FHIR Osiris Implementation Guide
2.1.0 - ci-build

FHIR Osiris Implementation Guide - Local Development build (v2.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: FamilyCancerHistory - Detailed Descriptions

Draft as of 2024-03-21

Definitions for the family-cancer-history resource profile.

Guidance on how to interpret the contents of this table can be found here

0. FamilyMemberHistory
2. FamilyMemberHistory.patient
TypeReference(Oncology Patient)
4. FamilyMemberHistory.relationship
BindingThe codes SHALL be taken from Parentage Value Set
(required to https://build.fhir.org/ig/arkhn/arkhn-ig-osiris/ValueSet/Parentage)
6. FamilyMemberHistory.condition
8. FamilyMemberHistory.condition.code
ShortInternational code for the localization of the oncologic primary site
BindingUnless not suitable, these codes SHALL be taken from Topography Value Set
(extensible to https://build.fhir.org/ig/arkhn/arkhn-ig-osiris/ValueSet/Topography)

Guidance on how to interpret the contents of this table can be found here

0. FamilyMemberHistory
Definition

Significant health conditions for a person related to the patient relevant in the context of care for the patient.

ShortInformation about patient's relatives, relevant for patient
Control0..*
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
fhs-2: Can only have estimatedAge if age[x] is present (age.exists() or estimatedAge.empty())
fhs-1: Can have age[x] or born[x], but not both (age.empty() or born.empty())
2. FamilyMemberHistory.implicitRules
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.

ShortA set of rules under which this content was created
Comments

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.

Control0..1
This element is affected by the following invariants: ele-1
Typeuri
Is Modifiertrue because 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. FamilyMemberHistory.modifierExtension
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).

ShortExtensions that cannot be ignored
Comments

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.

Control0..*
This element is affected by the following invariants: ele-1
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Standards StatusNormative (from Trial Use)
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.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on FamilyMemberHistory.modifierExtension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. FamilyMemberHistory.status
    Definition

    A code specifying the status of the record of the family history of a specific family member.

    Shortpartial | completed | entered-in-error | health-unknown
    Comments

    This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

    Control1..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from FamilyHistoryStatushttp://hl7.org/fhir/ValueSet/history-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/history-status|4.0.1)

    A code that identifies the status of the family history record.

    Typecode
    Is Modifiertrue because 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
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. FamilyMemberHistory.patient
    Definition

    The person who this history concerns.

    ShortPatient history is about
    Comments

    References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

    Control1..1
    This element is affected by the following invariants: ele-1
    TypeReference(Oncology Patient, Patient)
    Summarytrue
    Alternate NamesProband
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
    10. FamilyMemberHistory.relationship
    Definition

    The type of relationship this person has to the patient (father, mother, brother etc.).

    ShortRelationship to the subject
    Comments

    Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

    Control1..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from For example codes, see Parentage Value Sethttp://terminology.hl7.org/ValueSet/v3-FamilyMember
    (required to https://build.fhir.org/ig/arkhn/arkhn-ig-osiris/ValueSet/Parentage)
    TypeCodeableConcept
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. FamilyMemberHistory.born[x]
    Definition

    The actual or approximate date of birth of the relative.

    Short(approximate) date of birth
    Control0..1
    This element is affected by the following invariants: ele-1, fhs-1
    TypeChoice of: Period, date, string
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Requirements

    Allows calculation of the relative's age.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. FamilyMemberHistory.age[x]
    Definition

    The age of the relative at the time the family member history is recorded.

    Short(approximate) age
    Comments

    use estimatedAge to indicate whether the age is actual or not.

    Control0..1
    This element is affected by the following invariants: ele-1, fhs-1
    TypeChoice of: Age, Range, string
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    While age can be calculated from date of birth, sometimes recording age directly is more natural for clinicians.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. FamilyMemberHistory.estimatedAge
    Definition

    If true, indicates that the age value specified is an estimated value.

    ShortAge is estimated?
    Comments

    This element is labeled as a modifier because the fact that age is estimated can/should change the results of any algorithm that calculates based on the specified age.

    Control0..1
    This element is affected by the following invariants: ele-1, fhs-2
    Typeboolean
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Clinicians often prefer to specify an estimaged age rather than an age range.

    Meaning if MissingIt is unknown whether the age is an estimate or not
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

    Guidance on how to interpret the contents of this table can be found here

    0. FamilyMemberHistory
    Definition

    Significant health conditions for a person related to the patient relevant in the context of care for the patient.

    ShortInformation about patient's relatives, relevant for patient
    Control0..*
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    fhs-2: Can only have estimatedAge if age[x] is present (age.exists() or estimatedAge.empty())
    fhs-1: Can have age[x] or born[x], but not both (age.empty() or born.empty())
    2. FamilyMemberHistory.id
    Definition

    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

    ShortLogical id of this artifact
    Comments

    The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

    Control0..1
    Typeid
    Summarytrue
    4. FamilyMemberHistory.meta
    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.

    ShortMetadata about the resource
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeMeta
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    6. FamilyMemberHistory.implicitRules
    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.

