CARIN Digital Insurance Card
0.1.0 - STU 1 Ballot
CARIN Digital Insurance Card
0.1.0 - STU 1 Ballot
This page is part of the CARIN Digital Insurance Card (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions 
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Coverage;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "Example-Coverage1"];
fhir:Resource.meta [
fhir:Meta.versionId [ fhir:value "1" ];
fhir:Meta.lastUpdated [ fhir:value "2021-04-06T10:49:02.473+00:00"^^xsd:dateTime ];
fhir:Meta.profile [
fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage";
fhir:index 0;
fhir:link <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns='http://www.w3.org/1999/xhtml'>Acme Gold Plus</div>'"
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "memberId" ];
fhir:Extension.valueId [ fhir:value "102345672-01" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "name" ];
fhir:Extension.valueHumanName [
fhir:HumanName.family [ fhir:value "Doe" ];
fhir:HumanName.given [
fhir:value "John";
fhir:index 0 ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
], [
fhir:index 1;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "memberId" ];
fhir:Extension.valueId [ fhir:value "102345672-02" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "name" ];
fhir:Extension.valueHumanName [
fhir:HumanName.family [ fhir:value "Doe" ];
fhir:HumanName.given [
fhir:value "Jane";
fhir:index 0 ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
], [
fhir:index 2;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "memberId" ];
fhir:Extension.valueId [ fhir:value "102345672-03" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "name" ];
fhir:Extension.valueHumanName [
fhir:HumanName.family [ fhir:value "Doe" ];
fhir:HumanName.given [
fhir:value "Jimmy";
fhir:index 0 ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
], [
fhir:index 3;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "memberId" ];
fhir:Extension.valueId [ fhir:value "102345672-04" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "name" ];
fhir:Extension.valueHumanName [
fhir:HumanName.family [ fhir:value "Doe" ];
fhir:HumanName.given [
fhir:value "Ginny";
fhir:index 0 ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
], [
fhir:index 4;
fhir:Element.extension [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ];
fhir:Coding.code [ fhir:value "gpvisit" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "cost" ];
fhir:Extension.valueString [ fhir:value "N/A" ] ];
fhir:Extension.url [ fhir:value "costToBeneficiary" ] ], [
fhir:index 1;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ];
fhir:Coding.code [ fhir:value "spvisit" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "cost" ];
fhir:Extension.valueString [ fhir:value "N/A" ] ];
fhir:Extension.url [ fhir:value "costToBeneficiary" ] ], [
fhir:index 2;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ];
fhir:Coding.code [ fhir:value "emergency" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "cost" ];
fhir:Extension.valueString [ fhir:value "N/A" ] ];
fhir:Extension.url [ fhir:value "costToBeneficiary" ] ], [
fhir:index 3;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ];
fhir:Coding.code [ fhir:value "urgentcare" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "cost" ];
fhir:Extension.valueString [ fhir:value "N/A" ] ];
fhir:Extension.url [ fhir:value "costToBeneficiary" ] ], [
fhir:index 4;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "rx" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "cost" ];
fhir:Extension.valueString [ fhir:value "DED THEN $10/$40/$70/25%" ] ];
fhir:Extension.url [ fhir:value "costToBeneficiary" ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCosts-extension" ]
], [
fhir:index 5;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension" ];
fhir:Extension.valueAnnotation [
fhir:Annotation.text [ fhir:value "If you use a TTY, call 711.\nYou may be asked to present this card when you receive care or fill a perscription. This card does not gaurentee coverage. Intentionally misusing this card may be considered fraud or a violation of the law.\nWe encourage you to use a primary care physician as a valuable resource and personal health advocate." ] ]
], [
fhir:index 6;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension" ];
fhir:Extension.valueDate [ fhir:value "2020-12-15"^^xsd:date ]
], [
fhir:index 7;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.iso.org/standard/35883-TEMPORARY-WAITING-FOR-HTA-DEFINED-URL" ];
fhir:Coding.code [ fhir:value "#00bfff" ] ] ]
], [
fhir:index 8;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.iso.org/standard/35883-TEMPORARY-WAITING-FOR-HTA-DEFINED-URL" ];
fhir:Coding.code [ fhir:value "#ceebf5" ] ] ]
], [
fhir:index 9;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "label" ];
fhir:Extension.valueString [ fhir:value "ACME Inc." ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Company logo" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension" ]
], [
fhir:index 10;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "label" ];
fhir:Extension.valueString [ fhir:value "Some lable for this QR code" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Usage text for this QR code for the end user" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "iVBORw0KGgoAAAANSUhEUgAAABAAAAAkCAQAAAAqEXJRAAAABGdBTUEAALGPC/xhBQAAACBjSFJNAAB6JgAAgIQAAPoAAACA6AAAdTAAAOpgAAA6mAAAF3CculE8AAAAAmJLR0QA/4ePzL8AAAAHdElNRQflCBoOCChye9NTAAAAsklEQVQ4y+WSsQrCMBCGv9ZCUdwUBEcfR+c+kVPewHdxdxEcBQW1FBTpkFoQ6iJxiSHaRCdB9L/l5+6/kP/uAHpMOKCeYoegDdBlUyveY06zwZghPvQpYe3tVyhmARdi/DhGVvnEVLMRLc1irOcWRpqanAx5g98QRI6WhI6dsAcVkrB82IW0BTmr2rJkgHr5heIzNgsqv+CMYEDutlkh9ARSt81/PpjvONqt4XvDMq6alTdjhHqxFxxRQAAAACV0RVh0ZGF0ZTpjcmVhdGUAMjAyMS0wOC0yNlQxNDowODo0MCswMDowMF+TI3oAAAAldEVYdGRhdGU6bW9kaWZ5ADIwMjEtMDgtMjZUMTQ6MDg6NDArMDA6MDAuzpvGAAAAAElFTkSuQmCC"^^xsd:base64Binary ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension" ]
