NHSDigital · KazeemHamzat · Mar 31, 2026 · Mar 26, 2026 · Mar 26, 2026 · Mar 26, 2026
diff --git a/Bundle/Bundle-NonWGSScenario3-FetusAsProband-Example.json b/Bundle/Bundle-NonWGSScenario3-FetusAsProband-Example.json
@@ -136,6 +136,10 @@
        ]
       }
      },
+     {
+      "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+      "valueInteger": 2
+     },
      {
       "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
       "valueCodeableConcept": {

diff --git a/Bundle/Bundle-NonWGSScenario4-ProbandWithMultipleFetus-Example.json b/Bundle/Bundle-NonWGSScenario4-ProbandWithMultipleFetus-Example.json
@@ -137,6 +137,10 @@
        ]
       }
      },
+     {
+      "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+      "valueInteger": 2
+     },
      {
       "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
       "valueCodeableConcept": {
@@ -444,6 +448,10 @@
        ]
       }
      },
+     {
+      "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+      "valueInteger": 2
+     },
      {
       "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
       "valueCodeableConcept": {

diff --git a/Bundle/Bundle-NonWGSTestOrderForm-FetalScenario-Example.json b/Bundle/Bundle-NonWGSTestOrderForm-FetalScenario-Example.json
@@ -309,6 +309,10 @@
        ]
       }
      },
+     {
+      "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+      "valueInteger": 2
+     },
      {
       "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
       "valueCodeableConcept": {

diff --git a/DiagnosticReport/DiagnosticReport-AnitaLamberts-Example.json b/DiagnosticReport/DiagnosticReport-AnitaLamberts-Example.json
@@ -43,7 +43,7 @@
     "reference": "Patient/Patient-AnitaLamberts-Example",
     "identifier": {
       "system": "https://fhir.nhs.uk/Id/nhs-number",
-      "value": "8449303649",
+      "value": "8449303649"
     }
   },
   "issued": "2023-11-24T09:45:00Z",

diff --git a/...cReport-ExtensionMediaLinkR5-Example.json → ...ticReport-ExtensionMediaLink-Example.json b/...cReport-ExtensionMediaLinkR5-Example.json → ...ticReport-ExtensionMediaLink-Example.json
@@ -20,7 +20,7 @@
     "link": {
      "extension": [
       {
-       "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.media.link",
+       "url": "http://hl7.org/fhir/StructureDefinition/alternate-reference",
        "valueReference": {
         "reference": "DocumentReference/UKCore-DocumentReference-ECG-Example"
        }

diff --git a/DiagnosticReport/DiagnosticReport-FayMutlowGeneticReport-Example.json b/DiagnosticReport/DiagnosticReport-FayMutlowGeneticReport-Example.json
@@ -43,7 +43,7 @@
     "reference": "Patient/Patient-FayMutlow-Example",
     "identifier": {
       "system": "https://fhir.nhs.uk/Id/nhs-number",
-      "value": "9449307806",
+      "value": "9449307806"
     }
   },
   "issued": "2023-10-09T09:45:00Z",

diff --git a/DiagnosticReport/DiagnosticReport-GenomicVariantAssessment-Example.json b/DiagnosticReport/DiagnosticReport-GenomicVariantAssessment-Example.json
@@ -99,7 +99,7 @@
   "reference": "Patient/Patient-PheobeSmitham-Example",
   "identifier": {
    "system": "https://fhir.nhs.uk/Id/nhs-number",
-   "value": "9449307539",
+   "value": "9449307539"
   }
  },
  "effectiveDateTime": "2023-10-16T00:00:00-05:00",
@@ -122,7 +122,7 @@
    "link": {
     "extension": [
      {
-      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.media.link",
+      "url": "http://hl7.org/fhir/StructureDefinition/alternate-reference",
       "valueReference": {
        "reference": "DocumentReference/DocumentReference-StructureReporting-Example"
       }