    ShortA set of rules under which this content was created
    Comments

    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.

    Control0..1
    This element is affected by the following invariants: ele-1
    Typeuri
    Is Modifiertrue because 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
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. FamilyMemberHistory.language
    Definition

    The base language in which the resource is written.

    ShortLanguage of the resource content
    Comments

    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).

    Control0..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHOULD be taken from CommonLanguages
    (preferred to http://hl7.org/fhir/ValueSet/languages)

    A human language.

    Additional BindingsPurpose
    AllLanguagesMax Binding
    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. FamilyMemberHistory.text
    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.

    ShortText summary of the resource, for human interpretation
    Comments

    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.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeNarrative
    Alternate Namesnarrative, html, xhtml, display
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. FamilyMemberHistory.contained
    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.

    ShortContained, inline Resources
    Comments

    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.

    Control0..*
    TypeResource
    Alternate Namesinline resources, anonymous resources, contained resources
    14. FamilyMemberHistory.extension
    Definition

    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.

    ShortAdditional content defined by implementations
    Comments

    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.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension
    Standards StatusNormative (from Trial Use)
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on FamilyMemberHistory.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 16. FamilyMemberHistory.modifierExtension
      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).

      ShortExtensions that cannot be ignored
      Comments

      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.

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Standards StatusNormative (from Trial Use)
      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.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on FamilyMemberHistory.modifierExtension. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 18. FamilyMemberHistory.identifier
        Definition

        Business identifiers assigned to this family member history by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

        ShortExternal Id(s) for this record
        Comments

        This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeIdentifier
        Summarytrue
        Requirements

        Allows identification of the family member history as it is known by various participating systems and in a way that remains consistent across servers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. FamilyMemberHistory.instantiatesCanonical
        Definition

        The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.

        ShortInstantiates FHIR protocol or definition
        Comments

        see Canonical References

        Control0..*
        This element is affected by the following invariants: ele-1
        Typecanonical(PlanDefinition, Questionnaire, ActivityDefinition, Measure, OperationDefinition)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. FamilyMemberHistory.instantiatesUri
        Definition

        The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.

        ShortInstantiates external protocol or definition
        Comments

        This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

        Control0..*
        This element is affected by the following invariants: ele-1
        Typeuri
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. FamilyMemberHistory.status
        Definition

        A code specifying the status of the record of the family history of a specific family member.

        Shortpartial | completed | entered-in-error | health-unknown
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control1..1
        This element is affected by the following invariants: ele-1
        BindingThe codes SHALL be taken from FamilyHistoryStatus
        (required to http://hl7.org/fhir/ValueSet/history-status|4.0.1)

        A code that identifies the status of the family history record.

        Typecode
        Is Modifiertrue because 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
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. FamilyMemberHistory.dataAbsentReason
        Definition

        Describes why the family member's history is not available.

        Shortsubject-unknown | withheld | unable-to-obtain | deferred
        Comments

        Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

        Control0..1
        This element is affected by the following invariants: ele-1
        BindingFor example codes, see FamilyHistoryAbsentReason
        (example to http://hl7.org/fhir/ValueSet/history-absent-reason)

        Codes describing the reason why a family member's history is not available.

        TypeCodeableConcept
        Summarytrue
        Requirements

        This is a separate element to allow it to have a distinct binding from reasonCode.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. FamilyMemberHistory.patient
        Definition

        The person who this history concerns.

        ShortPatient history is about
        Comments

        References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

        Control1..1
        This element is affected by the following invariants: ele-1
        TypeReference(Oncology Patient)
        Summarytrue
        Alternate NamesProband
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
        30. FamilyMemberHistory.date
        Definition

        The date (and possibly time) when the family member history was recorded or last updated.

        ShortWhen history was recorded or last updated
        Comments

        This should be captured even if the same as the date on the List aggregating the full family history.

        Control0..1
        This element is affected by the following invariants: ele-1
        TypedateTime
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows determination of how current the summary is.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. FamilyMemberHistory.name
        Definition

        This will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair".

        ShortThe family member described
        Comments

        Note that FHIR strings SHALL NOT exceed 1MB in size

        Control0..1
        This element is affected by the following invariants: ele-1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows greater ease in ensuring the same person is being talked about.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. FamilyMemberHistory.relationship
        Definition

        The type of relationship this person has to the patient (father, mother, brother etc.).

        ShortRelationship to the subject
        Comments

        Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

        Control1..1
        This element is affected by the following invariants: ele-1
        BindingThe codes SHALL be taken from Parentage Value Set
        (required to https://build.fhir.org/ig/arkhn/arkhn-ig-osiris/ValueSet/Parentage)
        TypeCodeableConcept
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. FamilyMemberHistory.sex
        Definition

        The birth sex of the family member.

        Shortmale | female | other | unknown
        Comments

        This element should ideally reflect whether the individual is genetically male or female. However, as reported information based on the knowledge of the patient or reporting friend/relative, there may be situations where the reported sex might not be totally accurate. E.g. 'Aunt Sue' might be XY rather than XX. Questions soliciting this information should be phrased to encourage capture of genetic sex where known. However, systems performing analysis should also allow for the possibility of imprecision with this element.

