Da Vinci - Coverage Requirements Discovery
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.0.1: STU 2.0) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: Coverage example - JSON Representation

Page standards status: Informative

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{
  "resourceType" : "Coverage",
  "id" : "example",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"example\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Coverage &quot;example&quot; </p></div><p><b>identifier</b>: Member Number:\u00a012345</p><p><b>status</b>: active</p><p><b>type</b>: extended healthcare <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ActCode.html\">ActCode</a>#EHCPOL)</span></p><p><b>policyHolder</b>: <a href=\"http://example.org/FHIR/Organization/CBI35\">http://example.org/FHIR/Organization/CBI35</a></p><p><b>subscriber</b>: <a href=\"Patient-example.html\">Patient/example</a> &quot; SHAW&quot;</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Patient/example</a> &quot; SHAW&quot;</p><p><b>dependent</b>: 0</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2011-05-23 --&gt; 2012-05-23</p><p><b>payor</b>: <a href=\"http://example.org/fhir/Organization/example-payer\">http://example.org/fhir/Organization/example-payer: Payer XYZ</a></p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td>Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group)</span></td><td>CB135</td><td>Corporate Baker's Inc. Local #35</td></tr></table></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB"
          }
        ]
      },
      "system" : "http://example.com/fhir/NampingSystem/certificate",
      "value" : "12345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "policyHolder" : {
    "reference" : "http://example.org/FHIR/Organization/CBI35"
  },
  "subscriber" : {
    🔗 "reference" : "Patient/example"
  },
  "beneficiary" : {
    🔗 "reference" : "Patient/example"
  },
  "dependent" : "0",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2011-05-23",
    "end" : "2012-05-23"
  },
  "payor" : [
    {
      "reference" : "http://example.org/fhir/Organization/example-payer",
      "display" : "Payer XYZ"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ]
      },
      "value" : "CB135",
      "name" : "Corporate Baker's Inc. Local #35"
    }
  ]
}