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) - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="Dental-Aetna"/>
  <meta>
    <versionId value="6"/>
    <lastUpdated value="2020-08-06T17:04:20.329+00:00"/>
    <source value="#wVOzmfnx1oKPJar2"/>
    <profile
             value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <identifier>
    <system value="http://benefitsAetna.com/certificate"/>
    <value value="12345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="DENTAL"/>
      <display value="dental care policy"/>
    </coding>
  </type>
  <subscriber>
    <reference value="Patient/example-dental"/>
  </subscriber>
  <subscriberId value="123456"/>
  <beneficiary>
    <reference value="Patient/example-dental"/>
  </beneficiary>
  <dependent value="0"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
      <display value="Self"/>
    </coding>
  </relationship>
  <period>
    <start value="2020-01-01"/>
    <end value="2020-01-01"/>
  </period>
  <payor>
    <reference value="Organization/Aetna-organization"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
      </coding>
    </type>
    <value value="B37FC"/>
    <name value="Aetna Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/>
  </class>
</Coverage>