Eligibilityresponse.shex

ShEx statement for eligibilityresponse

PREFIX fhir: <http://hl7.org/fhir/> 
PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/>
PREFIX xsd: <http://www.w3.org/2001/XMLSchema#> 
BASE <http://hl7.org/fhir/shape/>

start=<EligibilityResponse> AND {fhir:nodeRole [fhir:treeRoot]}


# EligibilityResponse resource
<EligibilityResponse> CLOSED {
    a [fhir:EligibilityResponse];
    fhir:nodeRole [fhir:treeRoot]?;
    fhir:Resource.id @<id>?;                # Logical id of this artifact
    fhir:Resource.meta @<Meta>?;            # Metadata about the resource
    fhir:Resource.implicitRules @<uri>?;    # A set of rules under which this 
                                            # content was created 
    fhir:Resource.language @<code>?;        # Language of the resource content
    fhir:DomainResource.text @<Narrative>?;  # Text summary of the resource, for 
                                            # human interpretation 
    fhir:DomainResource.contained @<Resource>*;  # Contained, inline Resources
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:modifierExtension @<Extension>*;   # Extensions that cannot be ignored
    fhir:EligibilityResponse.identifier @<Identifier>*;  # Business Identifier
    fhir:EligibilityResponse.status @<code> AND
    	{fhir:value @fhirvs:eligibilityresponse-status};  # active | cancelled | draft | 
                                            # entered-in-error 
    (                                       # Claim reference
        fhir:EligibilityResponse.requestIdentifier @<Identifier>  |
        fhir:EligibilityResponse.requestReference @<EligibilityRequestReference> 
    )?;
    fhir:EligibilityResponse.outcome @<code> AND
    	{fhir:value @fhirvs:remittance-outcome}?;  # complete | error | partial
    fhir:EligibilityResponse.disposition @<string>?;  # Disposition Message
    fhir:EligibilityResponse.ruleset @<Coding>?;  # Resource version
    fhir:EligibilityResponse.originalRuleset @<Coding>?;  # Original version
    fhir:EligibilityResponse.created @<dateTime>?;  # Creation date
    (                                       # Insurer
        fhir:EligibilityResponse.organizationIdentifier @<Identifier>  |
        fhir:EligibilityResponse.organizationReference @<OrganizationReference> 
    )?;
    (                                       # Responsible practitioner
        fhir:EligibilityResponse.requestProviderIdentifier @<Identifier>  |
        fhir:EligibilityResponse.requestProviderReference @<PractitionerReference> 
    )?;
    (                                       # Responsible organization
        fhir:EligibilityResponse.requestOrganizationIdentifier @<Identifier>  |
        fhir:EligibilityResponse.requestOrganizationReference @<OrganizationReference> 
    )?;
    fhir:EligibilityResponse.inforce @<boolean>?;  # Coverage inforce
    fhir:EligibilityResponse.contract @<ContractReference>?;  # Contract details
    fhir:EligibilityResponse.form @<Coding> AND
    	{fhir:value @fhirvs:forms}?;  # Printed Form Identifier
    fhir:EligibilityResponse.benefitBalance @<EligibilityResponse.benefitBalance>*;  # Benefits by Category
    fhir:EligibilityResponse.error @<EligibilityResponse.error>*;  # Processing errors
    fhir:index xsd:integer?                 # Relative position in a list
}

# Benefits by Category
<EligibilityResponse.benefitBalance> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:modifierExtension @<Extension>*;   # Extensions that cannot be ignored
    fhir:EligibilityResponse.benefitBalance.category @<Coding>;  # Benefit Category
    fhir:EligibilityResponse.benefitBalance.subCategory @<Coding>?;  # Benefit SubCategory
    fhir:EligibilityResponse.benefitBalance.name @<string>?;  # Short name for the benefit
    fhir:EligibilityResponse.benefitBalance.description @<string>?;  # Description of the benefit
    fhir:EligibilityResponse.benefitBalance.network @<Coding>?;  # In or out of network
    fhir:EligibilityResponse.benefitBalance.unit @<Coding>?;  # Individual or family
    fhir:EligibilityResponse.benefitBalance.term @<Coding>?;  # Annual or lifetime
    fhir:EligibilityResponse.benefitBalance.financial @<EligibilityResponse.benefitBalance.financial>*;  # Benefit Summary
    fhir:index xsd:integer?                 # Relative position in a list
}

# Processing errors
<EligibilityResponse.error> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:modifierExtension @<Extension>*;   # Extensions that cannot be ignored
    fhir:EligibilityResponse.error.code @<Coding> AND
    	{fhir:value @fhirvs:adjudication-error};  # Error code detailing processing 
                                            # issues 
    fhir:index xsd:integer?                 # Relative position in a list
}

