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

Eligibilityrequest-example-2.json

Financial Management Work Group

Maturity Level: N/A

Ballot Status: Informative

Compartments: Patient, Practitioner

Raw JSON (canonical form)

Primary Coverage specifying Benefit Example

{
  "resourceType": "EligibilityRequest",
  "id": "52346",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityRequest</div>"
  },
  "identifier": [
    {
      "system": "http://happyvalley.com/elegibilityrequest",
      "value": "52346"
    }
  ],
  "status": "active",
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "patient": {
    "reference": "Patient/pat1"
  },
  "servicedDate": "2014-09-17",
  "created": "2014-08-16",
  "enterer": {
    "identifier": {
      "system": "http://happyvalleyclinic.com/staff",
      "value": "14"
    }
  },
  "provider": {
    "reference": "Organization/1"
  },
  "insurer": {
    "reference": "Organization/2"
  },
  "facility": {
    "identifier": {
      "system": "http://statecliniclicensor.com/clinicid",
      "value": "G35B9"
    }
  },
  "coverage": {
    "reference": "Coverage/9876B1"
  },
  "businessArrangement": "NB8742",
  "benefitCategory": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/benefit-category",
        "code": "medical"
      }
    ]
  },
  "benefitSubCategory": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/benefit-subcategory",
        "code": "69",
        "display": "Maternity"
      }
    ]
  }
}

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.