Release 5 Preview #3

This page is part of the FHIR Specification (v4.5.0: R5 Preview #3). 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

Standards Status: Informative

Compartments: Patient, RelatedPerson

Raw XML (canonical form + also see XML Format Specification)

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Self Payment Example (id = "SP1234")

<?xml version="1.0" encoding="UTF-8"?>

<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://terminology.hl7.org/CodeSystem/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.