Da Vinci Payer Data Exchange
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This page is part of the Da Vinci Payer Data Exchange (v2.1.0-ballot: STU2.1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

: PDexCoverageExample - XML Representation

Page standards status: Informative

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="Coverage1"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage Coverage1</b></p><a name="Coverage1"> </a><a name="hcCoverage1"> </a><a name="Coverage1-en-US"> </a><p><b>identifier</b>: Member Number/234567</p><p><b>status</b>: Active</p><p><b>subscriberId</b>: 93542106</p><p><b>beneficiary</b>: <a href="Patient-1.html">Johnny Appleseed  Male, DoB: 1986-01-01 ( Member Number)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>payor</b>: <a href="Organization-Payer1.html">Organization Payer 1</a></p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
    <system value="http://example.org/old-payer/identifiers/coverage"/>
    <value value="234567"/>
  </identifier>
  <status value="active"/>
  <subscriberId value="93542106"/>
  <beneficiary>🔗 
    <reference value="Patient/1"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <payor>🔗 
    <reference value="Organization/Payer1"/>
  </payor>
</Coverage>