{
  "resourceType" : "Coverage",
  "id" : "selfpaycoverage2001",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage selfpaycoverage2001</b></p><a name=\"selfpaycoverage2001\"> </a><a name=\"hcselfpaycoverage2001\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-coverage.html\">PCT Coverage</a></p></div><p><b>Extension Definition for Coverage.kind for Version 5.0</b>: self-pay</p><p><b>Self-Pay Declared</b>: true</p><p><b>status</b>: Active</p><p><b>subscriberId</b>: Absent because : not-applicable</p><p><b>beneficiary</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>payor</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind",
    "valueCode" : "self-pay"
  },
  {
    "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared",
    "valueBoolean" : true
  }],
  "status" : "active",
  "_subscriberId" : {
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
      "valueCode" : "not-applicable"
    }]
  },
  "beneficiary" : {
    "reference" : "Patient/patient1001"
  },
  "relationship" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
      "code" : "self",
      "display" : "Self"
    }]
  },
  "payor" : [{
    "reference" : "Patient/patient1001"
  }]
}