Generated Narrative: StructureDefinition uapi-copay-request-response-bundle Name Flags Card. Type Description & Constraints Bundle Bundle #xD; identifier 1..1 Identifier Persistent identifier for the bundle #xD; type #xD; coding #xD; system 1..1 uri Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/v2-0203 #xD; code 1..1 code Symbol in syntax defined by the system Required Pattern: RI #xD; value 0..1 string Mulesoft generated bundleId #xD; type S 1..1 code document | message | transaction | transaction-response | batch | batch-response | history | searchset | collection Fixed Value: message #xD; total 0..0 #xD; Slices for entry S 7..* BackboneElement Entry in the bundle - will have a resource or information Slice: Unordered, Open by type:resource, pattern:resource.ofType(Organization).type, pattern:resource.ofType(Coverage).type #xD; entry:All Slices Content/Rules for all slices #xD; search 0..0 #xD; request 0..0 #xD; response 0..0 #xD; entry:messageheader S 1..1 BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 1..1 UapiMessageHeader A resource that describes a message that is exchanged between systems #xD; entry:list S 1..1 BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 1..1 List A resource in the bundle #xD; entry:task S 1..2 BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 1..1 Task A resource in the bundle #xD; entry:patient S 1..1 BackboneElement Patient #xD; resource S 1..1 UapiPatient Information about an individual or animal receiving health care services #xD; entry:practice S 1..1 BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 UapiOrganization A grouping of people or organizations with a common purpose #xD; type 1..1 CodeableConcept Organization type for enrollment Required Pattern: At least the following #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/organization-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: prov #xD; entry:practitioner S 1..1 BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 1..1 UapiPractitioner A person with a formal responsibility in the provisioning of healthcare or related services #xD; entry:relatedperson S 0..1 BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 0..1 UapiRelatedPerson A person that is related to a patient, but who is not a direct target of care #xD; entry:req-questionnaireresponse S 1..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 1..1 QuestionnaireResponse A resource in the bundle #xD; entry:req-medicalCoverage S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 0..1 UapiCoverage Insurance or medical plan or a payment agreement #xD; type 1..1 CodeableConcept Coverage category such as medical or accident Required Pattern: At least the following #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/v3-ActCode #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: HIP #xD; entry:req-pharmacyCoverage S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 0..1 UapiCoverage Insurance or medical plan or a payment agreement #xD; type 1..1 CodeableConcept Coverage category such as medical or accident Required Pattern: At least the following #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/v3-ActCode #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: DRUGPOL #xD; entry:req-payer S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 0..1 UapiOrganization A grouping of people or organizations with a common purpose #xD; type 1..1 CodeableConcept Organization type for enrollment Required Pattern: At least the following #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/organization-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: ins #xD; entry:resp-explanationOfBenefits S 0..2 BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 0..1 ExplanationOfBenefit A resource in the bundle #xD; entry:resp-copayCoverage S 0..2 BackboneElement Entry in the bundle - will have a resource or information #xD; resource S 0..1 UapiCoverage Insurance or medical plan or a payment agreement #xD; type 1..1 CodeableConcept Coverage category such as medical or accident Required Pattern: At least the following #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/v3-ActCode #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: pay #xD; Documentation for this format
This profile constrains a Bundle resource which combines all elements from copay request with all elements from copay response. Combine uapi-copay-enrollment-bundle with uapi-bundle-query-response for copay.
