This page is part of the CCDA: Consolidated CDA Release (v3.0.0-ballot: CCDA 3.0 Ballot 1) based on FHIR (HL7® FHIR® Standard) v5.0.0. . For a full list of available versions, see the Directory of published versions
This content is an example of the Planned Coverage Logical Model and is not a FHIR Resource
<act classCode="ACT" moodCode="INT" xmlns="urn:hl7-org:v3">
<templateId root="2.16.840.1.113883.10.20.22.4.129" />
<id root="03f5e10b-7e79-4610-9626-d2984ff10cc1" />
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources" />
<statusCode code="active" />
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="INT">
<!-- These act/identifiers are unique identifiers
for the policy or program providing the coverage. -->
<id root="4c9a3be1-5f09-46dd-88e7-14c8ec612e4c" />
<code code="111" displayName="Medicare HMO"
codeSystemName="Source of Payment Typology (PHDSC)"
codeSystem="2.16.840.1.113883.3.221.5" />
<statusCode code="active" />
</act>
</entryRelationship>
</act>