# 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 Group | Attribute Group | Attribute Group |
|  --- | --- | --- |
| Names | Addresses | Dates of Birth |
| SSNs | Genders & Identities | Phone Numbers |
| Emails | Death Details | External Identifiers |
| Alternate Identifiers | Multiple Birth Indicators | Citizenship |
| Photos | Sexual Orientation | Race |
| Ethnicity | Religious Affiliation | Marital Status |
| Languages | Qualifications | Consents & 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 Cluster | Field | Type | Description |
|  --- | --- | --- | --- |
|  | `payerName` | Text | Name of the insurance payer |
|  | `status` | Code Set | Coverage status |
|  | `insuranceType` | Code Set | Type of insurance |
|  | `planType` | Code Set | Plan classification |
|  | `subscriberId` | Text | Subscriber identifier |
|  | `relationship` | Code Set | Relationship to subscriber |
|  | `groupNumber` | Text | Group number |
|  | `idNumber` | Text | Member or policy ID |
|  | `sequenceNumber` | Number | Coverage sequence |
|  | `effectiveDate` | Date | Coverage start date |
|  | `endDate` | Date | Coverage end date |


### Guarantor

Represents the individual financially responsible for the patient.

| Embedded Cluster | Field | Type | Description |
|  --- | --- | --- | --- |
|  | `relationship` | Code Set | Relationship to patient |
|  | `firstName` | Text | Guarantor first name |
|  | `middleName` | Text | Guarantor middle name |
|  | `lastName` | Text | Guarantor last name |
|  | `suffix` | Text | Name suffix |
|  | `dob` | Date | Date of birth |
|  | `ssn` | Text | Social Security Number |
|  | `addressLine1` | Text | Address line 1 |
|  | `addressLine2` | Text | Address line 2 |
|  | `city` | Text | City |
|  | `state` | Text | State |
|  | `zip` | Text | Postal code |
|  | `phone` | Text | Phone number |
|  | `onHold` | Boolean | Financial hold indicator |
|  | `startDate` | Date | Start date |
|  | `endDate` | Date | End date |


### Upcoming Appointments

Represents scheduled or planned future appointments for the patient.

| Embedded Cluster | Field | Type | Description |
|  --- | --- | --- | --- |
|  | `description` | Text | Appointment description |
|  | `status` | Code Set | Appointment status |
|  | `cancellationDate` | Date | Cancellation date |
|  | `cancellationReason` | Text | Reason for cancellation |
|  | `serviceCategory` | Code Set | Service category |
|  | `serviceType` | Code Set | Service type |
|  | `practitionerSpecialty` | Code Set | Practitioner specialty |
|  | `start` | Date-Time | Appointment |