Kenya National Cancer Control Programme (NCCP) FHIR Implementation Guide, published by Digital Health Agency (DHA), Kenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/nccpFHIRIG/ and changes regularly. See the Directory of published versions
| Official URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-oncology-coverage-eligibility-request | Version: 0.1.0 | ||||
| Draft as of 2026-06-04 | Computable Name: OncologyCoverageEligibilityRequest | ||||
Request to verify patient insurance coverage eligibility for oncology treatment.
Usages:
You can also check for usages in the FHIR IG Statistics
Description Differentials, Snapshots, and other representations.
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() |
SΣ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
S | 0..1 | Reference(CarePlan) | Regimen Reference Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-regimen-reference-extension |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) |
![]() ![]() |
SΣ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required) |
![]() ![]() |
SΣ | 1..1 | Reference(Patient) | Intended recipient of products and services |
![]() ![]() |
SΣ | 1..1 | dateTime | Creation date |
![]() ![]() |
S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request |
![]() ![]() |
SΣ | 1..1 | Reference(Organization) | Coverage issuer |
![]() ![]() |
0..* | BackboneElement | Patient insurance information | |
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() |
S | 1..1 | Reference(Coverage) | Insurance information |
![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() |
S | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| CoverageEligibilityRequest.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.purpose | Base | required | EligibilityRequestPurpose | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CoverageEligibilityRequest | 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 |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
| Path | Status | Usage | ValueSet | Version | Source |
| CoverageEligibilityRequest.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.purpose | Base | required | EligibilityRequestPurpose | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
Σ | 0..1 | id | Version specific identifier | ||||
![]() ![]() ![]() |
Σ | 0..1 | instant | When the resource version last changed | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
![]() ![]() ![]() |
SΣ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
![]() ![]() ![]() |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
![]() ![]() ![]() |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
S | 0..1 | Reference(CarePlan) | Regimen Reference Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-regimen-reference-extension | ||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) | ||||
![]() ![]() |
0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
![]() ![]() |
SΣ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required) | ||||
![]() ![]() |
SΣ | 1..1 | Reference(Patient) | Intended recipient of products and services | ||||
![]() ![]() |
0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() |
Period | |||||||
![]() ![]() |
SΣ | 1..1 | dateTime | Creation date | ||||
![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Author | |||||
![]() ![]() |
S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | ||||
![]() ![]() |
SΣ | 1..1 | Reference(Organization) | Coverage issuer | ||||
![]() ![]() |
0..1 | Reference(Location) | Servicing facility | |||||
![]() ![]() |
0..* | BackboneElement | Supporting information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() |
1..1 | Reference(Resource) | Data to be provided | |||||
![]() ![]() ![]() |
0..1 | boolean | Applies to all items | |||||
![]() ![]() |
0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..1 | boolean | Applicable coverage | |||||
![]() ![]() ![]() |
S | 1..1 | Reference(Coverage) | Insurance information | ||||
![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..* | positiveInt | Applicable exception or supporting information | |||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() |
S | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
![]() ![]() ![]() |
0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Perfoming practitioner | |||||
![]() ![]() ![]() |
0..1 | SimpleQuantity(4.0.1) | Count of products or services | |||||
![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() |
0..1 | Reference(Location | Organization) | Servicing facility | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Applicable diagnosis | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Condition) | |||||||
![]() ![]() ![]() |
0..* | Reference(Resource) | Product or service details | |||||
Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| CoverageEligibilityRequest.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.purpose | Base | required | EligibilityRequestPurpose | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| CoverageEligibilityRequest.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CoverageEligibilityRequest | 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 |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() |
SΣ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
S | 0..1 | Reference(CarePlan) | Regimen Reference Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-regimen-reference-extension |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) |
![]() ![]() |
SΣ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required) |
![]() ![]() |
SΣ | 1..1 | Reference(Patient) | Intended recipient of products and services |
![]() ![]() |
SΣ | 1..1 | dateTime | Creation date |
![]() ![]() |
S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request |
![]() ![]() |
SΣ | 1..1 | Reference(Organization) | Coverage issuer |
![]() ![]() |
0..* | BackboneElement | Patient insurance information | |
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() |
S | 1..1 | Reference(Coverage) | Insurance information |
![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() |
S | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| CoverageEligibilityRequest.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.purpose | Base | required | EligibilityRequestPurpose | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CoverageEligibilityRequest | 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 |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
| Path | Status | Usage | ValueSet | Version | Source |
| CoverageEligibilityRequest.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.purpose | Base | required | EligibilityRequestPurpose | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
Snapshot ViewView
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
Σ | 0..1 | id | Version specific identifier | ||||
![]() ![]() ![]() |
Σ | 0..1 | instant | When the resource version last changed | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
![]() ![]() ![]() |
SΣ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
![]() ![]() ![]() |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
![]() ![]() ![]() |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
S | 0..1 | Reference(CarePlan) | Regimen Reference Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-regimen-reference-extension | ||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) | ||||
![]() ![]() |
0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
![]() ![]() |
SΣ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required) | ||||
![]() ![]() |
SΣ | 1..1 | Reference(Patient) | Intended recipient of products and services | ||||
![]() ![]() |
0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() |
Period | |||||||
![]() ![]() |
SΣ | 1..1 | dateTime | Creation date | ||||
![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Author | |||||
![]() ![]() |
S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | ||||
![]() ![]() |
SΣ | 1..1 | Reference(Organization) | Coverage issuer | ||||
![]() ![]() |
0..1 | Reference(Location) | Servicing facility | |||||
![]() ![]() |
0..* | BackboneElement | Supporting information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() |
1..1 | Reference(Resource) | Data to be provided | |||||
![]() ![]() ![]() |
0..1 | boolean | Applies to all items | |||||
![]() ![]() |
0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..1 | boolean | Applicable coverage | |||||
![]() ![]() ![]() |
S | 1..1 | Reference(Coverage) | Insurance information | ||||
![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..* | positiveInt | Applicable exception or supporting information | |||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() |
S | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
![]() ![]() ![]() |
0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Perfoming practitioner | |||||
![]() ![]() ![]() |
0..1 | SimpleQuantity(4.0.1) | Count of products or services | |||||
![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() |
0..1 | Reference(Location | Organization) | Servicing facility | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Applicable diagnosis | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Condition) | |||||||
![]() ![]() ![]() |
0..* | Reference(Resource) | Product or service details | |||||
Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| CoverageEligibilityRequest.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.purpose | Base | required | EligibilityRequestPurpose | 📦4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| CoverageEligibilityRequest.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CoverageEligibilityRequest | 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 |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
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