This page is part of the Documentation Templates and Rules (v1.1.0-ballot: STU 1.1 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

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: DTRCoverage1002 - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "DTRCoverage1002",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-coverage-r4"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></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 \"DTRCoverage1002\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-dtr-coverage-r4.html\">DTR Coverage R4</a></p></div><p><b>PayerEndpoint</b>: <a href=\"http://payer.com\">http://payer.com</a></p><p><b>status</b>: active</p><p><b>subscriber</b>: <a href=\"Patient-example1.html\">Patient/example1</a></p><p><b>subscriberId</b>: PFP123450000</p><p><b>beneficiary</b>: <a href=\"Patient-example1.html\">Patient/example1</a></p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2022-01-01 --&gt; 2023-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> \"Insurance Company\"</p><h3>Classes</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td>*</td><td>Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan)</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><h3>CostToBeneficiaries</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Copay Percentage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-coverage-copay-type.html\">Coverage Copay Type Codes</a>#copaypct)</span></td><td>20</td></tr></table><p><b>contract</b>: <a href=\"Contract-contract1001.html\">Contract/contract1001</a></p></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/endpoint",
      "valueUrl" : "http://payer.com"
    }
  ],
  "status" : "active",
  "subscriber" : {
    "reference" : "Patient/example1"
  },
  "subscriberId" : "PFP123450000",
  "beneficiary" : {
    "reference" : "Patient/example1"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self",
        "display" : "Self"
      }
    ]
  },
  "period" : {
    "start" : "2022-01-01",
    "end" : "2023-01-01"
  },
  "payor" : [
    {
      "reference" : "Organization/org1001"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan",
            "display" : "Plan"
          }
        ]
      },
      "value" : "Premim Family Plus",
      "name" : "Premim Family Plus Plan"
    }
  ],
  "costToBeneficiary" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
            "code" : "copaypct",
            "display" : "Copay Percentage"
          }
        ]
      },
      "valueQuantity" : {
        "value" : 20
      }
    }
  ],
  "contract" : [
    {
      "reference" : "Contract/contract1001"
    }
  ]
}