# Supporting image - CARIN Digital Insurance Card v2.0.0-ballot

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Supporting image**

## Extension: Supporting image 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension | *Version*:2.0.0-ballot | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 2 | *Computable Name*:SupportingImage |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.9.42.15 | | |

This extension enables payers to provide other supporting images found on a member’s physicial insurance card. A supporting image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. These images may communicate additional information to the member such as the type of coverage provided or partner logos. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility.

**Context of Use**

This extension may be used on the following element(s):

* Element ID Coverage

#### Supporting Image Extension

The Supporting Image extension enables payers to provide images associated with a member's physical insurance card as part of the Coverage resource. A common use case is providing images of the **front** and **back** of the insurance card so that members can access a digital copy of their card through consuming applications.

##### Structure

Each instance of the Supporting Image extension contains three sub-extensions:

| | | | |
| :--- | :--- | :--- | :--- |
| `label` | string | 1..1 | A short label identifying the image (e.g., "Front of insurance card", "Back of insurance card"). |
| `description` | string | 1..1 | A detailed description of the image content. Detailed descriptions are encouraged to assist with accessibility. |
| `image` | Attachment or Reference(DocumentReference) | 1..1 | The image data provided as an inline Attachment (with contentType and base64-encoded data) or as a reference to a DocumentReference resource. |

##### Recording Front and Back of Card Images

To provide images of the front and back of a physical insurance card, include two instances of the Supporting Image extension on the Coverage resource. Use the `label` sub-extension to identify which side of the card the image represents and the `description` sub-extension to provide accessible text describing the image content.

**Example: Front and back card images using inline Attachments**

```
{
  "resourceType": "Coverage",
  "extension": [
    {
      "extension": [
        {
          "url": "label",
          "valueString": "Front of insurance card"
        },
        {
          "url": "description",
          "valueString": "Image of the front of the member's physical insurance card showing plan name, member ID, and group number"
        },
        {
          "url": "image",
          "valueAttachment": {
            "contentType": "image/jpeg",
            "data": "<base64-encoded image data>"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"
    },
    {
      "extension": [
        {
          "url": "label",
          "valueString": "Back of insurance card"
        },
        {
          "url": "description",
          "valueString": "Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information"
        },
        {
          "url": "image",
          "valueAttachment": {
            "contentType": "image/jpeg",
            "data": "<base64-encoded image data>"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"
    }
  ]
}

```

##### Guidance

* The extension is repeatable (0..*) on the Coverage resource, allowing multiple images to be attached.
* When providing card images, use descriptive `label` values such as "Front of insurance card" and "Back of insurance card" so that consuming applications can display them appropriately.
* The `description` sub-extension SHOULD contain sufficient detail for accessibility purposes (e.g., screen readers). Describe the key information visible on the card image.
* When providing inline image data, the `contentType` and `data` elements of the Attachment are required. Common content types include `image/jpeg` and `image/png`.
* Alternatively, the image may be provided as a reference to a DocumentReference resource if the payer prefers not to embed the image data inline.
* This extension may also be used for other supporting images beyond card front/back, such as images that communicate the type of coverage provided or partner logos.

**Usage info**

**Usages:**

* Use this Extension: [C4DIC Coverage](StructureDefinition-C4DIC-Coverage.md)
* Examples for this Extension: [Coverage/Example-Coverage-FSH](Coverage-Example-Coverage-FSH.md) and [Coverage/Example-Coverage1](Coverage-Example-Coverage1.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.insurance-card|current/StructureDefinition/StructureDefinition-C4DIC-SupportingImage-extension.json)

### Formal Views of Extension Content

 [Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-C4DIC-SupportingImage-extension.csv), [Excel](StructureDefinition-C4DIC-SupportingImage-extension.xlsx), [Schematron](StructureDefinition-C4DIC-SupportingImage-extension.sch) 

#### Terminology Bindings

#### Constraints



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "C4DIC-SupportingImage-extension",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "claims"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 2,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.9.42.15"
  }],
  "version" : "2.0.0-ballot",
  "name" : "SupportingImage",
  "title" : "Supporting image",
  "status" : "active",
  "date" : "2026-08-13T02:29:19+10:00",
  "publisher" : "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact" : [{
    "name" : "HL7 International / Payer/Provider Information Exchange Work Group",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/claims"
    },
    {
      "system" : "email",
      "value" : "pie@lists.HL7.org"
    }]
  }],
  "description" : "This extension enables payers to provide other supporting images found on a member's physicial insurance card. A supporting image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. These images may communicate additional information to the member such as the type of coverage provided or partner logos. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "complex-type",
  "abstract" : false,
  "context" : [{
    "type" : "element",
    "expression" : "Coverage"
  }],
  "type" : "Extension",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension",
      "short" : "Supporting image",
      "definition" : "This extension enables payers to provide other supporting images found on a member's physicial insurance card. A supporting image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. These images may communicate additional information to the member such as the type of coverage provided or partner logos. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility."
    },
    {
      "id" : "Extension.extension",
      "path" : "Extension.extension",
      "min" : 3
    },
    {
      "id" : "Extension.extension:description",
      "path" : "Extension.extension",
      "sliceName" : "description",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:description.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:description.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "description"
    },
    {
      "id" : "Extension.extension:description.value[x]",
      "path" : "Extension.extension.value[x]",
      "type" : [{
        "code" : "string"
      }]
    },
    {
      "id" : "Extension.extension:image",
      "path" : "Extension.extension",
      "sliceName" : "image",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:image.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:image.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "image"
    },
    {
      "id" : "Extension.extension:image.value[x]",
      "path" : "Extension.extension.value[x]",
      "slicing" : {
        "discriminator" : [{
          "type" : "type",
          "path" : "$this"
        }],
        "ordered" : false,
        "rules" : "open"
      },
      "type" : [{
        "code" : "Attachment"
      },
      {
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/DocumentReference"]
      }]
    },
    {
      "id" : "Extension.extension:image.value[x]:valueAttachment",
      "path" : "Extension.extension.value[x]",
      "sliceName" : "valueAttachment",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Attachment"
      }]
    },
    {
      "id" : "Extension.extension:image.value[x]:valueAttachment.contentType",
      "path" : "Extension.extension.value[x].contentType",
      "min" : 1
    },
    {
      "id" : "Extension.extension:image.value[x]:valueAttachment.data",
      "path" : "Extension.extension.value[x].data",
      "min" : 1
    },
    {
      "id" : "Extension.extension:image.value[x]:valueReference",
      "path" : "Extension.extension.value[x]",
      "sliceName" : "valueReference",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/DocumentReference"]
      }]
    },
    {
      "id" : "Extension.extension:image.value[x]:valueReference.reference",
      "path" : "Extension.extension.value[x].reference",
      "min" : 1
    },
    {
      "id" : "Extension.extension:label",
      "path" : "Extension.extension",
      "sliceName" : "label",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:label.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:label.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "label"
    },
    {
      "id" : "Extension.extension:label.value[x]",
      "path" : "Extension.extension.value[x]",
      "type" : [{
        "code" : "string"
      }]
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "fixedUri" : "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "max" : "0"
    }]
  }
}

```
