Middle name is tricky, as requirements are slightly different between countries and cultures. There is no Middle name in the patient resource, so middle names need to be handle with some type of extensions.

There seem to be two dinstict uses of "middle names"

• It is a second given name

• It is a second family name

The first can (should?) be supported by using the standard extension http://hl7.org/fhir/ValueSet/name-part-qualifier

The latter cannot be supported by the same extension, even though the definition of the code MID says so as family name is 0..1, so the name part qualifier has no use in the context of a family name. And setting MID on a given name to say its a middle name (of family name type) seems informatically incorrect.

"MID Indicates that the name part is a middle name. In general, the English "middle name" concept is all of the given names after the first. This qualifier may be used to explicitly indicate which given names are considered to be middle names. The middle name qualifier may also be used with family names. This is a Scandinavian use case, matching the concept of "mellomnavn"/"mellannamn". There are specific rules that indicate what names may be taken as a mellannamnin different Scandinavian countries"

Suggestion

Create a standard extension for midlde name to be used for the second use case above only. Maybe call it something like "middle name as family name" or something similar.

Norway have already created their own extension, and we in Sweden will likely have to create our own as well for the same use case.