FHIR-57322: Supporting Patient Type of New vs. Existing Patients

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ballot: https://jira.hl7.org/browse/FHIR-57322
resolution: remove binding to Slot.appointmentType and introduce extension for capturing patient type.

Highlights:

• per discussions at CMS Connectathon 2026 day 2, the group felt that slot.appointmentType was not the most ideal given the 0..1 cardinality and the orthogonal concept of patient type (i.e. new vs. existing patient) with all the other concepts that may be in slot.appointmentType
• two primary approaches discussed below
  • 1. new extension explicitly for patient type. We want to help disambiguate with our SSL FHIR IG, so we make an explicit extension just for patient type and additionally make it required.
  • 2. new extension for patient type using the R6/continuous build 'characteristic' data element and slicing it on patient type. This approach is more amenable to future attributes/changes.
• As of 8/3/26, we decided to go with the simple extension for patient type.

Note: the 2nd option is not included in this PR. We'll open a separate PR for that.

Rendered FHIR IG:

Patient Type Extension

Example

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Discussed during 7/29/26 SSL WG meeting. We're all aligned on this proposal due to:

1. Using an extension since there's no native field for this concept
2. Being very explicit about what we're modeling (i.e. Patient Type) so the simple extension works

Since ticket was submitted by Cooper, it'd be great to have him look at the PR to see if he still feels strongly about using the characteristic from R6. cc: @Culby @brandon-larue-zocdoc @abertnamanya

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Discussed 8/3

• simple extension for patient type since it's the term used by orgs
• submit ticket to THO for updating their value set to include new patients only: https://hl7.org/fhir/us/ndh/STU1/ValueSet-AcceptingPatientsVS.html

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Discussed 8/3

• simple extension for patient type since it's the term used by orgs
• submit ticket to THO for updating their value set to include new patients only: https://hl7.org/fhir/us/ndh/STU1/ValueSet-AcceptingPatientsVS.html

Cooper submitted to THO: https://jira.hl7.org/browse/UP-844

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Discussed during 8/5/26 SSL Workgroup meeting:

• require patient type 1..1 on slot (aka all publishers MUST populate patient type)
• decrease binding strength of patient type from required to extensible. One of the key reasons include the fact that the THO codesystem does not have a code for new patients only.