A container for a collection of resources.
total.empty() or (type = 'searchset') or (type = 'history')
not(f:total) or (f:type/@value = 'searchset') or (f:type/@value = 'history')
entry.search.empty() or (type = 'searchset')
not(f:entry/f:search) or (f:type/@value = 'searchset')
entry.request mandatory for batch/transaction/history, otherwise prohibited
entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
not(f:entry/f:request) or (f:type/@value = 'batch') or (f:type/@value = 'transaction') or (f:type/@value = 'history')
entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited
entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
not(f:entry/f:response) or (f:type/@value = 'batch-response') or (f:type/@value = 'transaction-response') or (f:type/@value = 'history')
FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles)
(type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
(f:type/@value = 'history') or (count(for $entry in f:entry[f:resource] return $entry[count(parent::f:Bundle/f:entry[f:fullUrl/@value=$entry/f:fullUrl/@value and ((not(f:resource/*/f:meta/f:versionId/@value) and not($entry/f:resource/*/f:meta/f:versionId/@value)) or f:resource/*/f:meta/f:versionId/@value=$entry/f:resource/*/f:meta/f:versionId/@value)])!=1])=0)
A document must have an identifier with a system and a value
type = 'document' implies (identifier.system.exists() and identifier.value.exists())
not(f:type/@value = 'document') or exists(f:identifier/f:system) or exists(f:identifier/f:value)
type = 'document' implies (timestamp.hasValue())
not(f:type/@value = 'document') or exists(f:timestamp/@value)
A document must have a Composition as the first resource
type = 'document' implies entry.first().resource.is(Composition)
not(f:type/@value='document') or f:entry[1]/f:resource/f:Composition
A message must have a MessageHeader as the first resource
type = 'message' implies entry.first().resource.is(MessageHeader)
not(f:type/@value='message') or f:entry[1]/f:resource/f:MessageHeader
ClinicalDocument, if bundle.type = document
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).
A persistent identifier for the bundle that won't change as a bundle is copied from server to server.
Persistent identity generally only matters for batches of type Document, Message, and Collection. It would not normally be populated for search and history results and servers ignore Bundle.identifier when processing batches and transactions. For Documents the .identifier SHALL be populated such that the .identifier is globally unique.
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
Additional content defined by implementations
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.
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")])
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.
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The identification of the code system that defines the meaning of the symbol in the code.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
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.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
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/R4B/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
document | message | transaction | transaction-response | batch | batch-response | history | searchset | collection
Indicates the purpose of this bundle - how it is intended to be used.
It's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.
Indicates the purpose of a bundle - how it is intended to be used.
The date/time that the bundle was assembled - i.e. when the resources were placed in the bundle.
For many bundles, the timestamp is equal to .meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated. Usage: * document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time * message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message * history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates * searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query * transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning The timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.
If a set of search matches, this is the total number of entries of type 'match' across all pages in the search. It does not include search.mode = 'include' or 'outcome' entries and it does not provide a count of the number of entries in the Bundle.
Only used if the bundle is a search result set. The total does not include resources such as OperationOutcome and included resources, only the total number of matching resources.
A series of links that provide context to this bundle.
Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. [HATEOAS](http://en.wikipedia.org/wiki/HATEOAS)). Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was [read](http://hl7.org/fhir/R4B/http.html#read) directly. This specification defines some specific uses of Bundle.link for [searching](http://hl7.org/fhir/R4B/search.html#conformance) and [paging](http://hl7.org/fhir/R4B/http.html#paging), but no specific uses for Bundle.entry.link, and no defined function in a transaction - the meaning is implementation specific.
All FHIR elements must have a @value or children unless an empty Parameters resource
hasValue() or (children().count() > id.count()) or $this is Parameters
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 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/R4B/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
See http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1
A name which details the functional use for this link - see [http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1](http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1).
Entry in the bundle - will have a resource or information
An entry in a bundle resource - will either contain a resource or information about a resource (transactions and history only).
For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
must be a resource unless there's a request or response
resource.exists() or request.exists() or response.exists()
exists(f:resource) or exists(f:request) or exists(f:response)
fullUrl cannot be a version specific reference
fullUrl.exists() implies fullUrl.contains('/_history/').not()
not(exists(f:fullUrl[contains(string(@value), '/_history/')]))
A series of links that provide context to this entry.
