# text.div
Name | Flags | Card. | Type | Description & Constraints
Patient | | 0..* | Patient | Information about an individual or animal receiving health care services
meta | | | |
profile | S | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to

Slices for extension

0..*

Extension

Extension
Slice: Unordered, Open by value:url

lastChangedBy

0..1

Reference(Practitioner)

Last changed by
URL: https://fhir.mona.icu/StructureDefinition/lastChangedBy

Slices for identifier

1..*

Identifier

An identifier for this patient
Slice: Unordered, Open by pattern:system

identifier:monaPatientNumber | S | 1..1 | Identifier | An identifier for this patient

system

1..1

uri

The namespace for the identifier value
Required Pattern: https://fhir.mona.icu/Identifier/mona-patient-number

Slices for name

1..*

HumanName

A name associated with the patient
Slice: Unordered, Open by pattern:$this

name:officialName

S

1..1

HumanName

A name associated with the patient
Required Pattern: At least the following

use

1..1

code

usual | official | temp | nickname | anonymous | old | maiden
Fixed Value: official

use | S | 1..1 | code | usual | official | temp | nickname | anonymous | old | maiden
family | S | 1..1 | string | Family name (often called 'Surname')
given | S | 1..* | string | Given names (not always 'first'). Includes middle names
gender | | 1..1 | code | male | female | other | unknown
birthDate | | 1..1 | date | The date of birth for the individual
deceased[x] | | 0..1 | dateTime | Indicates if the individual is deceased or not

Documentation for this format

# snapshot.element[].short
Information about an individual or animal receiving health care services

# snapshot.element[].definition
Demographics and other administrative information about an individual or animal receiving care or other health-related services.

# snapshot.element[].constraint[].human
If the resource is contained in another resource, it SHALL NOT contain nested Resources

# snapshot.element[].constraint[].human
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

# snapshot.element[].constraint[].human
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated

# snapshot.element[].constraint[].human
If a resource is contained in another resource, it SHALL NOT have a security label

# snapshot.element[].constraint[].extension[].valueMarkdown
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.

# snapshot.element[].constraint[].human
A resource should have narrative for robust management

# snapshot.element[].definition
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

# snapshot.element[].comment
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

# snapshot.element[].definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].definition
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

# snapshot.element[].comment
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
When the resource last changed - e.g. when the version changed.

# snapshot.element[].comment
This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R4/http.html#read) interaction.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Identifies where the resource comes from

# snapshot.element[].definition
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

# snapshot.element[].comment
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. 

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Profiles this resource claims to conform to

# snapshot.element[].comment
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time.  The list of profile URLs is a set.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Security Labels applied to this resource

# snapshot.element[].definition
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

# snapshot.element[].comment
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
Security Labels from the Healthcare Privacy and Security Classification System.

# snapshot.element[].definition
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

# snapshot.element[].comment
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

# snapshot.element[].short
A set of rules under which this content was created

# snapshot.element[].definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].isModifierReason
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

# snapshot.element[].definition
The base language in which the resource is written.

# snapshot.element[].comment
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).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Text summary of the resource, for human interpretation

# snapshot.element[].definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].definition
Stores which practitioner last changed the resource.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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).

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].isModifierReason
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them

# snapshot.element[].requirements
Patients are almost always assigned specific numerical identifiers.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].requirements
Patients are almost always assigned specific numerical identifiers.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
usual | official | temp | secondary | old (If known)

# snapshot.element[].comment
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

# snapshot.element[].requirements
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].isModifierReason
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

# snapshot.element[].binding.description
Identifies the purpose for this identifier, if known .

# snapshot.element[].definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Allows users to make use of identifiers when the identifier system is not known.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

# snapshot.element[].definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

# snapshot.element[].comment
Identifier.system is always case sensitive.

# snapshot.element[].requirements
There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].mapping[].map
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)

# snapshot.element[].short
Time period when id is/was valid for use

# snapshot.element[].definition
Time period during which identifier is/was valid for use.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].mapping[].map
Role.effectiveTime or implied by context

# snapshot.element[].short
Organization that issued id (may be just text)

# snapshot.element[].definition
Organization that issued/manages the identifier.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].mapping[].map
II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper

# snapshot.element[].short
Whether this patient's record is in active use

# snapshot.element[].definition
Whether this patient record is in active use. 
Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.

It is often used to filter patient lists to exclude inactive patients

Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.

# snapshot.element[].comment
If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

# snapshot.element[].requirements
Need to be able to mark a patient record as not to be used because it was created in error.

# snapshot.element[].meaningWhenMissing
This resource is generally assumed to be active if no value is provided for the active element

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].isModifierReason
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

# snapshot.element[].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.

# snapshot.element[].requirements
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].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.

# snapshot.element[].requirements
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
usual | official | temp | nickname | anonymous | old | maiden

# snapshot.element[].comment
Applications can assume that a name is current unless it explicitly says that it is temporary or old.