diff --git a/DiagnosticReport/DiagnosticReport-JamesMetcalfeGeneticReport-Example.json b/DiagnosticReport/DiagnosticReport-JamesMetcalfeGeneticReport-Example.json
@@ -43,7 +43,7 @@
     "reference": "Patient/Patient-JamesMetcalfe-Example",
     "identifier": {
       "system": "https://fhir.nhs.uk/Id/nhs-number",
-      "value": "7449306524",
+      "value": "7449306524"
     }
   },
   "issued": "2023-10-18T11:10:00Z",

diff --git a/DiagnosticReport/DiagnosticReport-PhoebeSmithGeneticReport-Example.json b/DiagnosticReport/DiagnosticReport-PhoebeSmithGeneticReport-Example.json
@@ -43,7 +43,7 @@
     "reference": "Patient/Patient-PheobeSmitham-Example",
     "identifier": {
       "system": "https://fhir.nhs.uk/Id/nhs-number",
-      "value": "9449307539",
+      "value": "9449307539"
     }
   },
   "issued": "2023-10-16T15:50:00Z",

diff --git a/Group/Group-FamilyPedigreeRepresentation-Example.json b/Group/Group-FamilyPedigreeRepresentation-Example.json
@@ -38,7 +38,7 @@
   },
   {
    "entity": {
-    "reference": "Patient/Patient-PheobeSmithamMother-Example"
+    "reference": "Patient/Patient-PheobeSmithamMother-Example",
     "identifier": {
      "system": "https://fhir.nhs.uk/Id/nhs-number",
      "value": "9449307246"

diff --git a/RequestGroup/RequestGroup-WGSTrioTesting-Example.json b/RequestGroup/RequestGroup-WGSTrioTesting-Example.json
@@ -1,6 +1,12 @@
 {
  "resourceType": "RequestGroup",
  "id": "RequestGroup-WGSTrioTesting-Example",
+ "extension": [
+  {
+   "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+   "valueInteger": 3
+  }
+ ],
  "identifier": [
   {
    "system": "https://fhir.leedssth.nhs.uk//Id/grouptestId",

diff --git a/ServiceRequest/ServiceRequest-NonWGSTestOrderForm-FetalScenario-Example.json b/ServiceRequest/ServiceRequest-NonWGSTestOrderForm-FetalScenario-Example.json
@@ -14,6 +14,10 @@
     ]
    }
   },
+  {
+   "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+   "valueInteger": 2
+  },
   {
    "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
    "valueCodeableConcept": {

diff --git a/ServiceRequest/ServiceRequest-NonWGSTestOrderForm-NewFollowupTest-Example.json b/ServiceRequest/ServiceRequest-NonWGSTestOrderForm-NewFollowupTest-Example.json
@@ -56,7 +56,7 @@
      }
     ]
    }
-  ]
+  ],
   "text": "Follow Up Test requested to aid interpretation. M code modified to: R65.1"
  },
  "subject": {

diff --git a/ServiceRequest/ServiceRequest-NonWGSTestOrderForm-OutOfCountry-Example.json b/ServiceRequest/ServiceRequest-NonWGSTestOrderForm-OutOfCountry-Example.json
@@ -85,7 +85,6 @@
      ]
     }
    ]
-   ]
   }
  ],
  "performer": [

diff --git a/ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example.json b/ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example.json
@@ -20,6 +20,10 @@
     ]
    }
   },
+  {
+   "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+   "valueInteger": 3
+  },
   {
    "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
    "valueCodeableConcept": {

diff --git a/ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProbandDGTS-Example.json b/ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProbandDGTS-Example.json
@@ -20,6 +20,10 @@
     ]
    }
   },
+  {
+   "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+   "valueInteger": 3
+  },
   {
    "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
    "valueCodeableConcept": {

diff --git a/ServiceRequest/ServiceRequest-WGSTestOrderFormUpdated-TrioTesting-Example.json b/ServiceRequest/ServiceRequest-WGSTestOrderFormUpdated-TrioTesting-Example.json
@@ -28,6 +28,10 @@
     ]
    }
   },
+  {
+   "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+   "valueInteger": 3
+  },
   {
    "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
    "valueCodeableConcept": {
@@ -76,7 +80,7 @@
  "priority": "routine",
  "code": {
   "coding": [
-  {
+   {
     "system": "https://fhir.nhs.uk/CodeSystem/England-DigitalGenomicTestService",
     "code": "GT317",
     "display": "Likely inborn error of metabolism - WGS",

