This page is part of the Da Vinci Unsolicited Notifications (v1.0.0: STU1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions 
JSON Format: Coverage-example-1
Download Raw json
{
"resourceType" : "Coverage",
"id" : "example-1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: example-1</p><p><b>identifier</b>: DZW9200000000</p><p><b>status</b>: active</p><p><b>type</b>: health insurance plan policy <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/v3-ActCode code 'HIP' = 'health insurance plan policy', given as 'health insurance plan policy'})</span></p><p><b>subscriber</b>: <a href=\"Patient-example.html\">First M LastName Jr. Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a></p><p><b>subscriberId</b>: DZW9200000000</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a></p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/subscriber-relationship code 'self' = 'Self', given as 'Self'})</span></p><p><b>period</b>: Jan 1, 2016 12:00:00 AM --> (ongoing)</p><p><b>payor</b>: Anthem Blue Cross of California</p><h3>Classes</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td>*</td><td>Plan <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/coverage-class code 'plan' = 'Plan)</span></td><td>1FZQ</td><td>Anthem Bronze 60 D HSA PPO</td></tr></table></div>"
},
"identifier" : [
{
"system" : "https://www.anthem.com/ca",
"value" : "DZW9200000000"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "HIP",
"display" : "health insurance plan policy"
}
]
},
"subscriber" : {
"reference" : "Patient/example",
"display" : "First M LastName Jr"
},
"subscriberId" : "DZW9200000000",
"beneficiary" : {
"reference" : "Patient/example"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self",
"display" : "Self"
}
]
},
"period" : {
"start" : "2016-01-01"
},
"payor" : [
{
"display" : "Anthem Blue Cross of California"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "1FZQ",
"name" : "Anthem Bronze 60 D HSA PPO"
}
]
}
