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Patient Data Model

Overview

The Patient domain represents a Person in the context of healthcare delivery. This domain extends the Core Person domain by adding healthcare‑specific attributes required for clinical, administrative, and operational workflows such as encounters, appointments, insurance coverage, and guarantor relationships.

The Patient domain is used when a person interacts with a healthcare organization as a recipient of care. It provides a healthcare‑specific view of the same underlying Person identity.


When to Use This Domain

  • Use the Patient domain when:
    • You are modeling individuals receiving clinical care.
    • Healthcare‑specific identifiers, insurance, or encounter data is required.
    • You are supporting care delivery, scheduling, billing, or patient access workflows.
  • Do not use this domain when:
    • Only general demographic or identity data is needed (use Core Person instead).

Relationship to Other Domains

  • Extends: Person – Core Person.
  • Shares Identity With: All Person domains.

Inherited from Core Person

The following attribute groups are inherited from Core Person and behave identically. Refer to the Person – Core Person Domain for detailed definitions of these fields.

Attribute GroupAttribute GroupAttribute Group
NamesAddressesDates of Birth
SSNsGenders & IdentitiesPhone Numbers
EmailsDeath DetailsExternal Identifiers
Alternate IdentifiersMultiple Birth IndicatorsCitizenship
PhotosSexual OrientationRace
EthnicityReligious AffiliationMarital Status
LanguagesQualificationsConsents & Preferences

Patient‑Specific Data Model Extensions

The following extensions define healthcare‑specific views. All fields are optional unless otherwise noted.

Health Insurance Coverage

Represents one or more insurance coverages associated with the patient.

Embedded ClusterFieldTypeDescription
payerNameTextName of the insurance payer
statusCode SetCoverage status
insuranceTypeCode SetType of insurance
planTypeCode SetPlan classification
subscriberIdTextSubscriber identifier
relationshipCode SetRelationship to subscriber
groupNumberTextGroup number
idNumberTextMember or policy ID
sequenceNumberNumberCoverage sequence
effectiveDateDateCoverage start date
endDateDateCoverage end date

Guarantor

Represents the individual financially responsible for the patient.

Embedded ClusterFieldTypeDescription
relationshipCode SetRelationship to patient
firstNameTextGuarantor first name
middleNameTextGuarantor middle name
lastNameTextGuarantor last name
suffixTextName suffix
dobDateDate of birth
ssnTextSocial Security Number
addressLine1TextAddress line 1
addressLine2TextAddress line 2
cityTextCity
stateTextState
zipTextPostal code
phoneTextPhone number
onHoldBooleanFinancial hold indicator
startDateDateStart date
endDateDateEnd date

Upcoming Appointments

Represents scheduled or planned future appointments for the patient.

Embedded ClusterFieldTypeDescription
descriptionTextAppointment description
statusCode SetAppointment status
cancellationDateDateCancellation date
cancellationReasonTextReason for cancellation
serviceCategoryCode SetService category
serviceTypeCode SetService type
practitionerSpecialtyCode SetPractitioner specialty
startDate-TimeAppointment