This page is part of the CARIN Blue Button Implementation Guide (v2.1.0-snapshot1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

• Narrative Content
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• JSON

: Dental Coverage Example1 - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="CoverageDental1"/>
  <meta>
    <lastUpdated value="2021-01-01T14:22:01.0314215+00:00"/>
    <profile
             value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.1.0-snapshot1"/>
  </meta>
  <language value="en-US"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><p class="res-header-id"><b>Generated Narrative: Coverage CoverageDental1</b></p><a name="CoverageDental1"> </a><a name="hcCoverageDental1"> </a><a name="CoverageDental1-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2021-01-01 14:22:01+0000; Language: en-US</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-C4BB-Coverage.html">C4BB Coverageversion: {0}2.1.0-snapshot1)</a></p></div><p><b>identifier</b>: Member Number/210300002</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode DENTAL}">dental care policy</span></p><p><b>policyHolder</b>: <a href="Patient-Patient2.html">Member 01 Test  Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501)</a></p><p><b>subscriber</b>: <a href="Patient-Patient2.html">Member 01 Test  Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501)</a></p><p><b>subscriberId</b>: 10300007</p><p><b>beneficiary</b>: <a href="Patient-Patient2.html">Member 01 Test  Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501)</a></p><p><b>dependent</b>: 01</p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>period</b>: 2021-01-01 --&gt; 2021-12-31</p><p><b>payor</b>: <a href="Organization-DentalPayer1.html">Organization INSURANCE COMPANY XYZ</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}">An employee group</span></p><p><b>value</b>: 10300007</p><p><b>name</b>: Transcorp - dental</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}">Plan</span></p><p><b>value</b>: 66783JJT</p><p><b>name</b>: INSURANCE COMPANY XYZ - PRIME</p></blockquote><p><b>network</b>: INSURANCE COMPANY XYZ - PRIME</p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
    <system value="https://www.xxxhealthplan.com/fhir/memberidentifier"/>
    <value value="210300002"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="DENTAL"/>
    </coding>
    <text value="dental care policy"/>
  </type>
  <policyHolder>🔗 
    <reference value="Patient/Patient2"/>
  </policyHolder>
  <subscriber>🔗 
    <reference value="Patient/Patient2"/>
  </subscriber>
  <subscriberId value="10300007"/>
  <beneficiary>🔗 
    <reference value="Patient/Patient2"/>
  </beneficiary>
  <dependent value="01"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2021-01-01"/>
    <end value="2021-12-31"/>
  </period>
  <payor>🔗 
    <reference value="Organization/DentalPayer1"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
      </coding>
      <text value="An employee group"/>
    </type>
    <value value="10300007"/>
    <name value="Transcorp - dental"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
      </coding>
      <text value="Plan"/>
    </type>
    <value value="66783JJT"/>
    <name value="INSURANCE COMPANY XYZ - PRIME"/>
  </class>
  <network value="INSURANCE COMPANY XYZ - PRIME"/>
</Coverage>