Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION
0.0.1-ballot - ci-build

Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION - Local Development build (v0.0.1-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

### Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

NP Core Encounter Profile | The NP Core Encounter Profile inherits from the FHIR Encounter resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Encounter resource to record, search, and fetch basic encounter information for an individual patient within the Nepal health system. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. By providing a standardized foundation for capturing encounters in Nepal (including OPD visits, outreach clinics, and home visits), this profile promotes interoperability, consistent data capture, and adoption across national health programs.
NP Core Immunization Profile | The NP Core Immunization Profile inherits from the FHIR Immunization resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Immunization resource to record, search, and fetch basic immunization information for an individual patient within the Nepal health system. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. By providing a standardized foundation for capturing immunization events in Nepal
NP Core Medication Dispense Profile | The NP Core MedicationDispense Profile inherits from the FHIR MedicationDispense resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the MedicationDispense resource to record, search, and fetch information about medications dispensed to a patient within the Nepal health system. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used.
NP Core Patient Profile | The NP Core Patient Profile inherits from the FHIR Patient resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Patient resource to record, search, and fetch core patient information within the Nepal health system. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. By providing a standardized foundation for capturing patient demographics, identifiers, and key health attributes, this profile promotes interoperability, consistent data capture, and adoption across national health programs
Nepal Person Profile | Foundational person registry profile for Nepal. Supports IDs, Name, and telecom.

### Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

Ethnic Code | Extension to capture जाति कोड (ethnicity) based on Nepali classification
Nepal Address | Extension to represent coded and textual forms of Nepal's administrative divisions (Province, District, Municipality, Ward).

### Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Administrative Gender | A value set containing administrative gender codes from the FHIR core.
Age Range | ValueSet including selected HMIS age ranges from the PeriodRangeCS CodeSystem
Child Nutritional Status (SNOMED CT) | Values representing a child's nutritional status
Condition / Diagnosis Severity | Preferred value set for Condition/Diagnosis severity grading
Condition/Problem/Diagnosis codes | Condition/Problem/Diagnosis codes
Dietary Supplements (SNOMED) | Vitamins, minerals, and other dietary supplements
District | All district used in administrative divisions
Educational Level | SNOMED CT for the highest level of education attained.
Employment (रोजगारी स्थिति) | Codes representing employment status of a person.
Ethnic Code | ValueSet for जाति कोड (Ethnic Codes in Nepal)
Free Cost | ValueSet for Free Cost
Free Service Eligibility | ValueSet representing individuals eligible for free health services
LocalBody | All LocalBody used in administrative divisions
Marital Status (वैवाहिक स्थिति) | Codes representing marital status of a person.
Option Set - Yes / No / Yes-only / Don't know / Not applicable | Master option set for Yes/No/Yes-only/Don't know/Not applicable, including Nepali designations:छ/छैन, हो/होइन, गराएको/नगराएको, लिएको/नलिएको, भएको/नभएको, पाएको/नपाएको Used for: Presumptive TB Case (सम्भावित क्षयरोग विरामी) Gender Based Violence (लैंगिक हिंसा) Exclusively Breastfeeding (शिशुलाइ जन्मेको ६ महिना सम्म स्तनपान मात्र गराएको) Complementary Food (६ महिना पछि स्तनपान साथै ठोस, अर्धठोस र नरम खाना सुरू) GDS Present (General Danger Sign Present) Chest Indrawing (Yes only) Stridor (Yes only) Wheezing (Yes only) Condom Use Lab test results (Positive/Negative)
HL7 v2-0532 Code | SNOMED CT Code | English Meaning | Nepali Variants
--- | --- | --- | ---
Y | 373066001 | Yes / Affirmative | हो / गराएको / लिएको / भएको / पाएको
N | 373067005 | No / Negative | होइन / नगराएको / नलिएको / नभएको / नपाएको
Patient Registration Type | Patient registration types mapped to SNOMED CT concepts with Nepali display.
Patient Visit Ordinal | ValueSet combining SNOMED CT codes for first and follow-up visits with local codes for second, third, and repeat visits.
Province | All provinces used in administrative divisions
Service Area Address Classification | Classification of address locations relative to the organization's service area and referral context, using SNOMED CT concepts to specify whether the address is inside or outside the service area and the type of location involved.
Service Type | Service Type
Vaccines (SNOMED CT) | ValueSet of routine vaccines in Nepal, based on SNOMED CT concepts.

### Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

Ethnic Code | जाति कोडहरू: दलित, जनजाती, मधेसी, मुस्लिम, ब्राह्मण/क्षेत्री, अन्य
Free Service Eligibility | Categories of individuals eligible for free health services (निशुल्क सेवा कोड)
Nepal Administrative Location Codes | Comprehensive code system for Nepals provinces, districts, and municipalities.
Nepal Health Facility Type | Types of health facilities in Nepal, based on Ministry of Health and Population classifications.
Period Range | HMIS period ranges codes based on IHE ADX Range Coding System. Reference: IHE QRPH Supplement ADX, CP-QRPH-238, https://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_ADX.pdf#page=78 Durations define the amount if an intervening time between two time points. These durations are represented in the form P[n]Y[n]M[n]DT[n]H[n]M[n]S or P[n]W. The [n] is replaced by the value for each of the time elements that follow the [n] and the letters have the meaning: P is the duration designator (for period) placed at the start of the duration representation. Y is the year designator that follows the value for the number of years. M is the month designator that follows the value for the number of months. W is the week designator that follows the value for the number of weeks. D is the day designator that follows the value for the number of days. T is the time designator that precedes the time components of the representation. H is the hour designator that follows the value for the number of hours. M is the minute designator that follows the value for the number of minutes. S is the second designator that follows the value for the number of seconds.
निशुल्क/शुल्क रू | निशुल्क/शुल्क रू
सेवाको किसिम कोड सिस्टम | स्वास्थ्य सेवाका विभिन्न किसिमहरूको कोड सूची

### Terminology: Naming Systems

These define identifier and/or code system identities used by systems conforming to this implementation guide.

National Health ID | The official National Health Identification Number assigned by the Government of Nepal.
Nepal National Identity Number | Nepalese National Identity Number issued by the Ministry of Home Affairs.

### Terminology: Concept Maps

These define transformations to convert between codes by systems conforming with this implementation guide.

HL7 Administrative Gender to SNOMED CT | Maps HL7 Administrative Gender codes to SNOMED CT concepts.
Yes / No Concept Map | Mapping between HL7 v2-0532, SNOMED CT, and Nepali Yes/No custom codes

### Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Encounter ANC Visit - Pregnant Woman | An antenatal care visit for a pregnant woman.
Immunization Record - BCG | An example of an immunization resource for BCG vaccine.
Immunization Record - DPT | An example of an immunization resource for Diphtheria, Pertussis, and Tetanus (DPT) vaccine.
Immunization Record - Fractional Injectable Polio Vaccine (fIPV) | Example immunization resource for fractional IPV, given intradermally at 14 weeks and 9 months (2 doses).
Immunization Record - HPV Vaccine | Example immunization resource for Human Papillomavirus vaccine, given intramuscularly to adolescent girls in grades 6-10 and out-of-school girls aged 10+.
Immunization Record - Japanese Encephalitis Vaccine | Example immunization resource for Japanese Encephalitis vaccine, given subcutaneously at 12 months.
Immunization Record - Measles-Rubella Vaccine | Example immunization resource for Measles-Rubella vaccine, given subcutaneously at 9 and 15 months.
Immunization Record - OPV | An example of an immunization resource for Oral Polio Vaccine (OPV).
Immunization Record - PCV | An example of an immunization resource for Pneumococcal Conjugate Vaccine (PCV).
Immunization Record - Pentavalent Vaccine | An example of an immunization resource for the Pentavalent vaccine (DPT-HepB-Hib).
Immunization Record - Polio | An example of an immunization resource for Poliomyelitis vaccine (IPV/OPV).
Immunization Record - Rotavirus | An example of an immunization resource for Rotavirus vaccine.
Immunization Record - Td | An example of an immunization resource for Tetanus and Diphtheria (Td) vaccine.
Immunization Record - Typhoid Vaccine | Example immunization resource for Typhoid vaccine, given intramuscularly at 15 months.
MedicationDispense - Albendazole | Example of albendazole to a pregnant woman according to NP Core MedicationDispense Profile.
MedicationDispense - Calcium Dispense | Example of dispensing 30 Calcium to a pregnant woman according to NP Core MedicationDispense Profile.
MedicationDispense - Iron Tablet Dispense | Example of dispensing 60 iron tablets to a pregnant woman according to NP Core MedicationDispense Profile.
Patient – Child | 1-year-old Suman Thapa from Kathmandu Metropolitan City Ward No. 12 visiting the Health Facility for routine immunizations.
Patient – Pregnant Woman (Mom-to-Be) | 21-year-old Hiramaya Tamang from Ilam Municipality Ward No. 5 visiting the district hospital for pregnancy-related care.