], [
fhir:index 11;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "label" ];
fhir:Extension.valueString [ fhir:value "Some lable for this Bar code" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Usage text for this Bar code for the end user" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension" ]
], [
fhir:index 12;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "label" ];
fhir:Extension.valueString [ fhir:value "Some label text" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Some text for the end user about the usage/meaning of this image" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ];
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension" ]
];
fhir:Coverage.identifier [
fhir:index 0;
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "MB" ];
fhir:Coding.display [ fhir:value "Member Number" ] ] ];
fhir:Identifier.system [ fhir:value "https://www.acmeinsurance.com/glossary/memberid" ];
fhir:Identifier.value [ fhir:value "102345672-02" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Acme Insurance Co" ] ]
];
fhir:Coverage.status [ fhir:value "active"];
fhir:Coverage.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
fhir:Coding.code [ fhir:value "HIP" ];
fhir:Coding.display [ fhir:value "health insurance plan policy" ] ];
fhir:CodeableConcept.text [ fhir:value "health insurance plan policy" ]
];
fhir:Coverage.subscriber [
fhir:Reference.reference [ fhir:value "Patient/Example-Patient1" ];
fhir:Reference.display [ fhir:value "John Doe" ]
];
fhir:Coverage.subscriberId [ fhir:value "102345672-01"];
fhir:Coverage.beneficiary [
fhir:Reference.reference [ fhir:value "Patient/Example-Patient2" ];
fhir:Reference.display [ fhir:value "Jane Doe" ]
];
fhir:Coverage.dependent [ fhir:value "02"];
fhir:Coverage.relationship [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ];
fhir:Coding.code [ fhir:value "spouse" ];
fhir:Coding.display [ fhir:value "Spouse" ] ];
fhir:CodeableConcept.text [ fhir:value "Spouse" ]
];
fhir:Coverage.period [
fhir:Period.start [ fhir:value "2021-01-01"^^xsd:date ]
];
fhir:Coverage.payor [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Organization/Example-PayerOrganization1" ];
fhir:Reference.display [ fhir:value "Acme Insurance Co" ]
];
fhir:Coverage.class [
fhir:index 0;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "group" ] ] ];
fhir:Coverage.class.value [ fhir:value "993355" ];
fhir:Coverage.class.name [ fhir:value "Stars Inc" ]
], [
fhir:index 1;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "plan" ] ] ];
fhir:Coverage.class.value [ fhir:value "11461128" ];
fhir:Coverage.class.name [ fhir:value "Acme Gold Plus" ]
], [
fhir:index 2;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS" ];
fhir:Coding.code [ fhir:value "division" ] ] ];
fhir:Coverage.class.value [ fhir:value "11" ]
], [
fhir:index 3;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS" ];
fhir:Coding.code [ fhir:value "network" ] ] ];
fhir:Coverage.class.value [ fhir:value "561490" ];
fhir:Coverage.class.name [ fhir:value "Acme Gold Plus South" ]
], [
fhir:index 4;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "rxbin" ] ] ];
fhir:Coverage.class.value [ fhir:value "100045" ]
], [
fhir:index 5;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "rxpcn" ] ] ];
fhir:Coverage.class.value [ fhir:value "1234000" ]
];
fhir:Coverage.costToBeneficiary [
fhir:index 0;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamOutDed" ];
fhir:Coding.display [ fhir:value "Family Out of Network Deductible" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "10000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 1;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamInDed" ];
fhir:Coding.display [ fhir:value "Family In Network Deductible" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "8000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 2;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamRxOutDed" ];
fhir:Coding.display [ fhir:value "Family Pharmacy Out of Network Deductible" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "2000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 3;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamRxInDed" ];
fhir:Coding.display [ fhir:value "Family Pharmacy In Network Deductible" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "1500.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 4;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamOutMax" ];
fhir:Coding.display [ fhir:value "Family Out of Network Out of Pocket Maximum" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "12000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 5;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamInMax" ];
fhir:Coding.display [ fhir:value "Family In Network Out of Pocket Maximum" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "10000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 6;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamRxOutMax" ];
fhir:Coding.display [ fhir:value "Family Pharmacy Out of Network Out of Pocket Maximum" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "3000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 7;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "FamRxInMax" ];
fhir:Coding.display [ fhir:value "Family Pharmacy In Network Out of Pocket Maximum" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Money.value [ fhir:value "2000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ HL7 Payer/Provider Information Exchange Working Group (PIE WG). Package hl7.fhir.us.insurance-card#0.1.0 based on FHIR 4.0.1. Generated 2021-12-06
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