This page is part of a downloaded copy of this specification. This page is part of the Da Vinci Care Coordination Alerts (v0.1.0: STU1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions
XML Format: Coverage-example-1
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<Coverage xmlns="http://hl7.org/fhir"> <id value="example-1"/> <text> <status value="generated"/> <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> </text> <!-- TODO discuss if want to use this or other Coverage profile for alerts <meta> <profile value="http://fhir.org/guides/argonaut-scheduling/StructureDefinition/argo-coverage"/> </meta> --> <identifier> <system value="https://www.anthem.com/ca"/> <value value="DZW9200000000"/> </identifier> <status value="active"/> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> <code value="HIP"/> <display value="health insurance plan policy"/> </coding> </type> <subscriber> <reference value="Patient/example"/> <display value="First M LastName Jr"/> </subscriber> <subscriberId value="DZW9200000000"/> <beneficiary> <reference value="Patient/example"/> </beneficiary> <relationship> <coding> <system value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/> <code value="self"/> <display value="Self"/> </coding> </relationship> <period> <start value="2016-01-01"/> </period> <payor> <display value="Anthem Blue Cross of California"/> </payor> <class> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="plan"/> </coding> </type> <value value="1FZQ"/> <name value="Anthem Bronze 60 D HSA PPO"/> </class> </Coverage>