Release 4B Snapshot #1

This page is part of the FHIR Specification (v4.3.0-snapshot1: Release 4B Snapshot #1). 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

Coverageeligibilityrequest-example.xml

Financial Management Work Group

Maturity Level: N/A

Standards Status: Informative

Compartments: Patient, Practitioner

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

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General Person Primary Coverage Example (id = "52345")

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

<CoverageEligibilityRequest xmlns="http://hl7.org/fhir">
  <id value="52345"/> 

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

  <identifier> 
    <system value="http://happyvalley.com/coverageelegibilityrequest"/> 
    <value value="52345"/> 
  </identifier> 

  <status value="active"/> 

  <priority> 
    <coding> 
      <code value="normal"/> 
    </coding> 
  </priority> 

  <purpose value="validation"/> 
  
  <patient> 
    <reference value="Patient/pat1"/> 
  </patient> 

  <created value="2014-08-16"/> 

  <provider> 
    <reference value="Organization/1"/> 
  </provider> 

  <insurer> 
    <reference value="Organization/2"/> 
  </insurer> 

  <insurance> 
    <focal value="true"/> 
    <coverage> 
      <reference value="Coverage/9876B1"/> 
    </coverage> 
  </insurance> 

</CoverageEligibilityRequest>

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.