This is the set of resources that conform to either of the profiles PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage) and PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage). E.g. what you have to deal with if you get resources conforming to one of them
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | C | 0..* | Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management hrex-cov-1: Coverage.identifier or Coverage.subscriberId SHALL be present | |
meta | Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children | |
text | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children | |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
identifier | SΣ | 0..1 | Identifier | Also known as Member identifier ele-1: All FHIR elements must have a @value or children |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children |
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children |
system | Σ | 0..1 | uri | The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient |
value | SΣ | 1..1 | string | The value that is unique within the system. ele-1: All FHIR elements must have a @value or children Example General: 123456 |
period | Σ | 0..1 | Period | Time period when id is/was valid for use ele-1: All FHIR elements must have a @value or children |
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. ele-1: All FHIR elements must have a @value or children |
policyHolder | Σ | 0..1 | Reference(US Core Patient Profile | HRex Organization Profile | RelatedPerson) | Owner of the policy ele-1: All FHIR elements must have a @value or children |
subscriber | Σ | 0..1 | Reference(US Core Patient Profile) | Required if subscriber is a person that is not the beneficiary. When date of birth or gender are not known, omit Patient.birthDate and set Patient.gender to unknown. ele-1: All FHIR elements must have a @value or children |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
reference | Σ | 0..1 | string | Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). ele-1: All FHIR elements must have a @value or children |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children |
display | Σ | 1..1 | string | Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber’s prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference. ele-1: All FHIR elements must have a @value or children |
subscriberId | SΣ | 1..1 | string | Subscriber ID ele-1: All FHIR elements must have a @value or children |
beneficiary | SΣ | 1..1 | Reference(HRex Patient Demographics) | Plan beneficiary ele-1: All FHIR elements must have a @value or children |
dependent | SΣ | 0..1 | string | Dependent number ele-1: All FHIR elements must have a @value or children |
relationship | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). ele-1: All FHIR elements must have a @value or children | |
period | Σ | 1..1 | Period | Coverage start and end dates ele-1: All FHIR elements must have a @value or children |
payor | SΣ | 1..1 | Reference(PCT Organization | #sd-davinci-pct-organization-davinci-pct-organization) | Issuer of the policy ele-1: All FHIR elements must have a @value or children |
class | 1..* | BackboneElement | Additional coverage classifications ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. ele-1: All FHIR elements must have a @value or children |
value | Σ | 1..1 | string | Value associated with the type ele-1: All FHIR elements must have a @value or children |
name | Σ | 1..1 | string | Human readable description of the type and value ele-1: All FHIR elements must have a @value or children |
order | Σ | 0..1 | positiveInt | Relative order of the coverage ele-1: All FHIR elements must have a @value or children |
network | Σ | 0..1 | string | Insurer network ele-1: All FHIR elements must have a @value or children |
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (required) ele-1: All FHIR elements must have a @value or children |
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary ele-1: All FHIR elements must have a @value or children | |
valueQuantity | Quantity(SimpleQuantity) | |||
valueMoney | Money | |||
exception | 0..* | BackboneElement | Exceptions for patient payments ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. ele-1: All FHIR elements must have a @value or children |
period | Σ | 0..1 | Period | The effective period of the exception ele-1: All FHIR elements must have a @value or children |
subrogation | 0..1 | boolean | Reimbursement to insurer ele-1: All FHIR elements must have a @value or children | |
contract | 0..* | Reference(Contract) | Contract details ele-1: All FHIR elements must have a @value or children | |
Documentation for this format |