This page is part of the Da Vinci Clinical Documentation Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

• Content
• XML
• JSON

XML Format: Coverage-cdex-example-coverage

Raw xml

<Coverage xmlns="http://hl7.org/fhir">
  <id value="cdex-example-coverage"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2019-04-09T10:59:17.000-04:00"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the coverage
        </div>
  </text>
  <identifier>
    <system value="http://benefitsinc.com/certificate"/>
    <value value="12345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="EHCPOL"/>
      <display value="extended healthcare"/>
    </coding>
  </type>
  <subscriber>
    <reference value="Patient/cdex-example-patient"/>
  </subscriber>
  <beneficiary>
    <reference value="Patient/cdex-example-patient"/>
  </beneficiary>
  <dependent value="0"/>
  <relationship>
    <coding>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2011-05-23"/>
    <end value="2012-05-23"/>
  </period>
  <payor>
    <reference value="Organization/cdex-example-payer"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
      </coding>
    </type>
    <value value="CB135"/>
    <name value="Corporate Baker&#39;s Inc. Local #35"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="subgroup"/>
      </coding>
    </type>
    <value value="123"/>
    <name value="Trainee Part-time Benefits"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
      </coding>
    </type>
    <value value="B37FC"/>
    <name value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="subplan"/>
      </coding>
    </type>
    <value value="P7"/>
    <name value="Includes afterlife benefits"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="class"/>
      </coding>
    </type>
    <value value="SILVER"/>
    <name value="Silver: Family Plan spouse only"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="subclass"/>
      </coding>
    </type>
    <value value="Tier2"/>
    <name value="Low deductable, max $20 copay"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="sequence"/>
      </coding>
    </type>
    <value value="9"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="rxid"/>
      </coding>
    </type>
    <value value="MDF12345"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="rxbin"/>
      </coding>
    </type>
    <value value="987654"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="rxgroup"/>
      </coding>
    </type>
    <value value="M35PT"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="rxpcn"/>
      </coding>
    </type>
    <value value="234516"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="sequence"/>
      </coding>
    </type>
    <value value="9"/>
  </class>
</Coverage>