Da Vinci - Documentation Templates and Rules
2.0.1 - STU 2 United States of America flag

This page is part of the Documentation Templates and Rules (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

: CoverageExample - XML Representation

Page standards status: Informative

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="CoverageExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Coverage</b><a name="CoverageExample"> </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;CoverageExample&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/HL7/davinci-crd//StructureDefinition-profile-coverage.html">CRD Coverage</a></p></div><p><b>status</b>: active</p><p><b>subscriber</b>: <a href="Patient-examplepatient.html">Patient/examplepatient</a></p><p><b>subscriberId</b>: PFP123450000</p><p><b>beneficiary</b>: <a href="Patient-examplepatient.html">Patient/examplepatient</a></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>: 2022-01-01 --&gt; 2023-01-01</p><p><b>payor</b>: <a name="OrgExample"> </a></p><blockquote><p/><p><a name="OrgExample"> </a></p><p><b>active</b>: true</p><p><b>type</b>: Payer <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html">Organization type</a>#pay)</span></p><p><b>name</b>: Insurance Company</p><p><b>telecom</b>: ph: 860-547-5001(WORK)</p><p><b>address</b>: 680 Asylum Street Hartford CT 06155 US </p></blockquote><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>Plan <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>#plan)</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><hr/><blockquote><p><b>Generated Narrative: Organization #OrgExample</b><a name="OrgExample"> </a></p><p><b>active</b>: true</p><p><b>type</b>: Payer <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html">Organization type</a>#pay)</span></p><p><b>name</b>: Insurance Company</p><p><b>telecom</b>: ph: 860-547-5001(WORK)</p><p><b>address</b>: 680 Asylum Street Hartford CT 06155 US </p></blockquote></div>
  </text>
  <contained>
    <Organization>
      <id value="OrgExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
      </meta>
      <active value="true"/>
      <type>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/organization-type"/>
          <code value="pay"/>
          <display value="Payer"/>
        </coding>
      </type>
      <name value="Insurance Company"/>
      <telecom>
        <system value="phone"/>
        <value value="860-547-5001"/>
        <use value="work"/>
      </telecom>
      <address>
        <line value="680 Asylum Street"/>
        <city value="Hartford"/>
        <state value="CT"/>
        <postalCode value="06155"/>
        <country value="US"/>
      </address>
    </Organization>
  </contained>
  <status value="active"/>
  <subscriber>🔗 
    <reference value="Patient/examplepatient"/>
  </subscriber>
  <subscriberId value="PFP123450000"/>
  <beneficiary>🔗 
    <reference value="Patient/examplepatient"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
      <display value="Self"/>
    </coding>
  </relationship>
  <period>
    <start value="2022-01-01"/>
    <end value="2023-01-01"/>
  </period>
  <payor>
    <reference value="#OrgExample"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
        <display value="Plan"/>
      </coding>
    </type>
    <value value="Premim Family Plus"/>
    <name value="Premim Family Plus Plan"/>
  </class>
</Coverage>