# Benefit Summary
<EligibilityResponse.benefitBalance.financial> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:modifierExtension @<Extension>*;   # Extensions that cannot be ignored
    fhir:EligibilityResponse.benefitBalance.financial.type @<Coding>;  # Deductable, visits, benefit amount
    (                                       # Benefits allowed
        fhir:EligibilityResponse.benefitBalance.financial.benefitUnsignedInt @<unsignedInt>  |
        fhir:EligibilityResponse.benefitBalance.financial.benefitString @<string>  |
        fhir:EligibilityResponse.benefitBalance.financial.benefitMoney @<Money> 
    )?;
    (                                       # Benefits used
        fhir:EligibilityResponse.benefitBalance.financial.benefitUsedUnsignedInt @<unsignedInt>  |
        fhir:EligibilityResponse.benefitBalance.financial.benefitUsedMoney @<Money> 
    )?;
    fhir:index xsd:integer?                 # Relative position in a list
}

#---------------------- Data Types -------------------

# Primitive Type dateTime
<dateTime> CLOSED {
    fhir:id @<id>?;                         # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:gYear OR xsd:gYearMonth OR xsd:date OR xsd:dateTime?;  # Primitive value for dateTime
    fhir:index xsd:integer?                 # Relative position in a list
}

# Metadata about a resource
<Meta> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:Meta.versionId @<id>?;             # Version specific identifier
    fhir:Meta.lastUpdated @<instant>?;      # When the resource version last 
                                            # changed 
    fhir:Meta.profile @<uri>*;              # Profiles this resource claims to 
                                            # conform to 
    fhir:Meta.security @<Coding>*;          # Security Labels applied to this 
                                            # resource 
    fhir:Meta.tag @<Coding>*;               # Tags applied to this resource
    fhir:index xsd:integer?                 # Relative position in a list
}

# Primitive Type code
<code> CLOSED {
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:string?;                 # Primitive value for code
    fhir:index xsd:integer?                 # Relative position in a list
}

# Primitive Type string
<string> CLOSED {
    fhir:id @<id>?;                         # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:string MAXLENGTH 1048576?;  # Primitive value for string
    fhir:index xsd:integer?                 # Relative position in a list
}

# Base Resource
<Resource> {a .+;
    fhir:Resource.id @<id>?;                # Logical id of this artifact
    fhir:Resource.meta @<Meta>?;            # Metadata about the resource
    fhir:Resource.implicitRules @<uri>?;    # A set of rules under which this 
                                            # content was created 
    fhir:Resource.language @<code>?;        # Language of the resource content
    fhir:index xsd:integer?
}

# Primitive Type uri
<uri> CLOSED {
    fhir:id @<id>?;                         # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:string?;                 # Primitive value for uri
    fhir:index xsd:integer?                 # Relative position in a list
}

<Extension> {fhir:extension @<Extension>*;
    fhir:index xsd:integer?
}

# An amount of economic utility in some recognised currency
<Money> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:Quantity.value @<decimal>?;        # Numerical value (with implicit 
                                            # precision) 
    fhir:Quantity.comparator @<code> AND
    	{fhir:value @fhirvs:quantity-comparator}?;  # < | <= | >= | > - how to 
                                            # understand the value 
    fhir:Quantity.unit @<string>?;          # Unit representation
    fhir:Quantity.system @<uri>?;           # System that defines coded unit form
    fhir:Quantity.code @<code>?;            # Coded form of the unit
    fhir:index xsd:integer?                 # Relative position in a list
}

# An identifier intended for computation
<Identifier> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:Identifier.use @<code> AND
    	{fhir:value @fhirvs:identifier-use}?;  # usual | official | temp | 
                                            # secondary (If known) 
    fhir:Identifier.type @<CodeableConcept>?;  # Description of identifier
    fhir:Identifier.system @<uri>?;         # The namespace for the identifier
    fhir:Identifier.value @<string>?;       # The value that is unique
    fhir:Identifier.period @<Period>?;      # Time period when id is/was valid 
                                            # for use 
    fhir:Identifier.assigner @<OrganizationReference>?;  # Organization that issued id (may 
                                            # be just text) 
    fhir:index xsd:integer?                 # Relative position in a list
}

# Primitive Type boolean
<boolean> CLOSED {
    fhir:id @<id>?;                         # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:boolean?;                # Primitive value for boolean
    fhir:index xsd:integer?                 # Relative position in a list
}

# A human-readable formatted text, including images
<Narrative> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:Narrative.status @<code> AND
    	{fhir:value @fhirvs:narrative-status};  # generated | extensions | 
                                            # additional | empty 
    fhir:Narrative.div xsd:string;          # Limited xhtml content
    fhir:index xsd:integer?                 # Relative position in a list
}

