R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). 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

Financial Management Work Group

Maturity Level: N/A

Ballot Status: Informative

Compartments: Patient, RelatedPerson

Raw XML (canonical form)

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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.