URI for resource (Absolute URL server address or URI for UUID/OID)
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that: * fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle) * Results from operations might involve resources that are not identified.
fullUrl might not be [unique in the context of a resource](http://hl7.org/fhir/R4B/bundle.html#bundle-unique). Note that since [FHIR resources do not need to be served through the FHIR API](http://hl7.org/fhir/R4B/references.html), the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the [regex](http://hl7.org/fhir/R4B/references.html#regex), then the 'id' portion of the fullUrl SHALL end with the Resource.id. Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Information about the search process that lead to the creation of this entry.
match | include | outcome - why this is in the result set
Why this entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
There is only one mode. In some corner cases, a resource may be included because it is both a match and an include. In these circumstances, 'match' takes precedence.
Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
When searching, the server's search ranking score for the entry.
Servers are not required to return a ranking score. 1 is most relevant, and 0 is least relevant. Often, search results are sorted by score, but the client may specify a different sort order. See [Patient Match](http://hl7.org/fhir/R4B/patient-operation-match.html) for the EMPI search which relates to this element.
Additional execution information (transaction/batch/history)
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
GET | HEAD | POST | PUT | DELETE | PATCH
In a transaction or batch, this is the HTTP action to be executed for this entry. In a history bundle, this indicates the HTTP action that occurred.
HTTP verbs (in the HTTP command line). See [HTTP rfc](https://tools.ietf.org/html/rfc7231) for details.
The URL for this entry, relative to the root (the address to which the request is posted).
E.g. for a Patient Create, the method would be "POST" and the URL would be "Patient". For a Patient Update, the method would be PUT and the URL would be "Patient/[id]".
If the ETag values match, return a 304 Not Modified status. See the API documentation for ["Conditional Read"](http://hl7.org/fhir/R4B/http.html#cread).
Only perform the operation if the last updated date matches. See the API documentation for ["Conditional Read"](http://hl7.org/fhir/R4B/http.html#cread).
Only perform the operation if the Etag value matches. For more information, see the API section ["Managing Resource Contention"](http://hl7.org/fhir/R4B/http.html#concurrency).
Instruct the server not to perform the create if a specified resource already exists. For further information, see the API documentation for ["Conditional Create"](http://hl7.org/fhir/R4B/http.html#ccreate). This is just the query portion of the URL - what follows the "?" (not including the "?").
Results of execution (transaction/batch/history)
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
The status code returned by processing this entry. The status SHALL start with a 3 digit HTTP code (e.g. 404) and may contain the standard HTTP description associated with the status code.
The location (if the operation returns a location)
The location header created by processing this operation, populated if the operation returns a location.
The Etag for the resource, if the operation for the entry produced a versioned resource (see [Resource Metadata and Versioning](http://hl7.org/fhir/R4B/http.html#versioning) and [Managing Resource Contention](http://hl7.org/fhir/R4B/http.html#concurrency)).
Etags match the Resource.meta.versionId. The ETag has to match the version id in the header if a resource is included.
The date/time that the resource was modified on the server.
This has to match the same time in the meta header (meta.lastUpdated) if a resource is included.
OperationOutcome with hints and warnings (for batch/transaction)
An OperationOutcome containing hints and warnings produced as part of processing this entry in a batch or transaction.
For a POST/PUT operation, this is the equivalent outcome that would be returned for prefer = operationoutcome - except that the resource is always returned whether or not the outcome is returned. This outcome is not used for error responses in batch/transaction, only for hints and warnings. In a batch operation, the error will be in Bundle.entry.response, and for transaction, there will be a single OperationOutcome instead of a bundle in the case of an error.
A resource that describes a message that is exchanged between systems
The header for a message exchange that is either requesting or responding to an action. The reference(s) that are the subject of the action as well as other information related to the action are typically transmitted in a bundle in which the MessageHeader resource instance is the first resource in the bundle.
The patient resource in the data source system.
Information about an individual or animal receiving health care services
Demographics and other administrative information about an individual or animal receiving care or other health-related services.
A grouping of people or organizations with a common purpose
A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc.
Organization(classCode=ORG, determinerCode=INST)
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.
Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems
($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
not(f:Citation|f:Evidence|f:EvidenceReport|f:EvidenceVariable|f:MedicinalProductDefinition|f:PackagedProductDefinition|f:AdministrableProductDefinition|f:Ingredient|f:ClinicalUseDefinition|f:RegulatedAuthorization|f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic) or not(parent::f:Citation|parent::f:Evidence|parent::f:EvidenceReport|parent::f:EvidenceVariable|parent::f:MedicinalProductDefinition|parent::f:PackagedProductDefinition|parent::f:AdministrableProductDefinition|parent::f:Ingredient|parent::f:ClinicalUseDefinition|parent::f:RegulatedAuthorization|parent::f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic)
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.
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 are expected to modify the meaning or interpretation of the resource that contains them
Identifier used by Genentech to determine insert vs update operation.
Identifier for the organization that is used to identify the organization across multiple disparate systems.
Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.
Whether the organization's record is still in active use
This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used. This element is labeled as a modifier because it may be used to mark that the resource was created in error.
Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.
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
./Status (however this concept in ServD more covers why the organization is active or not, could be delisted, deregistered, not operational yet) this could alternatively be derived from ./StartDate and ./EndDate and given a context date.
Only three types of organizations are supported - Provider organization, Insurance organization and Site of Treatment.
Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center. We expect that some jurisdictions will profile this optionality to be a single cardinality.
Need to be able to track the kind of organization that this is - different organization types have different uses.
A name associated with the organization.
If the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches.
Need to use the name as the label of the organization.
A list of alternate names that the organization is known as, or was known as in the past
There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization.
Over time locations and organizations go through many changes and can be known by different names. For searching knowing previous names that the organization was known by can be very useful.
The use code 'home' is not to be used. Note that these contacts are not the contact details of people who are employed by or represent the organization, but official contacts for the organization itself.
The telecom of an organization can never be of use 'home'
phone | fax | email | pager | url | sms | other
Telecommunications form for contact point - what communications system is required to make use of the contact.
Telecommunications form for contact point.
The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).
Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.
Need to support legacy numbers that are not in a tightly controlled format.
home | work | temp | old | mobile - purpose of this contact point
Identifies the purpose for the contact point.
Applications can assume that a contact is current unless it explicitly says that it is temporary or old.
Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.
This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one
Specify preferred order of use (1 = highest)
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
Time period when the contact point was/is in use
Address is required for Practice Organization and Site of Treatment
Organization may have multiple addresses with different uses or applicable periods. The use code 'home' is not to be used.
May need to keep track of the organization's addresses for contacting, billing or reporting requirements.
An address of an organization can never be of use 'home'
home | work | temp | old | billing - purpose of this 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
The use of an address (home / work / etc.).
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
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/R4B/location.html#) resource).
The type of an address (physical / postal).
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
This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.
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 name of the city, town, suburb, village or other community or delivery center.
The name of the administrative area (county).
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.
Standard state 2 characters (Ex: CA, AZ, NC..)
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).
A postal code designating a region defined by the postal service.
Country (e.g. can be ISO 3166 2 or 3 letter code)
Country - a nation as commonly understood or generally accepted.
ISO 3166 3 letter codes can be used in place of a human readable country name.
Allows addresses to be placed in historical context.
The organization of which this organization forms a part
Need to be able to track the hierarchy of organizations within an organization.
Contact is required for Practice Organization
Contact for the organization for a certain purpose.
Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.
Need to keep track of assigned contact points within bigger organization.
Indicates a purpose for which the contact can be reached.
Need to distinguish between multiple contact persons.
The purpose for which you would contact a contact party.
Need to be able to track the person by name.
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.
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.
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.
Family Name may be decomposed into specific parts using extensions (de, nl, es related cultures).
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.
Given Names appear in the correct order for presenting the name
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.
Prefixes appear in the correct order for presenting the name
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.
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.
A contact detail (e.g. a telephone number or an email address) by which the party may be contacted.
