype ContactPoint does not have these containers.
People have (primary) ways to contact them in some way such as phone, email.
Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc.
Implementation of the "TelephoneNumbers" concept of zib ContactInformation. Please note that, although the zib concepts TelecomType and NumberType are functionally equivalent to the FHIR concepts `ContactPoint.system` and `ContactPoint.use` respectively, a mismatch occurs on the concept of mobile phone numbers; the zib uses the first concept and FHIR the second. For this reason, the ValueSet on `ContactPoint.system` is too narrow and the zib code will need to be communicated using the ext-CodeSpecification extension.
A system is required if a value is provided.
not(exists(f:value)) or exists(f:system)
Implementation of the "EmailAddresses" concept of zib ContactInformation.
The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
Needed for identification of the individual, in combination with (at least) name and birth date.
Use ConceptMap GeslachtCodelijst-to-AdministrativeGender to translate terminology from the functional model to profile terminology in ValueSet AdministrativeGender.
player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
Optional Extension Element - found in all resources.
Patient’s date of birth. The date of birth is mandatory for a patient. A vague date (such as only the year) is permitted.
At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).
Age of the individual drives many clinical processes.
player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime
Indicates if the individual is deceased or not
Indicates if the individual is deceased or not.
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.
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.
This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.
player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime
The date on which the patient died. A ‘vague’ date, such as only the year, is permitted.
The zib recognizes both the DeathIndicator (boolean) and DateOfDeath (datetime) concepts, whereas in FHIR only one of these concepts may be present. Therefore, if deceasedDateTime is present and has a value, its value can be mapped to DateOfDeath and DeathIndicator is assumed to be true.
An indication stating whether the patient has died.
An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations which might not be valid for mail delivery. There are a variety of postal address formats defined around the world.
This datatype defines a common basis for expressing all addresses around the world, but adds extensions to express Dutch addresses specifically, according to the [zib AddressInformation v1.1 (2020)](https://zibs.nl/wiki/AddressInformation-v1.1(2020EN)). A Dutch Address still is a proper FHIR Address, which means that systems that cannot interpret the extensions will still be able to render and work with this datatype. To have true compatibility an implementer SHOULD use the core Address parts as intended. To have addresses work for Dutch context, the implementer SHOULD in addition use the extension elements. **Separate address parts** The first addition is that Dutch addresses make certain address parts separately communicable. These parts are required for use in true Dutch systems when dealing with Dutch addresses, but may not have value for international systems when information gets sent abroad. **Custom address types** The second addition is that the zib defines its own ValueSet for address types, which can only be partially expressed using the FHIR Address datatype and requires a mapping to multiple elements. The table below explains how the zib concepts are mapped to the various FHIR elements (see the ConceptMaps <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressUse> and <http://nictiz.nl/fhir/ConceptMap/AdresSoortCodelijst-to-AddressType> as well). The code from the zib should also be included using the extension on `Address.extension:addressType`. | zib | .ext:addressType | .use | .type | |-----------------------------------|------------------|------|----------| | Postal Address/Postadres | PST | | postal | | Primary Home/Officieel adres | HP | home | both | | Visit Address/Woon-/verblijfadres | PHYS | home | physical | | Temporary Address/Tijdelijk adres | TMP | temp | | | Work Place/Werkadres | WP | work | | | Vacation Home/Vakantie adres | HV | temp | | If `Address.type` is _both_ then this is to be understood as a dual purpose address (postal and physical), unless a specific _postal_ type address is added. Systems that support importing it like this are encouraged to do so, otherwise they may need to import this as two separate addresses. Note: FHIR core defines the AD-use extension to further specify the postal address type. However, the ValueSet used in that extension doesn't completely match the zib ValueSet. Therefore, a custom extension has been made. This doesn't preclude the use of the AD-use extension.
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
The type of address in question, such as a home address or mailing address.
Applications can assume that an address is current unless it explicitly says that it is temporary or old.
Allows an appropriate address to be chosen from a list of many.
This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
Use ConceptMap AdresSoortCodelijst-to-AddressUse to translate terminology from the functional model to profile terminology in ValueSet AddressUse.
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the [Location](http://hl7.org/fhir/R4/location.html#) resource).
Use ConceptMap AdresSoortCodelijst-to-AddressType to translate terminology from the functional model to profile terminology in ValueSet AddressType.
