Coverage-example-selfpay.json - FHIR v5.0.0-ballot

Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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

Example Coverage/SP1234 (JSON)

Financial Management Work Group

Maturity Level: N/A

Standards Status: Informative

Compartments: Patient, RelatedPerson

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

Self Payment Example

{
  "resourceType": "Coverage",
  "id": "SP1234",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of a Self Pay Agreement.</div>"
  },
  "identifier": [
    {
      "system": "http://hospitalx.com/selfpayagreement",
      "value": "SP12345678"
    }
  ],
  "status": "active",
  "kind": "self-pay",
  "paymentBy": [
    {
      "party": {
        "reference": "Patient/5"
      }
    }
  ],
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/coverage-selfpay",
        "code": "pay",
        "display": "PAY"
      }
    ]
  },
  "subscriber": {
    "reference": "Patient/5"
  },
  "beneficiary": {
    "reference": "Patient/5"
  },
  "relationship": {
    "coding": [
      {
        "code": "self"
      }
    ]
  },
  "period": {
    "end": "2012-03-17"
  }
}

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.