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

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: CDM Claim - Drug Coverage Example - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="CoverageDrugExample"/>
  <meta>
    <source value="http://acme-health.com/WellnessCenterPharmacy"/>
    <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="CoverageDrugExample"> </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 "CoverageDrugExample" </p><p style="margin-bottom: 0px">Information Source: http://acme-health.com/WellnessCenterPharmacy!</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-cdm-coverage.html">CDM Coverage</a></p></div><p><b>Age and Gender Groups</b>: Males 20-24 yr <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-age-gender-group.html">Age and Gender Group Codes</a>#7)</span></p><p><b>Snapshot Age In Years</b>: 21</p><p><b>Claim Group Identifier</b>: claim group id</p><p><b>Coverage Month</b>: 2017-06-01</p><p><b>Employee Count</b>: 1</p><p><b>Employee Status</b>: Active Full Time <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-payer-employee-status-code.html">payer Employee Status Codes</a>#1)</span></p><p><b>Employee Hire Date</b>: 2017-01-30</p><p><b>identifier</b>: Source System Row Identifier: encryp-id1234</p><p><b>status</b>: active</p><p><b>subscriber</b>: <a href="Patient-CDMPatientInstance.html">Patient/CDMPatientInstance</a> " MCLASTNAME"</p><p><b>beneficiary</b>: <span></span></p><p><b>relationship</b>: Self <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>#self)</span></p><p><b>period</b>: 2017-06-01 --&gt; 2017-06-30</p><p><b>payor</b>: <span></span></p></div>
  </text>
  <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="7"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years">
    <valueUnsignedInt value="21"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-group-identifier">
    <valueString value="claim group id"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-month">
    <valueDate value="2017-06-01"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-count">
    <valueUnsignedInt value="1"/>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-status">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-employee-status-code"/>
        <code value="1"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-hire-date">
    <valueDate value="2017-01-30"/>
  </extension>
  <identifier>
    <extension
               url="http://linuxforhealth.org/fhir/cdm/StructureDefinition/encrypted-state">
      <valueBoolean value="true"/>
    </extension>
    <type>
      <coding>
        <system
                value="http://linuxforhealth.org/fhir/cdm/CodeSystem/identifier-type"/>
        <code value="SSRI"/>
      </coding>
    </type>
    <system value="http://acme-health.com/emr1/WellnessCenterPharmacy"/>
    <value value="encryp-id1234"/>
  </identifier>
  <status value="active"/>
  <subscriber>
    <reference value="Patient/CDMPatientInstance"/>
  </subscriber>
  <beneficiary>
    <type value="Person"/>
    <identifier>
      <system value="http://acme-health.com/emr1/person"/>
      <value value="Payer1"/>
    </identifier>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2017-06-01"/>
    <end value="2017-06-30"/>
  </period>
  <payor>
    <type value="Organiation"/>
    <identifier>
      <system value="http://acme-health.com/payer1/payer"/>
      <value value="encryp-id1234"/>
    </identifier>
  </payor>
</Coverage>