STU3 Candidate

This page is part of the FHIR Specification (v1.8.0: STU 3 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

Coverage-example-selfpay.xml

Raw XML (canonical form)

Self Payment Example (id = "SP1234")

<Coverage xmlns="http://hl7.org/fhir">
 <id value="SP1234"/>

 <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of a Self Pay Agreement.</div>
  </text>

 <identifier>
   <system value="http://hospitalx.com/selfpayagreement"/>
   <value value="SP12345678"/>
 </identifier>
  
 <status value="active"/>
  
 <type>
  <coding>
    <system value="http://hl7.org/fhir/coverage-selfpay"/>
    <code value="pay"/>
    <display value="PAY"/>
  </coding>
 </type>

 <subscriber>
  <reference value="Patient/5"/>
 </subscriber>
 
 <beneficiary>
  <reference value="Patient/5"/>
 </beneficiary>
 
 <relationship>
  <coding>
    <code value="self"/>
  </coding>
 </relationship>

 <period> 
   <end value="2012-03-17"/>
 </period>

 <payor>
  <reference value="Patient/5"/>
 </payor>
 
</Coverage>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.