This page is part of the Quality Improvement Core Framework (v5.0.0: STU5 (v5.0.0)) based on FHIR R4. 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 - XML Representation
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<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: Coverage</b><a name="example"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Coverage "example" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-qicore-coverage.html">QICore Coverage</a></p></div><p><b>identifier</b>: id: 12345</p><p><b>status</b>: active</p><p><b>type</b>: Other Private Insurance <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.1.0/CodeSystem-SOPT.html">Source of Payment Typology</a>#59)</span></p><p><b>policyHolder</b>: <a href="Patient-example.html">Patient/example</a> " CHALMERS"</p><p><b>subscriber</b>: <a href="Patient-example.html">Patient/example</a> " CHALMERS"</p><p><b>beneficiary</b>: <a href="Patient-example.html">Patient/example</a> " CHALMERS"</p><p><b>dependent</b>: 0</p><p><b>relationship</b>: Self <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.1.0/CodeSystem-subscriber-relationship.html">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2011-05-23 --> 2012-05-23</p><p><b>payor</b>: <a href="Organization-example.html">Organization/example</a> "Health Level Seven International"</p><p><b>order</b>: 9</p></div>
</text>
<identifier>
<system value="http://benefitsinc.com/certificate"/>
<value value="12345"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="https://nahdo.org/sopt"/>
<code value="59"/>
<display value="Other Private Insurance"/>
</coding>
</type>
<policyHolder>
<reference value="Patient/example"/>
</policyHolder>
<subscriber>
<reference value="Patient/example"/>
</subscriber>
<beneficiary>
<reference value="Patient/example"/>
</beneficiary>
<dependent value="0"/>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
</coding>
</relationship>
<period>
<start value="2011-05-23"/>
<end value="2012-05-23"/>
</period>
<payor>
<reference value="Organization/example"/>
</payor>
<!-- No longer part of the Coverage resource in R4, not clear how to represent this in the R4 resource -->
<!-- grouping>
<group value="CBI35"/>
<groupDisplay value="Corporate Baker'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 -->
<order value="9"/>
</Coverage>