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
XAD.1 + XAD.2 + XAD.3 + XAD.4 + XAD.5 + XAD.6
Street name, number, direction & P.O. Box etc.
This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.
The mapping of zib AddressInformation on the FHIR Address datatype is the result of compatibility with HL7v3, which is the format that a lot of healthcare data in the Netherlands is stored in. The elements of Address stored in the address-part extensions will be ignored by applications that do not support them, so any information in them should also be duplicated in the `Address.line` to which they are attached. The value of `Address.line` should be populated with a complete string representation of all the separate extension values, like: "[Street] [HouseNumberIndication] [HouseNumber] [HouseNumberLetter] [HouseNumberAddition]".
The order in which lines should appear in an address label
XAD.1 + XAD.2 (note: XAD.1 and XAD.2 have different meanings for a company address than for a person address)
The number of a building, house or lot alongside the street. Also known as "primary street number". This does not number the street but rather the building.
Any alphabetic character, fraction or other text that may appear after the numeric portion of a building number.
Export: - If a HouseNumberLetter as well as a HouseNumberAddition is known: HouseNumberLetter first, followed by a space and finally the HouseNumberAddition. - If only a HouseNumberLetter is known, send just that. No trailing space is required. - If only a HouseNumberAddition is known, communicate that with a leading space. Import - If the value of buildingNumberSuffix contains no space, then the whole value is considered to be the HouseNumberLetter. - If the value of buildingNumberSuffix contains a space, then everything before the first space is considered to be the HouseNumberLetter, and the everything trailing the first space is considered to be the HouseNumberAddition. Note: While a leading space is allowed in string values in FHIR, the parsing of such space cannot be guaranteed in XML representations. Although aware of this issue, this mapping is not changed because of compatibility reasons. If an implementer cannot parse a leading space, the practical risk of mapping a HouseNumberIndication to a HouseNumberAddition is deemed insignificant.
This can be a unit designator, such as apartment number, suite number, or floor. There may be several unit designators in an address (e.g., "3rd floor, Appt. 342"). This can also be a designator pointing away from the location, rather than specifying a smaller location within some larger one (e.g., Dutch "t.o." means "opposite to" for house boats located across the street facing houses).
The indication used for addresses which do not consist of the usual street name and house number.
The mapping of zib AddressInformation on the FHIR Address datatype is the result of compatibility with HL7v3, which is the format that a lot of healthcare data in the Netherlands is stored in. As a result of this, the coded zib HouseNumberIndication concept (CD datatype) is mapped to a FHIR string datatype with a constraint added (the value can only be 'by' or 'to').
The number or name of a specific unit contained within a building or complex, as assigned by that building or complex.
Extra information such as the building name, building number, entrance, route number.
A geographically determined area which forms part of the municipal area. For Dutch places of residence, preferably use the name from the GBA, table 33 (OID: 2.16.840.1.113883.2.4.6.14).
Municipality of residence. For Dutch municipalities, preferably use the name from the GBA, table 33 (OID: 2.16.840.1.113883.2.4.6.14).
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).
Postcode of the address. In Dutch addresses, preferably use the postcode from the Postcode table (OID: 2.16.840.1.113883.2.4.4.15).
Country (e.g. can be ISO 3166 2 or 3 letter code)
Country - a nation as commonly understood or generally accepted.
The FHIR datatype does not properly support coding the country using a CodeableConcept or Coding datatype. If the sender supports coded countries, it SHALL send the coded value using the ext-CodeSpecification extension under `Address.country.extension:countryCode`.
Country in which the address is located.
Allows addresses to be placed in historical context.
A person’s marital status according to the terms and definition in the Dutch civil code.
Whether patient is part of a multiple birth
Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber
An indication stating whether the patient is of a multiple birth.
Guidelines: * Use id photos, not clinical photos. * Limit dimensions to thumbnail. * Keep byte count low to ease resource updates.
Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc
A contact party (e.g. guardian, partner, friend) for the patient.
Whereas the zib ContactPerson includes all (non-healthcare professional) persons that are involved in the care for a patient, FHIR distinguishes two use cases for these persons: * The RelatedPerson resource is used to capture information about any person that is related to the patient, using the profile <http://nictiz.nl/fhir/StructureDefinition/nl-core-ContactPerson>. * Information about persons that should be _contacted_ regarding the care for the patient is captured using the `Patient.contact` resource. If a person is both a related person and a contact person, then some data duplication is inevitable. The nl-core-ContactPerson can be referenced using the extension in `contact:contactPerson`.
