AU Base Implementation Guide
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## : Patient - as transgender person with sex and gender and sex parameter for clinical use - XML Representation

Page standards status: Informative

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    <Patient xmlns="http://hl7.org/fhir">
      <id value="example-sex-and-gender"/>
      <!-- This purpose of this example is to demonstrate the use of sex and gender elements:
        - Gender Harmony Gender Identity (Individual Gender Identity extension)
        - Gender Harmony Pronouns (Individual Pronouns extension)
        - Gender Harmony Recorded Sex or Gender (Person Recorded Sex Or Gender extension)
        - Gender Harmony Sex Assigned at Birth (Person Recorded Sex Or Gender extension)
       This example is taken and adapted from the R5 Transgender Person Example -->
      <meta>
        <profile value="http://hl7.org.au/fhir/StructureDefinition/au-patient"/>
      </meta>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Patient example-sex-and-gender</b></p><a name="example-sex-and-gender"> </a><a name="hcexample-sex-and-gender"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-au-patient.html">AU Base Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Patricia Roth  Male, DoB: 1974-12-25 ( Medical record number (use: usual, ))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Record is active">Active:</td><td>true</td><td style="background-color: #f3f5da" title="Known status of Patient">Deceased:</td><td colspan="3">false</td></tr><tr><td style="background-color: #f3f5da" title="Patient Links">Links:</td><td colspan="3"><ul><li>Managing Organization: <a href="Organization-example1.html">Organization Albion Hospital</a></li></ul></td></tr><tr><td style="background-color: #f3f5da" title="The pronouns to use when referring to an individual in verbal or written communication.">Individual Pronouns:</td><td colspan="3"><ul><li>value: <span title="Codes:{http://loinc.org LA29519-8}">she/her/her/hers/herself</span></li><li>period: 2001-05-06 --&gt; (ongoing)</li><li>comment: Patient transitioned from male to female in 2001.</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Recorded sex or gender (RSG) information includes the various sex and gender concepts that are often used in existing systems but are known NOT to represent a gender identity, sex parameter for clinical use, or attributes related to sexuality, such as sexual orientation, sexual activity, or sexual attraction. Examples of recorded sex or gender concepts include administrative gender, administrative sex, and sex assigned at birth.  When exchanging this concept, refer to the guidance in the [Gender Harmony Implementation Guide](http://hl7.org/xprod/ig/uv/gender-harmony/).">Person Recorded Sex Or Gender:</td><td colspan="3"><ul><li>value: <span title="Codes:{http://snomed.info/sct 248153007}">Male</span></li><li>type: <span title="Codes:{http://snomed.info/sct 1515311000168102}">Biological sex at birth</span></li><li>effectivePeriod: 1974-12-25 --&gt; (ongoing)</li><li>acquisitionDate: 2005-12-06</li><li>sourceDocument: <span title="Codes:{http://loinc.org 71230-7}, {http://snomed.info/sct 444561001}">Scan of birth certificate</span></li><li>sourceField: Sex</li><li>jurisdiction: <span title="Codes:{https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 QLD}">Queensland</span></li><li>comment: Patient transitioned from male to female in 2001, but their birth certificate still        indicates male.</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Recorded sex or gender (RSG) information includes the various sex and gender concepts that are often used in existing systems but are known NOT to represent a gender identity, sex parameter for clinical use, or attributes related to sexuality, such as sexual orientation, sexual activity, or sexual attraction. Examples of recorded sex or gender concepts include administrative gender, administrative sex, and sex assigned at birth.  When exchanging this concept, refer to the guidance in the [Gender Harmony Implementation Guide](http://hl7.org/xprod/ig/uv/gender-harmony/).">Person Recorded Sex Or Gender:</td><td colspan="3"><ul><li>value: <span title="Codes:{http://hl7.org/fhir/administrative-gender female}">Female</span></li><li>type: <span title="Codes:{http://loinc.org 46098-0}">Sex</span></li><li>effectivePeriod: 2024-12-25 --&gt; (ongoing)</li><li>sourceDocument: <span title="Codes:{http://terminology.hl7.org.au/CodeSystem/rsg-source-document-type passport}">Passport</span></li><li>sourceField: Sex</li><li>jurisdiction: <span title="Codes:{urn:iso:std:iso:3166 AU}">Australia</span></li></ul></td></tr><tr><td style="background-color: #f3f5da" title="A Sex Parameter for Clinical Use is a parameter that provides guidance on how a recipient should apply settings or reference ranges that are derived from observable information such as an organ inventory, recent hormone lab tests, genetic testing, menstrual status, obstetric history, etc..  This property is intended for use in clinical decision making, and indicates that treatment or diagnostic tests should consider best practices associated with the relevant reference population.  When exchanging these concepts, refer to the guidance in the [Gender Harmony Implementation Guide](http://hl7.org/xprod/ig/uv/gender-harmony/).">Patient Sex Parameter For Clinical Use:</td><td colspan="3"><ul><li>value: <span title="Codes:{http://terminology.hl7.org/CodeSystem/sex-parameter-for-clinical-use male-typical}">Apply male-typical setting or reference range</span></li><li>comment: Apply male-type setting for all radiology tests</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="A Sex Parameter for Clinical Use is a parameter that provides guidance on how a recipient should apply settings or reference ranges that are derived from observable information such as an organ inventory, recent hormone lab tests, genetic testing, menstrual status, obstetric history, etc..  This property is intended for use in clinical decision making, and indicates that treatment or diagnostic tests should consider best practices associated with the relevant reference population.  When exchanging these concepts, refer to the guidance in the [Gender Harmony Implementation Guide](http://hl7.org/xprod/ig/uv/gender-harmony/).">Patient Sex Parameter For Clinical Use:</td><td colspan="3"><ul><li>value: <span title="Codes:{http://terminology.hl7.org/CodeSystem/sex-parameter-for-clinical-use female-typical}">Apply female-typical setting or reference range</span></li><li>comment: Apply female-type setting for Lipids, LFT, TSH, T4 pathology tests</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else. This represents an individual’s identity, ascertained by asking them what that identity is.
