This page is part of the US Drug Formulary (v0.1.0: STU 1 Draft) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions
Definitions for usdf-CoveragePlan.
1. List:usdf-CoveragePlan | |
Definition | A health plan which contains links to administrative information, a list of formulary drugs covered under that plan, and a definition of drug tiers and their associated cost-sharing models. |
Control | 0..* |
Alternate Names | Collection, WorkingList, Organizer |
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: 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-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.div.exists()) lst-1: A list can only have an emptyReason if it is empty (: emptyReason.empty() or entry.empty()) lst-2: The deleted flag can only be used if the mode of the list is "changes" (: mode = 'changes' or entry.deleted.empty()) lst-3: An entry date can only be used if the mode of the list is "working" (: mode = 'working' or entry.date.empty()) |
2. List:usdf-CoveragePlan.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Control | 0..1 |
Type | id |
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
3. List:usdf-CoveragePlan.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Control | 0..1 |
Type | Meta |
4. List:usdf-CoveragePlan.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
5. List:usdf-CoveragePlan.language | |
Definition | The base language in which the resource is written. |
Control | 0..1 |
Binding | A human language. The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages |
Type | code |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
6. List:usdf-CoveragePlan.text | |
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
Control | 0..1 |
Type | Narrative |
Alternate Names | narrative, html, xhtml, display |
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
7. List:usdf-CoveragePlan.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. |
Control | 0..* |
Type | Resource |
Alternate Names | inline resources, anonymous resources, contained resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. |
8. List:usdf-CoveragePlan.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 4..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
9. List:usdf-CoveragePlan.extension:drugtierdefinition | |
Definition | A description of the drug tiers used by the formulary and how those tiers implement copay and coinsurance amounts. Drug tiers do not have any inherent meaning that is consistent across all formularies. Rather, each tier is defined using this element. |
Control | 1..* |
Type | Extension(DrugTierDefinition) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage) |
Must Support | true |
10. List:usdf-CoveragePlan.extension:network | |
Definition | Array of Networks within a plan. |
Control | 1..* |
Type | Extension(Network) (Extension Type: string) |
Must Support | true |
11. List:usdf-CoveragePlan.extension:summaryurl | |
Definition | The URL that goes directly to the formulary brochure for the specific standard plan or plan variation. |
Control | 1..1 |
Type | Extension(SummaryURL) (Extension Type: string) |
Must Support | true |
12. List:usdf-CoveragePlan.extension:formularyurl | |
Definition | The URL that goes directly to the formulary brochure for the specific standard plan or plan variation. |
Control | 0..1 |
Type | Extension(FormularyURL) (Extension Type: string) |
Must Support | true |
13. List:usdf-CoveragePlan.extension:emailplancontact | |
Definition | An email address for developers/public to report mistakes in the network and formulary data |
Control | 0..1 |
Type | Extension(EmailPlanContact) (Extension Type: string) |
Must Support | true |
14. List:usdf-CoveragePlan.extension:marketingurl | |
Definition | The URL that goes directly to the plan brochure for the specific standard plan or plan variation |
Control | 0..1 |
Type | Extension(MarketingURL) (Extension Type: string) |
Must Support | true |
15. List:usdf-CoveragePlan.extension:planidtype | |
Definition | Type of Plan ID. For all Marketplace plans this should be: HIOS-PLAN-ID |
Control | 1..1 |
Type | Extension(PlanIDType) (Extension Type: string) |
Must Support | true |
16. List:usdf-CoveragePlan.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
17. List:usdf-CoveragePlan.identifier | |
Definition | Identifier for the List assigned for business purposes outside the context of FHIR. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..1 |
Type | Identifier |
Must Support | true |
18. List:usdf-CoveragePlan.status | |
Definition | Indicates the current state of this list. |
Control | 1..1 |
Binding | The current state of the list. The codes SHALL be taken from ListStatus |
Type | code |
Is Modifier | true |
Must Support | true |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
19. List:usdf-CoveragePlan.mode | |
Definition | How this list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted. |
Control | 1..1 |
Binding | The processing mode that applies to this list. The codes SHALL be taken from ListMode |
Type | code |
Is Modifier | true |
Must Support | true |
Requirements | Lists are used in various ways, and it must be known in what way it is safe to use them. |
Comments | This element is labeled as a modifier because a change list must not be misunderstood as a complete list. |
20. List:usdf-CoveragePlan.title | |
Definition | A label for the list assigned by the author. |
Control | 1..1 |
Type | string |
Requirements | Allows customization beyond just the code identifying the kind of list. |
21. List:usdf-CoveragePlan.code | |
Definition | This code defines the purpose of the list - why it was created. |
Control | 0..1 |