diff --git a/StructureDefinition/Extension-GenomicTest-ParticipantCount.json b/StructureDefinition/Extension-GenomicTest-ParticipantCount.json
@@ -0,0 +1,66 @@
+{
+  "resourceType": "StructureDefinition",
+  "id": "Extension-GenomicTest-ParticipantCount",
+  "url": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount",
+  "version": "0.1.0",
+  "name": "ExtensionGenomicTestParticipantCount",
+  "title": "Extension Genomic Test ParticipantCount",
+  "status": "draft",
+  "date": "2026-03-26",
+  "publisher": "NHS England",
+  "contact": [
+    {
+      "name": "NHS England",
+      "telecom": [
+        {
+          "system": "email",
+          "value": "interoperabilityteam@nhs.net",
+          "use": "work",
+          "rank": 1
+        }
+      ]
+    }
+  ],
+  "description": "An Extension used to record the total number of participants in a group test request.(e.g. family, duo / trio).",
+  "purpose": "This is a use case from Genomics, used to record the total number of participants in a family or group test request.",
+  "copyright": "Copyright © 2026+ NHS England Licensed under the Apache License, Version 2.0 (the \\\\\\\"License\\\\\\\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \\\\\\\"AS IS\\\\\\\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
+  "fhirVersion": "4.0.1",
+  "kind": "complex-type",
+  "abstract": false,
+  "context": [
+    {
+      "type": "element",
+      "expression": "RequestGroup"
+    },
+    {
+      "type": "element",
+      "expression": "ServiceRequest"
+    }
+  ],
+  "type": "Extension",
+  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
+  "derivation": "constraint",
+  "differential": {
+    "element": [
+      {
+        "id": "Extension.extension",
+        "path": "Extension.extension",
+        "max": "0"
+      },
+      {
+        "id": "Extension.url",
+        "path": "Extension.url",
+        "fixedUri": "https://fhir.nhs.uk/England/StructureDefinition/Extension-GenomicTest-ParticipantCount"
+      },
+      {
+        "id": "Extension.value[x]",
+        "path": "Extension.value[x]",
+        "type": [
+          {
+            "code": "integer"
+          }
+        ]
+      }
+    ]
+  }
+}
diff --git a/fhirpkg.lock.json b/fhirpkg.lock.json
@@ -1,5 +1,5 @@
 {
-  "updated": "2026-03-17T13:27:37.444214+00:00",
+  "updated": "2026-03-26T11:41:42.0351721+00:00",
   "dependencies": {
     "hl7.fhir.r4.core": "4.0.1",
     "hl7.fhir.uv.genomics-reporting": "3.0.0-ballot",
@@ -12,8 +12,7 @@
     "us.nlm.vsac": "0.9.0",
     "ihe.iti.balp": "1.1.1",
     "hl7.fhir.uv.extensions.r4": "5.3.0-ballot-tc1",
-    "hl7.terminology.r4": "6.5.0",
-    "hl7.fhir.uv.xver-r5.r4": "0.0.1-snapshot-2"
+    "hl7.terminology.r4": "7.1.0"
   },
   "missing": {}
 }
diff --git a/package.json b/package.json
@@ -9,8 +9,7 @@
     "hl7.fhir.eu.laboratory": "0.1.0-ballot",
     "fhir.r4.ukcore.stu3.currentbuild": "0.28.0-pre-release",
     "ihe.iti.pcf": "1.0.0-comment",
-    "hl7.fhir.uv.extensions.r4": "5.3.0-ballot-tc1",
-    "hl7.fhir.uv.xver-r5.r4": "0.0.1-snapshot-2"
+    "hl7.fhir.uv.extensions.r4": "5.3.0-ballot-tc1"
   },
   "fhirVersions": [
     "4.0.1"
-Original file line number
+Diff line change
@@ Expand Up / @@ -56,7 +56,7 @@ @@
          }
         ]
        }
-      ]
+      ],
       "text": "Follow Up Test requested to aid interpretation. M code modified to: R65.1"
      },
      "subject": {
@@ Expand Down @@