Consolidated CDA
3.0.0-ballot - ballot United States of America flag

This page is part of the CCDA: Consolidated CDA Release (v3.0.0-ballot: CCDA 3.0 Ballot 1) based on FHIR (HL7® FHIR® Standard) v5.0.0. . For a full list of available versions, see the Directory of published versions

Example Binary: Coverage Activity Example

This content is an example of the Coverage Activity Logical Model and is not a FHIR Resource

    
<act classCode="ACT" moodCode="EVN" xmlns="urn:hl7-org:v3">
  <templateId root="2.16.840.1.113883.10.20.22.4.60" extension="2024-05-01" />
  <id root="1fe2cdd0-7aad-11db-9fe1-0800200c9a66" />
  <code code="52556-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment sources" />
  <text><reference value="#coverage"/></text>
  <statusCode code="completed" />
  <effectiveTime value="20230501"/>
  <entryRelationship typeCode="COMP">
    <sequenceNumber value="2" />
    <act classCode="ACT" moodCode="EVN">
      <!-- Policy Activity -->
      <templateId root="2.16.840.1.113883.10.20.22.4.61" extension="2023-05-01" />
      <id root="1fe2cdd0-7aad-11db-9fe1-0800200c9a66"/>
      <code code="1" codeSystem="2.16.840.1.113883.3.221.5" codeSystemName="SOP" displayName="MEDICARE"/>
      <statusCode code="completed"/>
      <performer typeCode="PRF">
        <templateId root="2.16.840.1.113883.10.20.22.4.87"/>
        <assignedEntity>
          <!-- Payer ID -->
          <id root="2.16.840.1.113883.6.300" extension="PAYER1"/>
        </assignedEntity>
      </performer>
      <participant typeCode="COV">
        <!-- Coverage Target -->
        <templateId root="2.16.840.1.113883.10.20.22.4.89"/>
        <participantRole>
          <id root="1fe2cdd0-7aad-11db-9fe1-0800200c9a66"/>
          <code code="SELF" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode" displayName="self"/>
        </participantRole>
      </participant>
    </act>
  </entryRelationship>
</act>