With all the different ways "sex" and "gender" can be represented in US Core, plus the need to align with Gender Harmony guidance plus content in C-CDA, there is a need for a section that clarifies to users what all the different extensions and elements can be used for and how to map between them. This needs to significantly expand the paragraph in the patient profile and make it easy to find. This improved guidance needs to include the proper use of the Sexual Orientation Observation Profile, which is one of the reasons (also see below regarding SPCU) why this guidance should not be just on the Patient Profile. It can also add textual clarity on required search support. I will note that only this year did CMS clarify in abstractions that sex assigned at birth, gender identity, and sexual orientation should not be jumbled into one field.

The guidance should discuss the following "objects", including bindings:
Patient.gender
Patient.sex (extension)
Patient.birthsex (extension)
Patient.genderIdentity (extension)
Sexual Orientation profile

I will help create this new material.