This page is part of the De-identified, Anonymized FHIR Profiles Library (DAPL) IG (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions
| Official URL: http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-coverage | Version: 1.0.0-ballot | |||
| Standards status: Trial-use | Maturity Level: 2 | Computable Name: DAPLCoverage | ||
The profile establishes the core elements, extensions, vocabularies and value sets for representing deidentified or anonymized Coverage.
This profile is used to represent de-identified Coverage information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.
The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.
According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes diagnosis dates, visit dates, onset dates etc.
In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Coverage resource text element may contain information such as the covrage date. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.
Ids and References
The original Coverage resource id should not be included in the De-identified Coverage instance. Instead a new id should be created and provided as part of the FHIR resource. This Data Submitter should be capable of using the generated id to relink the data to the original Coverage. All resource references to the Coverage submitted as part of the data exchange should refer to newly generated id.
Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed
Date Truncation
The DARTS Service Provider has to truncate the following dates to only have a precision of year
Examples
Examples of identifiable data and its corresponding de-identifiable data are present in the FHIR Artifacts examples
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | DAPL Coverage | |
![]() ![]() |
SΣ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active |
![]() ![]() |
SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
![]() ![]() |
SΣ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary |
![]() ![]() |
SΣC | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a |
![]() ![]() |
SΣ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dapl-cov-1 | error | Coverage.period | All Period.start data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
|
| dapl-cov-1a | error | Coverage.period | All Period.start data elements should have valid year > 1900 |
$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
|
| dapl-cov-2 | error | Coverage.period | All Period.emd data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
|
| dapl-cov-2a | error | Coverage.period | All Period.end data elements should have valid year > 1900 |
$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
|
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from Coverage
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | DAPL Coverage | |
![]() ![]() |
S | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service |
![]() ![]() |
0..0 | Cannot include any text in the resource as part of the deidentified or anonymized data. | ||
![]() ![]() |
0..0 | Cannot include any contained resources in the resource as part of the deidentified or anonymized data. | ||
![]() ![]() |
S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active |
![]() ![]() |
S | 1..1 | CodeableConcept | Coverage category such as medical or accident |
![]() ![]() |
||||
![]() ![]() ![]() |
0..0 | Text alternative for the resource | ||
![]() ![]() |
S | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary |
![]() ![]() ![]() |
0..0 | Text alternative for the resource | ||
![]() ![]() |
SC | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a |
![]() ![]() |
S | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy |
![]() ![]() ![]() |
0..0 | Text alternative for the resource | ||
![]() ![]() |
0..0 | Patient payments for services/products | ||
Documentation for this format | ||||
| Id | Grade | Path(s) | Description | Expression |
| dapl-cov-1 | error | Coverage.period | All Period.start data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
|
| dapl-cov-1a | error | Coverage.period | All Period.start data elements should have valid year > 1900 |
$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
|
| dapl-cov-2 | error | Coverage.period | All Period.emd data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
|
| dapl-cov-2a | error | Coverage.period | All Period.end data elements should have valid year > 1900 |
$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
|
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | Coverage | DAPL Coverage | |||||
![]() ![]() |
SΣ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | ||||
![]() ![]() |
SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() |
Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() |
SΣ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() |
Σ | 0..1 | string | Dependent number | ||||
![]() ![]() |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
![]() ![]() |
SΣC | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a | ||||
![]() ![]() |
SΣ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() |
Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
![]() ![]() |
Σ | 0..1 | string | Insurer network | ||||
![]() ![]() |
0..1 | boolean | Reimbursement to insurer | |||||
![]() ![]() |
0..* | Reference(Contract) | Contract details | |||||
Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std. |
| Coverage.policyHolder.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.beneficiary.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std. |
| Coverage.payor.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dapl-cov-1 | error | Coverage.period | All Period.start data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
|
| dapl-cov-1a | error | Coverage.period | All Period.start data elements should have valid year > 1900 |
$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
|
| dapl-cov-2 | error | Coverage.period | All Period.emd data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
|
| dapl-cov-2a | error | Coverage.period | All Period.end data elements should have valid year > 1900 |
$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
|
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from Coverage
Summary
Mandatory: 1 element
Must-Support: 6 elements
Fixed: 1 element
Prohibited: 6 elements
Structures
This structure refers to these other structures:
Maturity: 2
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | DAPL Coverage | |
![]() ![]() |
SΣ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active |
![]() ![]() |
SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
![]() ![]() |
SΣ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary |
![]() ![]() |
SΣC | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a |
![]() ![]() |
SΣ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dapl-cov-1 | error | Coverage.period | All Period.start data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
|
| dapl-cov-1a | error | Coverage.period | All Period.start data elements should have valid year > 1900 |
$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
|
| dapl-cov-2 | error | Coverage.period | All Period.emd data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
|
| dapl-cov-2a | error | Coverage.period | All Period.end data elements should have valid year > 1900 |
$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
|
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from Coverage
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | DAPL Coverage | |
![]() ![]() |
S | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service |
![]() ![]() |
0..0 | Cannot include any text in the resource as part of the deidentified or anonymized data. | ||
![]() ![]() |
0..0 | Cannot include any contained resources in the resource as part of the deidentified or anonymized data. | ||
![]() ![]() |
S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active |
![]() ![]() |
S | 1..1 | CodeableConcept | Coverage category such as medical or accident |
![]() ![]() |
||||
![]() ![]() ![]() |
0..0 | Text alternative for the resource | ||
![]() ![]() |
S | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary |
![]() ![]() ![]() |
0..0 | Text alternative for the resource | ||
![]() ![]() |
SC | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a |
![]() ![]() |
S | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy |
![]() ![]() ![]() |
0..0 | Text alternative for the resource | ||
![]() ![]() |
0..0 | Patient payments for services/products | ||
Documentation for this format | ||||
| Id | Grade | Path(s) | Description | Expression |
| dapl-cov-1 | error | Coverage.period | All Period.start data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
|
| dapl-cov-1a | error | Coverage.period | All Period.start data elements should have valid year > 1900 |
$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
|
| dapl-cov-2 | error | Coverage.period | All Period.emd data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
|
| dapl-cov-2a | error | Coverage.period | All Period.end data elements should have valid year > 1900 |
$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
|
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | Coverage | DAPL Coverage | |||||
![]() ![]() |
SΣ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | ||||
![]() ![]() |
SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() |
Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() |
SΣ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() |
Σ | 0..1 | string | Dependent number | ||||
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0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
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SΣC | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a | ||||
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SΣ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
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Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
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Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
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0..* | BackboneElement | Additional coverage classifications | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
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Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
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Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
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Σ | 0..1 | string | Insurer network | ||||
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0..1 | boolean | Reimbursement to insurer | |||||
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0..* | Reference(Contract) | Contract details | |||||
Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std. |
| Coverage.policyHolder.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.beneficiary.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std. |
| Coverage.payor.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dapl-cov-1 | error | Coverage.period | All Period.start data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
|
| dapl-cov-1a | error | Coverage.period | All Period.start data elements should have valid year > 1900 |
$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
|
| dapl-cov-2 | error | Coverage.period | All Period.emd data elements should be truncated to a year only for de-identified resources. |
$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
|
| dapl-cov-2a | error | Coverage.period | All Period.end data elements should have valid year > 1900 |
$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
|
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from Coverage
Summary
Mandatory: 1 element
Must-Support: 6 elements
Fixed: 1 element
Prohibited: 6 elements
Structures
This structure refers to these other structures:
Maturity: 2
Other representations of profile: CSV, Excel, Schematron