This page is part of a downloaded copy of this specification. This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v0.1.0: STU 1 Ballot 1) based on FHIR v3.5.0. . For a full list of available versions, see the Directory of published versions

This is a pre-release version (Ballot 1) of Coverage Requirements Discovery (CRD) R1/STU. There is no current official version.
For a full list of available versions, see the Directory of published versions .

## StructureDefinition: CRD Coverage

The official URL for this profile is:

    http://hl7.org/fhir/us/davinci-crd/STU3/StructureDefinition/profile-coverage-deident-stu3

### Formal Views of Profile Content

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

- Text Summary
- Differential Table
- Snapshot Table
- All

This structure is derived from Coverage

Summary

Must-Support: 7 elements
Prohibited: 21 elements

Structures

This structure refers to these other structures:

- http://hl7.org/fhir/us/davinci-crd/STU3/StructureDefinition/profile-patient-stu3

This structure is derived from Coverage

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage |  | 0..* |  |
identifier |  | 0..0 |  |
status | S | 0..1 | code |
type | S | 0..1 | CodeableConcept |
policyHolder |  | 0..0 |  |
subscriber |  | 0..0 |  |
subscriberId |  | 0..0 |  |
beneficiary |  | 0..0 |  |
relationship |  | 0..0 |  |
period | S | 0..1 | Period |
payor | S | 0..* | Reference(CRD Patient | CRD Organization) |
grouping | S | 0..1 | BackboneElement |
group |  | 0..0 |  |
groupDisplay |  | 0..0 |  |
subGroup |  | 0..0 |  |
subGroupDisplay |  | 0..0 |  |
plan | S | 0..1 | string |
planDisplay | S | 0..1 | string |
subPlan |  | 0..0 |  |
subPlanDisplay |  | 0..0 |  |
class |  | 0..0 |  |
classDisplay |  | 0..0 |  |
subClass |  | 0..0 |  |
subClassDisplay |  | 0..0 |  |
dependent |  | 0..0 |  |
sequence |  | 0..0 |  |
order |  | 0..0 |  |
network |  | 0..0 |  |
contract |  | 0..0 |  |
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage | I | 0..* |  | Insurance or medical plan or a payment agreement
id | Î£ | 0..1 | id | Logical id of this artifact
meta | Î£ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Î£ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible)
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Î£ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required)
type | S Î£ | 0..1 | CodeableConcept | Type of coverage such as medical or accident Binding: Coverage Type and Self-Pay Codes (preferred)
period | S Î£ | 0..1 | Period | Coverage start and end dates
payor | S Î£ | 0..* | Reference(CRD Patient | CRD Organization) | Identifier for the plan or agreement issuer
grouping | S I | 0..1 | BackboneElement | Additional coverage classifications
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Î£ | 0..* | Extension | Extensions that cannot be ignored
plan | S Î£ | 0..1 | string | An identifier for the plan
planDisplay | S Î£ | 0..1 | string | Display text for the plan
Documentation for this format

This structure is derived from Coverage

Summary

Must-Support: 7 elements
Prohibited: 21 elements

Structures

This structure refers to these other structures:

- http://hl7.org/fhir/us/davinci-crd/STU3/StructureDefinition/profile-patient-stu3

Differential View

This structure is derived from Coverage

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage |  | 0..* |  |
identifier |  | 0..0 |  |
status | S | 0..1 | code |
type | S | 0..1 | CodeableConcept |
policyHolder |  | 0..0 |  |
subscriber |  | 0..0 |  |
subscriberId |  | 0..0 |  |
beneficiary |  | 0..0 |  |
relationship |  | 0..0 |  |
period | S | 0..1 | Period |
payor | S | 0..* | Reference(CRD Patient | CRD Organization) |
grouping | S | 0..1 | BackboneElement |
group |  | 0..0 |  |
groupDisplay |  | 0..0 |  |
subGroup |  | 0..0 |  |
subGroupDisplay |  | 0..0 |  |
plan | S | 0..1 | string |
planDisplay | S | 0..1 | string |
subPlan |  | 0..0 |  |
subPlanDisplay |  | 0..0 |  |
class |  | 0..0 |  |
classDisplay |  | 0..0 |  |
subClass |  | 0..0 |  |
subClassDisplay |  | 0..0 |  |
dependent |  | 0..0 |  |
sequence |  | 0..0 |  |
order |  | 0..0 |  |
network |  | 0..0 |  |
contract |  | 0..0 |  |
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage | I | 0..* |  | Insurance or medical plan or a payment agreement
id | Î£ | 0..1 | id | Logical id of this artifact
meta | Î£ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Î£ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible)
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Î£ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required)
type | S Î£ | 0..1 | CodeableConcept | Type of coverage such as medical or accident Binding: Coverage Type and Self-Pay Codes (preferred)
period | S Î£ | 0..1 | Period | Coverage start and end dates
payor | S Î£ | 0..* | Reference(CRD Patient | CRD Organization) | Identifier for the plan or agreement issuer
grouping | S I | 0..1 | BackboneElement | Additional coverage classifications
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Î£ | 0..* | Extension | Extensions that cannot be ignored
plan | S Î£ | 0..1 | string | An identifier for the plan
planDisplay | S Î£ | 0..1 | string | Display text for the plan
Documentation for this format

Other representations of profile: Schematron

### Terminology Bindings

Path | Name | Conformance | ValueSet
Coverage.language | Common Languages | extensible | Common Languages
Coverage.status | Financial Resource Status Codes | required | Financial Resource Status Codes
Coverage.type | Coverage Type and Self-Pay Codes | preferred | Coverage Type and Self-Pay Codes

### Constraints

Id | Path | Details | Requirements
dom-2 | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-1 | Coverage | If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty() |
dom-4 | 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-3 | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty() |
ele-1 | Coverage.grouping | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) |