# snapshot.element[].requirements
Allows the appropriate name for a particular context of use to be selected from among a set of names.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].isModifierReason
This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one

# snapshot.element[].mapping[].map
XPN.7, but often indicated by which field contains the name

# snapshot.element[].definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.

# snapshot.element[].comment
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present,  no content is included in the text that isn't found in a part.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

# snapshot.element[].comment
Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Given names (not always 'first'). Includes middle names

# snapshot.element[].comment
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations.  This element is not called "first name" since given names do not always come first.

# snapshot.element[].orderMeaning
Given Names appear in the correct order for presenting the name

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.

# snapshot.element[].orderMeaning
Prefixes appear in the correct order for presenting the name

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

# snapshot.element[].orderMeaning
Suffixes appear in the correct order for presenting the name

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Indicates the period of time when this name was valid for the named person.

# snapshot.element[].requirements
Allows names to be placed in historical context.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

# snapshot.element[].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 might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

# snapshot.element[].requirements
People have (primary) ways to contact them in some way such as phone, email.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Needed for identification of the individual, in combination with (at least) name and birth date.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
The gender of a person used for administrative purposes.

# snapshot.element[].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 maternity/infant care systems).

# snapshot.element[].requirements
Age of the individual drives many clinical processes.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Indicates if the individual is deceased or not

# snapshot.element[].definition
Indicates if the individual is deceased or not.

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].isModifierReason
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.

# snapshot.element[].comment
Patient may have multiple addresses with different uses or applicable periods.

# snapshot.element[].requirements
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
This field contains a patient's most recent marital (civil) status.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
The domestic partnership status of a person.

# snapshot.element[].short
Whether patient is part of a multiple birth

# snapshot.element[].definition
Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).

# snapshot.element[].comment
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).

# snapshot.element[].requirements
For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].comment
Guidelines:
* Use id photos, not clinical photos.
* Limit dimensions to thumbnail.
* Keep byte count low to ease resource updates.

# snapshot.element[].requirements
Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
A contact party (e.g. guardian, partner, friend) for the patient

# snapshot.element[].definition
A contact party (e.g. guardian, partner, friend) for the patient.

# snapshot.element[].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.

# snapshot.element[].requirements
Need to track people you can contact about the patient.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL at least contain a contact's details or a reference to an organization

# snapshot.element[].definition
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
Extensions that cannot be ignored even if unrecognized

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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).

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].isModifierReason
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

# snapshot.element[].definition
The nature of the relationship between the patient and the contact person.

# snapshot.element[].requirements
Used to determine which contact person is the most relevant to approach, depending on circumstances.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
The nature of the relationship between a patient and a contact person for that patient.

# snapshot.element[].short
A name associated with the contact person

# snapshot.element[].definition
A name associated with the contact person.

# snapshot.element[].requirements
Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
A contact detail for the person, e.g. a telephone number or an email address.

# snapshot.element[].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.

# snapshot.element[].requirements
People have (primary) ways to contact them in some way such as phone, email.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].requirements
Need to keep track where the contact person can be contacted per postal mail or visited.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
The gender of a person used for administrative purposes.

# snapshot.element[].short
Organization that is associated with the contact

# snapshot.element[].definition
Organization on behalf of which the contact is acting or for which the contact is working.

# snapshot.element[].requirements
For guardians or business related contacts, the organization is relevant.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
The period during which this contact person or organization is valid to be contacted relating to this patient

# snapshot.element[].definition
The period during which this contact person or organization is valid to be contacted relating to this patient.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
A language which may be used to communicate with the patient about his or her health

# snapshot.element[].definition
A language which may be used to communicate with the patient about his or her health.

# snapshot.element[].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.

# snapshot.element[].requirements
If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
Extensions that cannot be ignored even if unrecognized

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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).

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].isModifierReason
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

# snapshot.element[].short
The language which can be used to communicate with the patient about his or her health

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].requirements
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

# snapshot.element[].comment
This language is specifically identified for communicating healthcare information.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Patient's nominated primary care provider

# snapshot.element[].comment
This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles.  It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.
Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Organization that is the custodian of the patient record

# snapshot.element[].definition
Organization that is the custodian of the patient record.

# snapshot.element[].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).

# snapshot.element[].requirements
Need to know who recognizes this patient record, manages and updates it.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Link to another patient resource that concerns the same actual person

# snapshot.element[].definition
Link to another patient resource that concerns the same actual patient.

# snapshot.element[].comment
There is no assumption that linked patient records have mutual links.

# snapshot.element[].requirements
There are multiple use cases:   

* Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and 
* Distribution of patient information across multiple servers.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].isModifierReason
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'

# snapshot.element[].definition
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
Extensions that cannot be ignored even if unrecognized

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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).

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].isModifierReason
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

# snapshot.element[].short
The other patient or related person resource that the link refers to

# snapshot.element[].definition
The other patient resource that the link refers to.

# snapshot.element[].comment
Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
replaced-by | replaces | refer | seealso

# snapshot.element[].definition
The type of link between this patient resource and another patient resource.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
The type of link between this patient resource and another patient resource.