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

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.1.0-preview: STU 2.1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

: Coverage example - XML Representation

Page standards status: Informative

Raw xml | Download


<Coverage xmlns="http://hl7.org/fhir">
  <id value="example"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage example</b></p><a name="example"> </a><a name="hcexample"> </a><a name="example-en-US"> </a><p><b>identifier</b>: Member Number/12345</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode EHCPOL}">extended healthcare</span></p><p><b>policyHolder</b>: <a href="https://simplifier.net/resolve?scope=hl7.fhir.us.core.v311@3.1.1&amp;canonical=http://example.org/FHIR/Organization/CBI35">??</a></p><p><b>subscriber</b>: <a href="Patient-example.html">Amy V. Shaw  Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))</a></p><p><b>beneficiary</b>: <a href="Patient-example.html">Amy V. Shaw  Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))</a></p><p><b>dependent</b>: 0</p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>period</b>: 2011-05-23 --&gt; 2012-05-23</p><p><b>payor</b>: <a href="https://simplifier.net/resolve?scope=hl7.fhir.us.core.v311@3.1.1&amp;canonical=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><span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}">Group</span></td><td>CB135</td><td>Corporate Baker's Inc. Local #35</td></tr></table></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
    <system value="http://example.com/fhir/NampingSystem/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>
  <policyHolder>
    <reference value="http://example.org/FHIR/Organization/CBI35"/>
  </policyHolder>
  <subscriber>🔗 
    <reference value="Patient/example"/>
  </subscriber>
  <beneficiary>🔗 
    <reference value="Patient/example"/>
  </beneficiary>
  <dependent value="0"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2011-05-23"/>
    <end value="2012-05-23"/>
  </period>
  <payor>
    <reference value="http://example.org/fhir/Organization/example-payer"/>
    <display value="Payer XYZ"/>
  </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's Inc. Local #35"/>
  </class>
</Coverage>