Coverage.questionnaire.xml

Generated Questionnaire for Coverage

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

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="qs1"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
  </identifier>
  <status value="draft"/>
  <date value="2015-03-27T00:13:00+11:00"/>
  <publisher value="HL7 FHIR Project (Financial Management)"/>
  <group>
    <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
      <valueString value="Financial instrument which may be used to pay for or reimburse for health care products and services."/>
    </extension>
    <linkId value="Coverage"/>
    <title value="Insurance or medical plan"/>
    <required value="true"/>
    <repeats value="false"/>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="string"/>
      </extension>
      <linkId value="Coverage.id"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.id.value"/>
        <text value="Logical id of this artefact"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource."/>
      </extension>
      <linkId value="Coverage.meta"/>
      <text value="Metadata about the resource"/>
      <required value="false"/>
      <repeats value="true"/>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="uri"/>
      </extension>
      <linkId value="Coverage.implicitRules"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.implicitRules.value"/>
        <text value="A set of rules under which this content was created"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource

Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="code"/>
      </extension>
      <linkId value="Coverage.language"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.language.value"/>
        <text value="language"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative."/>
      </extension>
      <linkId value="Coverage.text"/>
      <text value="Text summary of the resource, for human interpretation"/>
      <required value="false"/>
      <repeats value="true"/>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again."/>
      </extension>
      <linkId value="Coverage.contained"/>
      <text value="Contained, inline Resources"/>
      <required value="false"/>
      <repeats value="true"/>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The program or plan underwriter or payor."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Reference"/>
      </extension>
      <linkId value="Coverage.issuer"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
          <valueString value="/Organization?subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="Coverage.issuer.value"/>
        <text value="An identifier for the plan issuer"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="Business Identification Number (BIN number) used to identify the routing  of eclaims if the insurer themselves don&#39;t have a BIN number for all of their business."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Identifier"/>
      </extension>
      <linkId value="Coverage.bin"/>
      <text value="BIN Number"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.bin.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.bin.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.bin.value"/>
        <text value="value:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="Time period during which the coverage is in force. A missing start date indicates the start date isn&#39;t known, a missing end date means the coverage is continuing to be in force."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Period"/>
      </extension>
      <linkId value="Coverage.period"/>
      <text value="Coverage start and end dates"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.period.low"/>
        <text value="start:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.period.end"/>
        <text value="end:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Coding"/>
      </extension>
      <linkId value="Coverage.type"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.type.value"/>
        <text value="Type of coverage"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The id issued to the subscriber."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Identifier"/>
      </extension>
      <linkId value="Coverage.subscriberId"/>
      <text value="Subscriber ID"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.subscriberId.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.subscriberId.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.subscriberId.value"/>
        <text value="value:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Subscriber Id, Certificate number or Personal Health Number or Case ID."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Identifier"/>
      </extension>
      <linkId value="Coverage.identifier"/>
      <text value="The primary coverage ID"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.identifier.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.identifier.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.identifier.value"/>
        <text value="value:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="string"/>
      </extension>
      <linkId value="Coverage.group"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.group.value"/>
        <text value="An identifier for the group"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="string"/>
      </extension>
      <linkId value="Coverage.plan"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.plan.value"/>
        <text value="An identifier for the plan"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a specific employer group within a class of employers. May be referred to as a Section or Division ID."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="string"/>
      </extension>
      <linkId value="Coverage.subPlan"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.subPlan.value"/>
        <text value="An identifier for the subsection of the plan"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="A unique identifier for a dependent under the coverage."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="integer"/>
      </extension>
      <linkId value="Coverage.dependent"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.dependent.value"/>
        <text value="The dependent number"/>
        <type value="integer"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="An optional counter for a particular instance of the identified coverage which increments upon each renewal."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="integer"/>
      </extension>
      <linkId value="Coverage.sequence"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.sequence.value"/>
        <text value="The plan instance or sequence counter"/>
        <type value="integer"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The party who &#39;owns&#39; the insurance contractual relationship to the policy or to whom the benefit of the policy is due."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Reference"/>
      </extension>
      <linkId value="Coverage.subscriber"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
          <valueString value="/Patient?subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="Coverage.subscriber.value"/>
        <text value="Plan holder information"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The identifier for a community of providers."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Identifier"/>
      </extension>
      <linkId value="Coverage.network"/>
      <text value="Insurer network"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <linkId value="Coverage.network.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.network.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
      <question>
        <linkId value="Coverage.network.value"/>
        <text value="value:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
    <group>
      <extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
        <valueString value="The policy(s) which constitute this insurance coverage."/>
      </extension>
      <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
        <valueString value="Reference"/>
      </extension>
      <linkId value="Coverage.contract"/>
      <required value="false"/>
      <repeats value="true"/>
      <question>
        <extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
          <valueString value="/Contract?subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="Coverage.contract.value"/>
        <text value="Contract details"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </question>
    </group>
  </group>
</Questionnaire>