QI-Core Implementation Guide: STU 3.2 (v3.2.0 for FHIR 3.0.1)

This page is part of the Quality Improvement Core Framework (v3.2.0: STU 3) based on FHIR R3. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Coverage example

Formats: Narrative, XML, JSON, Turtle

Raw xml 


<Coverage xmlns="http://hl7.org/fhir">
  <id value="example"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: example</p><p><b>meta</b>: </p><p><b>identifier</b>: 12345</p><p><b>status</b>: active</p><p><b>type</b>: extended healthcare <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/v3/ActCode code 'EHCPOL' = 'extended healthcare', given as 'extended healthcare'})</span></p><p><b>policyHolder</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); -unknown-(HOME), ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 25/12/1974; </a></p><p><b>subscriber</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); -unknown-(HOME), ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 25/12/1974; </a></p><p><b>beneficiary</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); -unknown-(HOME), ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 25/12/1974; </a></p><p><b>relationship</b>: self <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'self' = 'self)</span></p><p><b>period</b>: 23/05/2011 12:00:00 AM --&gt; 23/05/2012 12:00:00 AM</p><p><b>payor</b>: <a href="Organization-example.html">Generated Summary: id: example; ??; active; <span title="Codes: {http://hl7.org/fhir/organization-type team}">Organizational team</span>; name: Health Level Seven International; ph: (+1) 734-677-7777, fax: (+1) 734-677-6622, hq@HL7.org</a></p><h3>Groupings</h3><table class="grid"><tr><td>-</td><td><b>Group</b></td><td><b>GroupDisplay</b></td><td><b>SubGroup</b></td><td><b>SubGroupDisplay</b></td><td><b>Plan</b></td><td><b>PlanDisplay</b></td><td><b>SubPlan</b></td><td><b>SubPlanDisplay</b></td><td><b>Class</b></td><td><b>ClassDisplay</b></td><td><b>SubClass</b></td><td><b>SubClassDisplay</b></td></tr><tr><td>*</td><td>CBI35</td><td>Corporate Baker's Inc. Local #35</td><td>123</td><td>Trainee Part-time Benefits</td><td>B37FC</td><td>Full Coverage: Medical, Dental, Pharmacy, Vision, EHC</td><td>P7</td><td>Includes afterlife benefits</td><td>SILVER</td><td>Silver: Family Plan spouse only</td><td>Tier2</td><td>Low deductable, max $20 copay</td></tr></table><p><b>dependent</b>: 0</p><p><b>sequence</b>: 9</p></div>
  </text>
  <identifier>
    <system value="http://benefitsinc.com/certificate"/>
    <value value="12345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/v3/ActCode"/>
      <code value="EHCPOL"/>
      <display value="extended healthcare"/>
    </coding>
  </type>
  <policyHolder>
    <reference value="Patient/example"/>
  </policyHolder>
  <subscriber>
    <reference value="Patient/example"/>
  </subscriber>
  <beneficiary>
    <reference value="Patient/example"/>
  </beneficiary>
  <relationship>
    <coding>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2011-05-23"/>
    <end value="2012-05-23"/>
  </period>
  <payor>
    <reference value="Organization/example"/>
  </payor>
  <grouping>
    <group value="CBI35"/>
    <groupDisplay value="Corporate Baker&#39;s Inc. Local #35"/>
    <subGroup value="123"/>
    <subGroupDisplay value="Trainee Part-time Benefits"/>
    <plan value="B37FC"/>
    <planDisplay value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/>
    <subPlan value="P7"/>
    <subPlanDisplay value="Includes afterlife benefits"/>
    <class value="SILVER"/>
    <classDisplay value="Silver: Family Plan spouse only"/>
    <subClass value="Tier2"/>
    <subClassDisplay value="Low deductable, max $20 copay"/>
  </grouping>
  <dependent value="0"/>
  <sequence value="9"/>
</Coverage>