This page is part of the National Healthcare Safety Network (NHSN) Digital Quality Measure (dQM) Reporting Implementation Guide (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

• Narrative Content
• XML
• JSON

: Coverage - Example ACH Pass1 - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "coverage-example-ach-pass1",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage coverage-example-ach-pass1</b></p><a name=\"coverage-example-ach-pass1\"> </a><a name=\"hccoverage-example-ach-pass1\"> </a><a name=\"coverage-example-ach-pass1-en-US\"> </a><p><b>identifier</b>: Member Number/084536836</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode SUBSUPP}\">subsidized supplemental health program</span></p><p><b>policyHolder</b>: Mom Parent</p><p><b>subscriberId</b>: 98435938934</p><p><b>beneficiary</b>: <a href=\"Patient-patient-example-ach-ach-pass1.html\">Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN:\u00a01601191901010308\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship child}\">Child</span></p><p><b>period</b>: 2020-08-01 --&gt; (ongoing)</p><p><b>payor</b>: Medicaid</p></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ]
      },
      "system" : "http://example.org/fhir/memberidentifier",
      "value" : "084536836"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "SUBSUPP",
        "display" : "subsidized supplemental health program"
      }
    ]
  },
  "policyHolder" : {
    "display" : "Mom Parent"
  },
  "subscriberId" : "98435938934",
  "beneficiary" : {
    🔗 "reference" : "Patient/patient-example-ach-ach-pass1"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "child",
        "display" : "Child"
      }
    ],
    "text" : "Child"
  },
  "period" : {
    "start" : "2020-08-01"
  },
  "payor" : [
    {
      "display" : "Medicaid"
    }
  ]
}