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

: Coverage Dependent Example - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="CoverageDependentExample"/>
  <meta>
    <extension
               url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/source-file-id">
      <valueString value="e00083333"/>
    </extension>
    <source value="http://acme-health.com/WellnessInsuranceCompany"/>
    <profile
             value="http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-coverage"/>
  </meta>
  <text>
    <status value="extensions"/>
    <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>
  </text>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/subscriberId-encrypted">
    <valueString value="p58299i3-3t5z-2hyg-7256-g2un4f887e08"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-gender-group">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://linuxforhealth.org/fhir/cdm/CodeSystem/age-gender-group"/>
        <code value="4"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years">
    <valueUnsignedInt value="13"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://linuxforhealth.org/fhir/cdm/CodeSystem/hipaa-benefit-status"/>
        <code value="A"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-month">
    <valueDate value="2000-06-01"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-name-on-enrollment">
    <valueString value="Dr Kelly"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-zip-on-enrollment">
    <valueString value="75014"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp">
    <valueString value="EnrollmentPCP1"/>
  </extension>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://linuxforhealth.org/fhir/cdm/CodeSystem/identifier-type"/>
        <code value="SSRI"/>
      </coding>
    </type>
    <system value="http://acme-health.com/emr1/coverage"/>
    <value value="c35466d6-0d2b-4efa-8265-b9ac3f887e08"/>
    <assigner>
      <display value="Acme Health - EMR1"/>
    </assigner>
  </identifier>
  <status value="active"/>
  <subscriberId value="FamilyId_0001"/>
  <beneficiary>
    <reference value="Patient/CDMPatientInstance"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="child"/>
    </coding>
    <coding>
      <system
              value="http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-subscriber-relationship"/>
      <code value="childother"/>
    </coding>
  </relationship>
  <period>
    <start value="2000-01-01"/>
    <end value="2000-10-31"/>
  </period>
  <payor>
    <type value="Organiation"/>
    <identifier>
      <system value="http://acme-health.com/payer1/payer"/>
      <value value="PayerId09876"/>
    </identifier>
  </payor>
  <class>
    <type>
      <coding>
        <system
                value="http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class"/>
        <code value="election-tier"/>
      </coding>
    </type>
    <value value="Family"/>
  </class>
  <class>
    <type>
      <coding>
        <system
                value="http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class"/>
        <code value="group-type"/>
      </coding>
    </type>
    <value value="HMO"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
      </coding>
    </type>
    <value value="GR12345"/>
  </class>
</Coverage>