Binding | What the purpose of a list is. For example codes, see ExampleUseCodesForList |
Type | CodeableConcept |
Requirements | Lists often contain subsets of resources rather than an exhaustive list. The code identifies what type of subset is included. |
Comments | If there is no code, the purpose of the list is implied where it is used, such as in a document section using Document.section.code. |
22. List:usdf-CoveragePlan.subject | |
Definition | The common subject (or patient) of the resources that are in the list if there is one. |
Control | 0..1 |
Type | Reference(Patient | Group | Device | Location) |
Requirements | The primary purpose of listing the subject explicitly is to help with finding the right list. |
Comments | Some purely arbitrary lists do not have a common subject, so this is optional. |
23. List:usdf-CoveragePlan.encounter | |
Definition | The encounter that is the context in which this list was created. |
Control | 0..1 |
Type | Reference(Encounter) |
24. List:usdf-CoveragePlan.date | |
Definition | The date that the list was prepared. |
Control | 0..1 |
Type | dateTime |
Requirements | Identifies how current the list is which affects relevance. |
Comments | The actual important date is the date of currency of the resources that were summarized, but it is usually assumed that these are current when the preparation occurs. |
25. List:usdf-CoveragePlan.source | |
Definition | The entity responsible for deciding what the contents of the list were. Where the list was created by a human, this is the same as the author of the list. |
Control | 0..1 |
Type | Reference(Practitioner | PractitionerRole | Patient | Device) |
Requirements | Allows follow-up as well as context. |
Alternate Names | Author |
Comments | The primary source is the entity that made the decisions what items are in the list. This may be software or user. |
26. List:usdf-CoveragePlan.orderedBy | |
Definition | What order applies to the items in the list. |
Control | 0..1 |
Binding | What order applies to the items in a list. The codes SHOULD be taken from ListOrderCodes |
Type | CodeableConcept |
Requirements | Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries. |
Comments | Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order. |
27. List:usdf-CoveragePlan.note | |
Definition | Comments that apply to the overall list. |
Control | 0..* |
Type | Annotation |
28. List:usdf-CoveragePlan.entry | |
Definition | Entries in this list. |
Control | 0..* This element is affected by the following invariants: lst-1 |
Type | BackboneElement |
Comments | If there are no entries in the list, an emptyReason SHOULD be provided. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
29. List:usdf-CoveragePlan.entry.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
30. List:usdf-CoveragePlan.entry.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
31. List:usdf-CoveragePlan.entry.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
32. List:usdf-CoveragePlan.entry.flag | |
Definition | The flag allows the system constructing the list to indicate the role and significance of the item in the list. |
Control | 0..1 |
Binding | Codes that provide further information about the reason and meaning of the item in the list. For example codes, see PatientMedicineChangeTypes |
Type | CodeableConcept |
Requirements | This field is present to support various clinical uses of lists, such as a discharge summary medication list, where flags specify whether the medication was added, modified, or deleted from the list. |
Comments | The flag can only be understood in the context of the List.code. If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true. Deleted can only be used if the List.mode is "changes". |
33. List:usdf-CoveragePlan.entry.deleted | |
Definition | True if this item is marked as deleted in the list. |
Control | 0..1 This element is affected by the following invariants: lst-2 |
Type | boolean |
Is Modifier | true |
Requirements | The flag element may contain codes that an application processing the list does not understand. However there can be no ambiguity if a list item is actually marked as "deleted". |
Comments | If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true. Both flag and deleted can only be used if the List.mode is "changes". A deleted entry should be displayed in narrative as deleted. This element is labeled as a modifier because it indicates that an item is (to be) no longer in the list. |
Meaning if Missing | List items are generally only treated as deleted when this element explicitly carries a value of true. Systems SHOULD always populate this value when mode is 'changes' |
34. List:usdf-CoveragePlan.entry.date | |
Definition | When this item was added to the list. |
Control | 0..1 |
Type | dateTime |
Requirements | The date may be significant for understanding the meaning of items in a working list. |
35. List:usdf-CoveragePlan.entry.item | |
Definition | A reference to the actual resource from which data was derived. |
Control | 1..1 |
Type | Reference(FormularyDrug) |
36. List:usdf-CoveragePlan.emptyReason | |
Definition | If the list is empty, why the list is empty. |
Control | 0..1 This element is affected by the following invariants: lst-1 |
Binding | If a list is empty, why it is empty. The codes SHOULD be taken from ListEmptyReasons |
Type | CodeableConcept |
Requirements | Allows capturing things like "none exist" or "not asked" which can be important for most lists. |
Comments | The various reasons for an empty list make a significant interpretation to its interpretation. Note that this code is for use when the entire list has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases. |