        Control0..1
        This element is affected by the following invariants: ele-1
        BindingUnless not suitable, these codes SHALL be taken from AdministrativeGender
        (extensible to http://hl7.org/fhir/ValueSet/administrative-gender)

        Codes describing the sex assigned at birth as documented on the birth registration.

        TypeCodeableConcept
        Summarytrue
        Requirements

        Not all relationship codes imply sex and the relative's sex can be relevant for risk assessments.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. FamilyMemberHistory.born[x]
        Definition

        The actual or approximate date of birth of the relative.

        Short(approximate) date of birth
        Control0..1
        This element is affected by the following invariants: ele-1, fhs-1
        TypeChoice of: Period, date, string
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Requirements

        Allows calculation of the relative's age.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. FamilyMemberHistory.age[x]
        Definition

        The age of the relative at the time the family member history is recorded.

        Short(approximate) age
        Comments

        use estimatedAge to indicate whether the age is actual or not.

        Control0..1
        This element is affected by the following invariants: ele-1, fhs-1
        TypeChoice of: Age, Range, string
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        While age can be calculated from date of birth, sometimes recording age directly is more natural for clinicians.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. FamilyMemberHistory.estimatedAge
        Definition

        If true, indicates that the age value specified is an estimated value.

        ShortAge is estimated?
        Comments

        This element is labeled as a modifier because the fact that age is estimated can/should change the results of any algorithm that calculates based on the specified age.

        Control0..1
        This element is affected by the following invariants: ele-1, fhs-2
        Typeboolean
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Clinicians often prefer to specify an estimaged age rather than an age range.

        Meaning if MissingIt is unknown whether the age is an estimate or not
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. FamilyMemberHistory.deceased[x]
        Definition

        Deceased flag or the actual or approximate age of the relative at the time of death for the family member history record.

        ShortDead? How old/when?
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeChoice of: boolean, Age, Range, date, string
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. FamilyMemberHistory.reasonCode
        Definition

        Describes why the family member history occurred in coded or textual form.

        ShortWhy was family member history performed?
        Comments

        Textual reasons can be captured using reasonCode.text.

        Control0..*
        This element is affected by the following invariants: ele-1
        BindingFor example codes, see SNOMEDCTClinicalFindings
        (example to http://hl7.org/fhir/ValueSet/clinical-findings)

        Codes indicating why the family member history was done.

        TypeCodeableConcept
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. FamilyMemberHistory.reasonReference
        Definition

        Indicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event.

        ShortWhy was family member history performed?
        Comments

        References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeReference(Condition, Observation, AllergyIntolerance, QuestionnaireResponse, DiagnosticReport, DocumentReference)
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
        50. FamilyMemberHistory.note
        Definition

        This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible.

        ShortGeneral note about related person
        Comments

        For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeAnnotation
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. FamilyMemberHistory.condition
        Definition

        The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition.

        ShortCondition that the related person had
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeBackboneElement
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. FamilyMemberHistory.condition.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        XML FormatIn the XML format, this property is represented as an attribute.
        56. FamilyMemberHistory.condition.extension
        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.

        ShortAdditional content defined by implementations
        Comments

        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.

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension
        Standards StatusNormative (from Trial Use)
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on FamilyMemberHistory.condition.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 58. FamilyMemberHistory.condition.modifierExtension
          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          60. FamilyMemberHistory.condition.code
          Definition

          The actual condition specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system.

          ShortInternational code for the localization of the oncologic primary site
          Comments

          Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

          Control1..1
          This element is affected by the following invariants: ele-1
          BindingUnless not suitable, these codes SHALL be taken from Topography Value Set
          (extensible to https://build.fhir.org/ig/arkhn/arkhn-ig-osiris/ValueSet/Topography)
          TypeCodeableConcept
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          62. FamilyMemberHistory.condition.outcome
          Definition

          Indicates what happened following the condition. If the condition resulted in death, deceased date is captured on the relation.

          Shortdeceased | permanent disability | etc.
          Comments

          Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

          Control0..1
          This element is affected by the following invariants: ele-1
          BindingFor example codes, see ConditionOutcomeCodes
          (example to http://hl7.org/fhir/ValueSet/condition-outcome)

          The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.

          TypeCodeableConcept
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          64. FamilyMemberHistory.condition.contributedToDeath
          Definition

          This condition contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown.

          ShortWhether the condition contributed to the cause of death
          Control0..1
          This element is affected by the following invariants: ele-1
          Typeboolean
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          66. FamilyMemberHistory.condition.onset[x]
          Definition

          Either the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence.

          ShortWhen condition first manifested
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeChoice of: Age, Range, Period, string
          [x] NoteSee Choice of Data Types for further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Requirements

          Age of onset of a condition in relatives is predictive of risk for the patient.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. FamilyMemberHistory.condition.note
          Definition

          An area where general notes can be placed about this specific condition.

          ShortExtra information about condition
          Comments

          For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

          Control0..*
          This element is affected by the following invariants: ele-1
          TypeAnnotation
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))