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Is there a way to patch a resource with an identifier other than the index? 

```const result = await medplum.patchResource('Patient', '123', [
  {op: 'replace', path: '/name/0/family', value: 'Smith'},
]);
console.log(result.meta.versionId);```

Or... Is there a way to know the index if I'm using list args?

Hi <@880200155981316177> , the patch resource follows the JSON patch specification, which requires an index, unfortunately. The only exception is that you can use the `-` character to refer to the end of a list

https://jsonpatch.com/

We've discussed internally implementing the FHIRPatch spec, which *might* solve your problem. But this is an untested part of the spec so we just want to be cautious. Let us know if this would help 
 http://hl7.org/fhir/R4/fhirpatch.html