What should be the rules to represent ManagingOrganization element?
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The reference SHALL be to an Organization resource which conforms to ILCoreOrganization profile.
It is important to note that HMO's have been decided to be represented as an extension.
This element may reference different organizations in different instances - where the organization represents the custodian of the specific resource instance, so it is not appropriate for the 1-1 relationship between a patient and their HMO.