     In the case where the gender identity is communicated by a third party, for example, if a spouse indicates the gender identity of their partner on an intake form, a Provenance resource can be used with a Provenance.target referring to the Patient, with a targetElement extension identifying the gender identity extension as the target element within the Patient resource.  When exchanging this concept, refer to the guidance in the [Gender Harmony Implementation Guide](http://hl7.org/xprod/ig/uv/gender-harmony/).">Individual Gender Identity:</td><td colspan="3"><ul><li>value: <span title="Codes:{http://snomed.info/sct 446141000124107}">Identifies as female gender</span></li></ul></td></tr></table></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/individual-genderIdentity">
        <extension url="value">
          <valueCodeableConcept>
            <coding>
              <system value="http://snomed.info/sct"/>
              <code value="446141000124107"/>
              <display value="Identifies as female gender"/>
            </coding>
          </valueCodeableConcept>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/individual-pronouns">
        <extension url="value">
          <valueCodeableConcept>
            <coding>
              <system value="http://loinc.org"/>
              <code value="LA29519-8"/>
              <display value="she/her/her/hers/herself"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="period">
          <valuePeriod>
            <start value="2001-05-06"/>
          </valuePeriod>
        </extension>
        <extension url="comment">
          <valueString value="Patient transitioned from male to female in 2001."/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender">
        <extension url="value">
          <valueCodeableConcept>
            <coding>
              <system value="http://snomed.info/sct"/>
              <code value="248153007"/>
              <display value="Male"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="type">
          <valueCodeableConcept>
            <coding>
              <system value="http://snomed.info/sct"/>
              <code value="1515311000168102"/>
              <display value="Biological sex at birth"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="effectivePeriod">
          <valuePeriod>
            <start value="1974-12-25"/>
          </valuePeriod>
        </extension>
        <extension url="acquisitionDate">
          <valueDateTime value="2005-12-06"/>
        </extension>
        <extension url="sourceDocument">
          <valueCodeableConcept>
            <coding>
              <system value="http://loinc.org"/>
              <code value="71230-7"/>
              <display value="Birth certificate"/>
            </coding>
            <coding>
              <system value="http://snomed.info/sct"/>
              <code value="444561001"/>
              <display value="Birth certificate"/>
            </coding>
            <text value="Scan of birth certificate"/>
          </valueCodeableConcept>
        </extension>
        <extension url="sourceField">
          <valueString value="Sex"/>
        </extension>
        <extension url="jurisdiction">
          <valueCodeableConcept>
            <coding>
              <system
                      value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1"/>
              <code value="QLD"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="comment">
          <valueString
                       value="Patient transitioned from male to female in 2001, but their birth certificate still        indicates male."/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender">
        <extension url="value">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/administrative-gender"/>
              <code value="female"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="type">
          <valueCodeableConcept>
            <coding>
              <system value="http://loinc.org"/>
              <code value="46098-0"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="effectivePeriod">
          <valuePeriod>
            <start value="2024-12-25"/>
          </valuePeriod>
        </extension>
        <extension url="sourceDocument">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org.au/CodeSystem/rsg-source-document-type"/>
              <code value="passport"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="sourceField">
          <valueString value="Sex"/>
        </extension>
        <extension url="jurisdiction">
          <valueCodeableConcept>
            <coding>
              <system value="urn:iso:std:iso:3166"/>
              <code value="AU"/>
              <display value="Australia"/>
            </coding>
          </valueCodeableConcept>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/patient-sexParameterForClinicalUse">
        <extension url="value">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/sex-parameter-for-clinical-use"/>
              <code value="male-typical"/>
              <display value="Apply male-typical setting or reference range"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="comment">
          <valueString value="Apply male-type setting for all radiology tests"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/patient-sexParameterForClinicalUse">
        <extension url="value">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/sex-parameter-for-clinical-use"/>
              <code value="female-typical"/>
              <display value="Apply female-typical setting or reference range"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="comment">
          <valueString
                       value="Apply female-type setting for Lipids, LFT, TSH, T4 pathology tests"/>
        </extension>
      </extension>
      <identifier>
        <use value="usual"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
            <code value="MR"/>
          </coding>
        </type>
        <system
                value="http://ns.electronichealth.net.au/id/abn-scoped/medicalrecord/1.0/51824753556"/>
        <value value="11223344"/>
      </identifier>
      <active value="true"/>
      <!-- Legal Name: Patrick Roth, goes by Patricia (formally), but also Pat (informally) -->
      <name>
        <use value="official"/>
        <family value="Roth"/>
        <given value="Patrick"/>
      </name>
      <name>
        <use value="usual"/>
        <family value="Roth"/>
        <given value="Patricia"/>
      </name>
      <name>
        <use value="nickname"/>
        <given value="Pat"/>
      </name>
      <gender value="male"/>
      <birthDate value="1974-12-25"/>
      <deceasedBoolean value="false"/>
      <managingOrganization>🔗
        <reference value="Organization/example1"/>
      </managingOrganization>
    </Patient>