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

input/fsh/examples/ExampleSlotWithAppointmentType.fsh

@@ -4,20 +4,26 @@ Usage: #example
 Title: "Slot Accepting New and Existing Patients"
 Description: "A slot that is accepting new and existing patients"
 
-* appointmentType = http://terminology.hl7.org/CodeSystem/accepting-patients#newpt
 * schedule = Reference(ExampleSchedule)
 * status = #free
 * start = "2026-03-21T10:45:00-04:00"
 * end = "2026-03-21T11:15:00-04:00"
 
+* extension[+].url = "http://hl7.org/fhir/uv/smart-scheduling-links/StructureDefinition/patient-type"
+* extension[=].valueCoding.system = "http://terminology.hl7.org/CodeSystem/accepting-patients"
+* extension[=].valueCoding.code = #newpt
+
 Instance: AcceptOnlyExistingPatients
 InstanceOf: SmartSchedulingSlot
 Usage: #example
 Title: "Slot Accepting Only Existing Patients"
 Description: "A slot that is accepting only existing patients"
 
-* appointmentType = http://terminology.hl7.org/CodeSystem/accepting-patients#existptonly
 * schedule = Reference(ExampleSchedule)
 * status = #free
 * start = "2026-03-21T10:45:00-04:00"
 * end = "2026-03-21T11:15:00-04:00"
+
+* extension[+].url = "http://hl7.org/fhir/uv/smart-scheduling-links/StructureDefinition/patient-type"
+* extension[=].valueCoding.system = "http://terminology.hl7.org/CodeSystem/accepting-patients"
+* extension[=].valueCoding.code = #existptonly

input/fsh/extensions/patient-type.fsh

@@ -0,0 +1,17 @@
+Extension: PatientType
+Id: patient-type
+Title: "Patient Type"
+Description: """
+This extension enables SSL to represent new-patient acceptance policy and binding to
+AcceptingPatientsVS. 
+"""
+
+* ^context.type = #element
+* ^context.expression = "Slot"
+
+* value[x] only Coding
+* valueCoding 1..1
+* valueCoding.system 1..1
+* valueCoding.system = "http://terminology.hl7.org/CodeSystem/accepting-patients"
+* valueCoding.code 1..1
+* valueCoding.code from http://hl7.org/fhir/us/ndh/ValueSet/AcceptingPatientsVS (extensible)

input/fsh/profiles/slot.fsh

@@ -19,18 +19,17 @@ timing (e.g., "between 9 a.m. and 5 p.m." or "between noon and five p.m.").
 // start 1..1
 // end 1..1
 
+* id 1..1 MS
 * schedule MS
 * schedule only Reference(SmartSchedulingSchedule)
 * status MS
 * start MS
 * end MS
-* appointmentType MS
-* appointmentType from AppointmentTypeAndReasonsVS (preferred)
 
-// 
 * extension contains
-    BookingDeepLink named bookingDeepLink 0..1 and
-    BookingPhone named bookingPhone 0..1
+    BookingDeepLink named bookingDeepLink 0..1 MS and
+    BookingPhone named bookingPhone 0..1 MS and
+    PatientType named patientType 1..1 MS // double check to see if we wanted to make this required. 
 
 Instance: ExampleSlot
 InstanceOf: SmartSchedulingSlot
@@ -43,6 +42,11 @@ Usage: #example
 * end = "2026-03-21T11:15:00-04:00"
 * extension[0].url = "http://hl7.org/fhir/uv/smart-scheduling-links/StructureDefinition/booking-deep-link"
 * extension[=].valueUrl = "https://ehr.example.org/booking/slots/123"
+
 * extension[+].url = "http://hl7.org/fhir/uv/smart-scheduling-links/StructureDefinition/booking-phone"
 * extension[=].valueContactPoint.system = #phone
 * extension[=].valueContactPoint.value = "+1-555-123-4567"
+
+* extension[+].url = "http://hl7.org/fhir/uv/smart-scheduling-links/StructureDefinition/patient-type"
+* extension[=].valueCoding.system = "http://terminology.hl7.org/CodeSystem/accepting-patients"
+* extension[=].valueCoding.code = #newpt

input/pagecontent/StructureDefinition-smart-scheduling-slot-intro.md

@@ -16,9 +16,9 @@ The following data elements must always be present or must be supported if the d
 - end
 
 **Each Slot Must Support:**
-- appointmentType
 - booking deep link
 - booking phone number
+- patient type
 
 **Profile Specific Implementation Guidance:**
 

input/pagecontent/StructureDefinition-smart-scheduling-slot-notes.md

@@ -0,0 +1,7 @@
+Discussed extensively in [February 2026 as captured in these confluence notes](https://confluence.hl7.org/spaces/PA/pages/413256942/New+vs.+Existing+Patients), but also during the 2026 CMS Connectathon in July. General options included:
+- being very opionated about modeling patient type in a new extension that is required
+- using an extension that is inspired by the 'characteristic' data element in R6/continuous build. This would function like a patient badge of sorts. We'd then slice on characteristic to model patient type.
+
+In all scenarios discussed, the group agreed that slot.appointmentType was not ideal given the 0..1 cardinality and the fact that patient type is orothogonal to appointmentType as it could represent a variety of other things. 
+
+After [discussions on 8/3/2026](https://github.com/HL7/smart-scheduling-links/pull/46), we decided to use the simple extension for patient type. Opinions weren't overtly strong either way, but the fact that "patient type" was a concept used in a lot of places, we decided to keep our simple extension.