This page is part of the Da Vinci Unsolicited Notifications (v0.2.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

• Narrative Content
• XML
• JSON

XML Format: Coverage-admit-discharge-notification-coverage-01

Download Raw xml

<Coverage xmlns="http://hl7.org/fhir">
  <id value="admit-discharge-notification-coverage-01"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-alerts/StructureDefinition/admit-discharge-notification-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: admit-discharge-notification-coverage-01</p><p><b>meta</b>: </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="urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4">urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4</a></p><p><b>subscriberId</b>: DZW9200000000</p><p><b>beneficiary</b>: <a href="urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4">urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4</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 --&gt; (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>Bronze D HSA</td></tr></table></div>
  </text>
  <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="urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4"/>
  </subscriber>
  <subscriberId value="DZW9200000000"/>
  <beneficiary>
    <reference value="urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4"/>
  </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="Bronze D HSA"/>
  </class>
</Coverage>