Need to track people you can contact about the patient.
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()
exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization)
player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
This contact may have further details in this RelatedPerson
In some cases a Patient.contact will also be populated as a RelatedPerson resource. This linkage permits the linkage between the 2 resources to be able to accurately indicate a representation of the same individual, and updating details between could be appropriate.
Reference to an [nl-core-ContactPerson](http://nictiz.nl/fhir/StructureDefinition/nl-core-ContactPerson) instance containing the full details for the current contact.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The nature of the relationship between the patient and the contact person.
Used to determine which contact person is the most relevant to approach, depending on circumstances.
The nature of the relationship between a patient and a contact person for that patient.
Defines the role of the contact in relation to the patient.
Defines the contact’s familial relationship to the patient.
Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
The contact’s telephone number and/or e-mail address.
This element can and should not completely capture the AddressInformation concept from zib ContactPerson; it should just be used for the information that is needed for contacting the person in relation to care of the patient. The full address information should instead be captured using an instance of [nl-core-ContactPerson](http://nictiz.nl/fhir/StructureDefintion/nl-core-ContactPerson), which can then be referenced from this resource. See the comment on `Patient.contact` for more information.
Need to keep track where the contact person can be contacted per postal mail or visited.
Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
The gender of a person used for administrative purposes.
Organization that is associated with the contact
Organization on behalf of which the contact is acting or for which the contact is working.
For guardians or business related contacts, the organization is relevant.
The period during which this contact person or organization is valid to be contacted relating to this patient
The period during which this contact person or organization is valid to be contacted relating to this patient.
A language which may be used to communicate with the patient about his or her health.
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.
If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
LanguageControlListening / LanguageControlSpeaking / LanguageControlReading
The ability to understand spoken text in the language in question. The ability to express oneself in spoken language. The ability to understand written text in he language in question.
The zib concepts LanguageControlListening, LanguageControlReading, LanguageControlSpeaking are captured using a core extension from the R4 FHIR specification. Each of these three concepts is encoded as a copy of the extension, typed using the code in the type slice according to the following mapping: * LanguageControlListening maps to code 'RSP' (Received spoken) * LanguageControlReading maps to code 'RWR' (Received written) * LanguageControlSpeaking maps to code 'ESP' (Expressed spoken)
The proficiency level of the communication
How well the patient can communicate this communication (good, poor, etc.).
The zib ValueSets TaalvaardigheidBegrijpenCodelijst, TaalvaardigheidSprekenCodelijst and TaalvaardigheidLezenCodelijst are equal to the default FHIR ValueSet.
The proficiency level for the communication.
The proficiency type of the communication
What type of communication for the proficiency (spoken, written, etc.).
The proficiency type for the communication.
A comment on the linguistic proficiency. When using sign language, this field can be used to clarify, for example, which sign language is used. This can be informative, as there is not always a one-to-one relationship between the spoken language and sign language.
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.
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
This language is specifically identified for communicating healthcare information.
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.
Patient's nominated primary care provider
Each occurrence of the zib HealthProfessional is normally represented by _two_ FHIR resources: a PractitionerRole resource (instance of [nl-core-HealthProfessional-PractitionerRole](http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole)) and a Practitioner resource (instance of [nl-core-HealthProfessional-Practitioner](http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner)). The Practitioner resource is referenced from the PractitionerRole instance. For this reason, sending systems should fill the reference to the PractitionerRole instance here, and not the Practitioner resource. Receiving systems can then retrieve the reference to the Practitioner resource from that PractitionerRole instance. In rare circumstances, there is only a Practitioner instance, in which case it is that instance which will be referenced here. However, since this should be the exception, the nl-core-HealthProfessional-Practitioner profile is not explicitly mentioned as a target profile.
Organization that is the custodian of the patient record
Organization that is the custodian of the patient record.
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).
Need to know who recognizes this patient record, manages and updates it.
Link to another patient resource that concerns the same actual person
Link to another patient resource that concerns the same actual patient.
There is no assumption that linked patient records have mutual links.
There are multiple use cases: * Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers.
This element is labeled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'
The other patient or related person resource that the link refers to
The other patient resource that the link refers to.
Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
replaced-by | replaces | refer | seealso
The type of link between this patient resource and another patient resource.