Dental Data Exchange
0.1.0 - STU1 Ballot

This page is part of the Dental Data Exchange (v0.1.0: STU 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

: Coverage (example) - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "Dental-Aetna",
  "meta" : {
    "versionId" : "6",
    "lastUpdated" : "2020-08-06T17:04:20.329+00:00",
    "source" : "#wVOzmfnx1oKPJar2",
    "profile" : [
      "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>id</b>: Dental-Aetna</p><p><b>meta</b>: </p><p><b>identifier</b>: id: 12345</p><p><b>status</b>: active</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode DENTAL}\">dental care policy</span></p><p><b>subscriber</b>: <a href=\"Patient-example-dental.html\">Generated Summary: id: example-dental; Medical Record Number: 5152020 (USUAL); active; Patient A ; ph: 123-456-7890(HOME), testA@email.com; gender: male; birthDate: 1990-01-01</a></p><p><b>subscriberId</b>: 123456</p><p><b>beneficiary</b>: <a href=\"Patient-example-dental.html\">Generated Summary: id: example-dental; Medical Record Number: 5152020 (USUAL); active; Patient A ; ph: 123-456-7890(HOME), testA@email.com; gender: male; birthDate: 1990-01-01</a></p><p><b>dependent</b>: 0</p><p><b>relationship</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2020-01-01 --&gt; 2020-01-01</p><p><b>payor</b>: <a href=\"Organization-Aetna-organization.html\">Generated Summary: id: Aetna-organization; id: 9316452725; active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}\">Payer</span>; name: Aetna Insurance; ph: (+1) 720-677-7777, customer2-service@Aetna.org</a></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><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></td><td>B37FC</td><td>Aetna Full Coverage: Medical, Dental, Pharmacy, Vision, EHC</td></tr></table></div>"
  },
  "identifier" : [
    {
      "system" : "http://benefitsAetna.com/certificate",
      "value" : "12345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "DENTAL",
        "display" : "dental care policy"
      }
    ]
  },
  "subscriber" : {
    "reference" : "Patient/example-dental"
  },
  "subscriberId" : "123456",
  "beneficiary" : {
    "reference" : "Patient/example-dental"
  },
  "dependent" : "0",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self",
        "display" : "Self"
      }
    ]
  },
  "period" : {
    "start" : "2020-01-01",
    "end" : "2020-01-01"
  },
  "payor" : [
    {
      "reference" : "Organization/Aetna-organization"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ]
      },
      "value" : "B37FC",
      "name" : "Aetna Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
    }
  ]
}