De-identified, Anonymized FHIR Profiles Library
1.0.0-ballot - STU 1 Ballot

De-identified, Anonymized FHIR Profiles Library - Downloaded Version 1.0.0-ballot See the Directory of published versions

## Resource Profile: DAPL Coverage

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.

### Introduction

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

- beneficiary
- payor

Date Truncation

The DARTS Service Provider has to truncate the following dates to only have a precision of year

- period and its sub elements.

Examples

Examples of identifiable data and its corresponding de-identifiable data are present in the FHIR Artifacts examples

Usages:

- Examples for this Profile: Coverage/de-identified-example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | DAPL Coverage
id | S Σ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 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.
beneficiary | S Σ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary
period | S Σ C | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a
payor | S Σ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy
Documentation for this format

#### Terminology Bindings

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.

#### Constraints

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: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | DAPL Coverage
id | S | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service
text |  | 0..0 |  | Cannot include any text in the resource as part of the deidentified or anonymized data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the deidentified or anonymized data.
status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident
policyHolder |  |  |  |
display |  | 0..0 |  | Text alternative for the resource
beneficiary | S | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary
display |  | 0..0 |  | Text alternative for the resource
period | S C | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a
payor | S | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy
display |  | 0..0 |  | Text alternative for the resource
costToBeneficiary |  | 0..0 |  | Patient payments for services/products
Documentation for this format

#### Constraints

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: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | DAPL Coverage
id | S Σ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 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.
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | 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).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber
beneficiary | S Σ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | 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).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
dependent | Σ | 0..1 | string | Dependent number
relationship |  | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period | S Σ C | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a
payor | S Σ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | 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).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
class |  | 0..* | BackboneElement | Additional coverage classifications
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value | Σ | 1..1 | string | Value associated with the type
name | Σ | 0..1 | string | Human readable description of the type and value
order | Σ | 0..1 | positiveInt | Relative order of the coverage
network | Σ | 0..1 | string | Insurer network
subrogation |  | 0..1 | boolean | Reimbursement to insurer
contract |  | 0..* | Reference(Contract) | Contract details
Documentation for this format

#### Terminology Bindings

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.

#### Constraints

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:

- DAPL De-identified Patient (http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-deidentified-patient)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- DAPL De-identified RelatedPerson (http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-deidentified-relatedperson)

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | DAPL Coverage
id | S Σ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 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.
beneficiary | S Σ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary
period | S Σ C | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a
payor | S Σ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy
Documentation for this format

#### Terminology Bindings

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.

#### Constraints

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: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | DAPL Coverage
id | S | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service
text |  | 0..0 |  | Cannot include any text in the resource as part of the deidentified or anonymized data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the deidentified or anonymized data.
status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident
policyHolder |  |  |  |
display |  | 0..0 |  | Text alternative for the resource
beneficiary | S | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary
display |  | 0..0 |  | Text alternative for the resource
period | S C | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a
payor | S | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy
display |  | 0..0 |  | Text alternative for the resource
costToBeneficiary |  | 0..0 |  | Patient payments for services/products
Documentation for this format

#### Constraints

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: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | DAPL Coverage
id | S Σ | 0..1 | id | The Coverage identifier generated by the DARTS deidentification or anonymization service
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 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.
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | 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).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber
beneficiary | S Σ | 1..1 | Reference(DAPL De-identified Patient) | Plan beneficiary
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | 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).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
dependent | Σ | 0..1 | string | Dependent number
relationship |  | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period | S Σ C | 0..1 | Period | Coverage start and end dates Constraints: dapl-cov-1, dapl-cov-1a, dapl-cov-2, dapl-cov-2a
payor | S Σ | 1..* | Reference(DAPL De-identified Patient | US Core Organization Profile | DAPL De-identified RelatedPerson) | Issuer of the policy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | 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).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
class |  | 0..* | BackboneElement | Additional coverage classifications
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value | Σ | 1..1 | string | Value associated with the type
name | Σ | 0..1 | string | Human readable description of the type and value
order | Σ | 0..1 | positiveInt | Relative order of the coverage
network | Σ | 0..1 | string | Insurer network
subrogation |  | 0..1 | boolean | Reimbursement to insurer
contract |  | 0..* | Reference(Contract) | Contract details
Documentation for this format

#### Terminology Bindings

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.

#### Constraints

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:

- DAPL De-identified Patient (http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-deidentified-patient)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- DAPL De-identified RelatedPerson (http://hl7.org/fhir/us/dapl/StructureDefinition/dapl-deidentified-relatedperson)

Maturity: 2

Other representations of profile: CSV, Excel, Schematron