LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: Coverage Dependent Example - JSON Representation

Raw json | Download

{
  "resourceType" : "Coverage",
  "id" : "CoverageDependentExample",
  "meta" : {
    "extension" : [
      {
        "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/source-file-id",
        "valueString" : "e00083333"
      }
    ],
    "source" : "http://acme-health.com/WellnessInsuranceCompany",
    "profile" : [
      "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-coverage"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"CoverageDependentExample\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Coverage \"CoverageDependentExample\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/WellnessInsuranceCompany!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-coverage.html\">CDM Coverage</a></p></div><p><b>SubscriberId Encrypted</b>: p58299i3-3t5z-2hyg-7256-g2un4f887e08</p><p><b>Age and Gender Groups</b>: Males 10-14 yr <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-age-gender-group.html\">Age and Gender Group Codes</a>#4)</span></p><p><b>Snapshot Age In Years</b>: 13</p><p><b>Benefit Status</b>: Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hipaa-benefit-status.html\">HIPAA Benefit Status Codes</a>#A)</span></p><p><b>Coverage Month</b>: 2000-06-01</p><p><b>Enrollment PCP Name On Enrollment</b>: Dr Kelly</p><p><b>Enrollment PCP Zip On Enrollment</b>: 75014</p><p><b>Enrollment PCP</b>: EnrollmentPCP1</p><p><b>identifier</b>: Source System Row Identifier: c35466d6-0d2b-4efa-8265-b9ac3f887e08(use: OFFICIAL)</p><p><b>status</b>: active</p><p><b>subscriberId</b>: FamilyId_0001</p><p><b>beneficiary</b>: <a href=\"Patient-CDMPatientInstance.html\">Patient/CDMPatientInstance</a> \" MCLASTNAME\"</p><p><b>relationship</b>: Child <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#child; <a href=\"CodeSystem-payer-subscriber-relationship.html\">Payer Subscriber Relationship Codes</a>#childother)</span></p><p><b>period</b>: 2000-01-01 --&gt; 2000-10-31</p><p><b>payor</b>: <span></span></p><blockquote><p><b>class</b></p><p><b>type</b>: Election Tier <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-coverage-class.html\">Payer Coverage Class Codes</a>#election-tier)</span></p><p><b>value</b>: Family</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Group Type <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-coverage-class.html\">Payer Coverage Class Codes</a>#group-type)</span></p><p><b>value</b>: HMO</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group)</span></p><p><b>value</b>: GR12345</p></blockquote></div>"
  },
  "extension" : [
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/subscriberId-encrypted",
      "valueString" : "p58299i3-3t5z-2hyg-7256-g2un4f887e08"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-gender-group",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/age-gender-group",
            "code" : "4"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years",
      "valueUnsignedInt" : 13
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/hipaa-benefit-status",
            "code" : "A"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-month",
      "valueDate" : "2000-06-01"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-name-on-enrollment",
      "valueString" : "Dr Kelly"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-zip-on-enrollment",
      "valueString" : "75014"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp",
      "valueString" : "EnrollmentPCP1"
    }
  ],
  "identifier" : [
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/identifier-type",
            "code" : "SSRI"
          }
        ]
      },
      "system" : "http://acme-health.com/emr1/coverage",
      "value" : "c35466d6-0d2b-4efa-8265-b9ac3f887e08",
      "assigner" : {
        "display" : "Acme Health - EMR1"
      }
    }
  ],
  "status" : "active",
  "subscriberId" : "FamilyId_0001",
  "beneficiary" : {
    "reference" : "Patient/CDMPatientInstance"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "child"
      },
      {
        "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-subscriber-relationship",
        "code" : "childother"
      }
    ]
  },
  "period" : {
    "start" : "2000-01-01",
    "end" : "2000-10-31"
  },
  "payor" : [
    {
      "type" : "Organiation",
      "identifier" : {
        "system" : "http://acme-health.com/payer1/payer",
        "value" : "PayerId09876"
      }
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class",
            "code" : "election-tier"
          }
        ]
      },
      "value" : "Family"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class",
            "code" : "group-type"
          }
        ]
      },
      "value" : "HMO"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ]
      },
      "value" : "GR12345"
    }
  ]
}