# A reference to a code defined by a terminology system
<Coding> CLOSED {
    fhir:concept IRI?;
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:Coding.system @<uri>?;             # Identity of the terminology system
    fhir:Coding.version @<string>?;         # Version of the system - if relevant
    fhir:Coding.code @<code>?;              # Symbol in syntax defined by the 
                                            # system 
    fhir:Coding.display @<string>?;         # Representation defined by the 
                                            # system 
    fhir:Coding.userSelected @<boolean>?;   # If this coding was chosen directly 
                                            # by the user 
    fhir:index xsd:integer?                 # Relative position in a list
}

# Primitive Type unsignedInt
<unsignedInt> CLOSED {
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:nonNegativeInteger?;     # Primitive value for unsignedInt
    fhir:index xsd:integer?                 # Relative position in a list
}

# Primitive Type id
<id> CLOSED {
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:string?;                 # Primitive value for id
    fhir:index xsd:integer?                 # Relative position in a list
}

# Time range defined by start and end date/time
<Period> CLOSED {
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:Period.start @<dateTime>?;         # Starting time with inclusive 
                                            # boundary 
    fhir:Period.end @<dateTime>?;           # End time with inclusive boundary, 
                                            # if not ongoing 
    fhir:index xsd:integer?                 # Relative position in a list
}

# Primitive Type instant
<instant> CLOSED {
    fhir:id @<id>?;                         # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:dateTime?;               # Primitive value for instant
    fhir:index xsd:integer?                 # Relative position in a list
}

# Primitive Type decimal
<decimal> CLOSED {
    fhir:id @<id>?;                         # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:value xsd:decimal?;                # Primitive value for decimal
    fhir:index xsd:integer?                 # Relative position in a list
}

# Concept - reference to a terminology or just  text
<CodeableConcept> CLOSED {
    fhir:concept IRI*;
    fhir:Element.id @<string>?;             # xml:id (or equivalent in JSON)
    fhir:extension @<Extension>*;           # Additional Content defined by 
                                            # implementations 
    fhir:CodeableConcept.coding @<Coding>*;  # Code defined by a terminology 
                                            # system 
    fhir:CodeableConcept.text @<string>?;   # Plain text representation of the 
                                            # concept 
    fhir:index xsd:integer?                 # Relative position in a list
}

#---------------------- Reference Types -------------------

<PractitionerReference> CLOSED {
    fhir:Element.id @<id>?;
    fhir:extension @<Extension>*;
    fhir:link @<Practitioner> OR CLOSED {a fhir:Practitioner}?;
    fhir:Reference.reference @<string>?;
    fhir:Reference.display @<string>?;
    fhir:index xsd:integer?
}

<OrganizationReference> CLOSED {
    fhir:Element.id @<id>?;
    fhir:extension @<Extension>*;
    fhir:link @<Organization> OR CLOSED {a fhir:Organization}?;
    fhir:Reference.reference @<string>?;
    fhir:Reference.display @<string>?;
    fhir:index xsd:integer?
}

<EligibilityRequestReference> CLOSED {
    fhir:Element.id @<id>?;
    fhir:extension @<Extension>*;
    fhir:link @<EligibilityRequest> OR CLOSED {a fhir:EligibilityRequest}?;
    fhir:Reference.reference @<string>?;
    fhir:Reference.display @<string>?;
    fhir:index xsd:integer?
}

<ContractReference> CLOSED {
    fhir:Element.id @<id>?;
    fhir:extension @<Extension>*;
    fhir:link @<Contract> OR CLOSED {a fhir:Contract}?;
    fhir:Reference.reference @<string>?;
    fhir:Reference.display @<string>?;
    fhir:index xsd:integer?
}

#---------------------- Value Sets ------------------------

# A code specifying the state of the resource instance.
@fhirvs:eligibilityresponse-status = ["active" "cancelled" "draft" "entered-in-error"]

# This value set includes a sample set of Forms codes.
@fhirvs:forms = ["1" "2"]

# How the Quantity should be understood and represented.
@fhirvs:quantity-comparator = ["<" "<=" ">=" ">"]

# The status of a resource narrative
@fhirvs:narrative-status = ["generated" "extensions" "additional" "empty"]

# This value set includes a Claim Processing Outcome codes.
@fhirvs:remittance-outcome = ["complete" "error" "partial"]

# This value set includes a smattering of adjudication codes.
@fhirvs:adjudication-error = ["a001" "a002"]

# Identifies the purpose for this identifier, if known .
@fhirvs:identifier-use = ["usual" "official" "temp" "secondary"]