People have (primary) ways to contact them in some way such as phone, email.
Contact details (telephone, email, etc.) for a contact
Visiting or postal addresses for the contact
May need to keep track of a contact party's address for contacting, billing or reporting requirements.
Technical endpoints providing access to services operated for the organization
Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.
A person with a formal responsibility in the provisioning of healthcare or related services
A person who is directly or indirectly involved in the provisioning of healthcare.
A person that is related to a patient, but who is not a direct target of care
Information about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.
Insurance or medical plan or a payment agreement
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
Describes Plan year for Coverage Status Outcome
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Describes Reference Number for Coverage Status Outcome
Date when the insurance company issued the insurance card.
A unique identifier assigned to this coverage.
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
Allows coverages to be distinguished and referenced.
active | cancelled | draft | entered-in-error
This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
A code specifying the state of the resource instance.
Coverage category such as medical or accident
The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
The order of application of coverages is dependent on the types of coverage.
The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
The party who 'owns' the insurance policy.
For example: may be an individual, corporation or the subscriber's employer.
This provides employer information in the case of Worker's Compensation and other policies.
IN1-16, 18, 19-name of insured, address, date of birth
The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.
May be self or a parent in the case of dependants.
This is the party who is entitled to the benfits under the policy.
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
The insurer assigned ID for the Subscriber.
The insurer requires this identifier on correspondance and claims (digital and otherwise).
The party who benefits from the insurance coverage; the patient when products and/or services are provided.
This is the party who receives treatment for which the costs are reimbursed under the coverage.
A unique identifier for a dependent under the coverage.
Periodically the member number is constructed from the subscriberId and the dependant number.
For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.
- No exact HL7 v2 equivalent concept seems to exist;
Beneficiary relationship to the subscriber
The relationship of beneficiary (patient) to the subscriber.
Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.
To determine relationship between the patient and the subscriber to determine coordination of benefits.
The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
Some insurers require the submission of the coverage term.
The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.
Need to identify the issuer to target for claim processing and for coordination of benefit processing.
A suite of underwriter specific classifiers.
For example may be used to identify a class of coverage or employer group, Policy, Plan.
The codes provided on the health card which identify or confirm the specific policy for the insurer.
The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
The insurer issued label for a specific health card value.
The policy classifications, eg. Group, Plan, Class, etc.
The alphanumeric string value associated with the insurer issued label.
The insurer issued label and value are necessary to identify the specific policy.
Human readable description of the type and value
Used to provide a meaningful description in correspondence to the patient.
The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
Used in managing the coordination of benefits.
The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
Used in referral for treatment and in claims processing.
A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
Required by providers to manage financial transaction with the patient.
The category of patient centric costs associated with treatment.
For example visit, specialist visits, emergency, inpatient care, etc.
Needed to identify the category associated with the amount for the patient.
The types of services to which patient copayments are specified.
The amount or percentage due from the beneficiary
The amount due from the patient for the cost category.
Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.
Needed to identify the amount for the patient associated with the category.
A suite of codes indicating exceptions or reductions to patient costs and their effective periods.
Needed to identify the exception associated with the amount for the patient.
The types of exceptions from the part or full value of financial obligations such as copays.
The timeframe during when the exception is in force.
Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
The policy(s) which constitute this insurance coverage.
To reference the legally binding contract between the policy holder and the insurer.
Digital Signature - base64 encoded. XML-DSig or a JWT.
The signature could be created by the "author" of the bundle or by the originating device. Requirements around inclusion of a signature, verification of signatures and treatment of signed/non-signed bundles is implementation-environment specific.
A Signature holds an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature may either be a cryptographic type (XML DigSig or a JWS), which is able to provide non-repudiation proof, or it may be a graphical image that represents a signature or a signature process. This element allows capturing signatures on documents, messages, transactions or even search responses, to support content-authentication, non-repudiation or other business cases. This is primarily relevant where the bundle may travel through multiple hops or via other mechanisms where HTTPS non-repudiation is insufficient.