# PCT-GFE-Bundle-Inst-1 - Patient Cost Transparency Implementation Guide v2.0.1

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **PCT-GFE-Bundle-Inst-1**

## Example Bundle: PCT-GFE-Bundle-Inst-1



## Resource Content

```json
{
  "resourceType" : "Bundle",
  "id" : "PCT-GFE-Bundle-Inst-1",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-bundle"]
  },
  "identifier" : {
    "system" : "http://example.com/identifiers/bundle",
    "value" : "59688475-2324-3242-23473847"
  },
  "type" : "collection",
  "timestamp" : "2021-11-09T11:01:00+05:00",
  "entry" : [{
    "fullUrl" : "http://example.org/fhir/Claim/PCT-GFE-Summary-1",
    "resource" : {
      "resourceType" : "Claim",
      "id" : "PCT-GFE-Summary-1",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_PCT-GFE-Summary-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim PCT-GFE-Summary-1</b></p><a name=\"PCT-GFE-Summary-1\"> </a><a name=\"hcPCT-GFE-Summary-1\"> </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-gfe-summary.html\">PCT Good Faith Estimate  Summary</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse estimate-summary}\">Estimate Summary</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>billablePeriod</b>: 2021-10-31 --&gt; 2021-10-31</p><p><b>created</b>: 2021-10-05</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: ?rref?</p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td><td><b>PackageCode</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm S06.30}\">Unspecified focal traumatic brain injury</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/diagnosistype principal}\">Principal Diagnosis</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup 400}\">Head trauma - concussion</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --&gt; 2022-01-01</a></td></tr></table><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></div>"
      },
      "status" : "active",
      "type" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
          "code" : "estimate-summary",
          "display" : "Estimate Summary"
        }]
      },
      "use" : "predetermination",
      "patient" : {
        "reference" : "Patient/patient1001"
      },
      "billablePeriod" : {
        "start" : "2021-10-31",
        "end" : "2021-10-31"
      },
      "created" : "2021-10-05",
      "insurer" : {
        "reference" : "Organization/org1001"
      },
      "provider" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
          "valueCode" : "not-applicable"
        }]
      },
      "priority" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
          "code" : "normal"
        }]
      },
      "diagnosis" : [{
        "sequence" : 1,
        "diagnosisCodeableConcept" : {
          "coding" : [{
            "system" : "http://hl7.org/fhir/sid/icd-10-cm",
            "code" : "S06.30",
            "display" : "Unspecified focal traumatic brain injury"
          }]
        },
        "type" : [{
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
            "code" : "principal"
          }]
        }],
        "packageCode" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup",
            "code" : "400",
            "display" : "Head trauma - concussion"
          }]
        }
      }],
      "insurance" : [{
        "sequence" : 1,
        "focal" : true,
        "coverage" : {
          "reference" : "Coverage/coverage1001"
        }
      }],
      "total" : {
        "value" : 200,
        "currency" : "USD"
      }
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Claim/PCT-GFE-Institutional-1",
    "resource" : {
      "resourceType" : "Claim",
      "id" : "PCT-GFE-Institutional-1",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional"]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_PCT-GFE-Institutional-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim PCT-GFE-Institutional-1</b></p><a name=\"PCT-GFE-Institutional-1\"> </a><a name=\"hcPCT-GFE-Institutional-1\"> </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-gfe-institutional.html\">PCT Good Faith Estimate Institutional</a></p></div><p><b>ProviderEventMethodology</b>: EEMM1021</p><p><b>GFEDisclaimer</b>: For estimation purposes only</p><blockquote><p><b>GFEServiceLinkingInfo</b></p><ul><li>linkingIdentifier: <code>http://example.org/Claim/identifiers</code>/223452-2342-2435-008001</li><li>plannedPeriodOfService: 2021-10-31</li></ul></blockquote><p><b>identifier</b>: Placer Identifier/GFEProviderAssignedID0001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>created</b>: 2021-10-05</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: <a href=\"Organization-Submitter-Org-1.html\">Organization GFE Service Help INC.</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><p><b>referral</b>: Referral Number</p><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType typeofbill}\">Type of Bill</span></td><td><span title=\"Codes:{https://www.nubc.org/CodeSystem/TypeOfBill 011X}\">Hospital Inpatient (Part A)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td><td><b>PackageCode</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm S06.30}\">Unspecified focal traumatic brain injury</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/diagnosistype principal}\">Principal Diagnosis</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup 400}\">Head trauma - concussion</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --&gt; 2022-01-01</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Service Description</b>: Imaging</p><p><b>sequence</b>: 1</p><p><b>revenue</b>: <span title=\"Codes:{https://www.nubc.org/CodeSystem/RevenueCodes 0611}\">Magnetic Resonance Technology (MRT) - Brain/brain stem</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>modifier</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>serviced</b>: 2021-10-31</p><p><b>quantity</b>: 1</p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></div>"
      },
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology",
        "valueString" : "EEMM1021"
      },
      {
        "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer",
        "valueString" : "For estimation purposes only"
      },
      {
        "extension" : [{
          "url" : "linkingIdentifier",
          "valueIdentifier" : {
            "system" : "http://example.org/Claim/identifiers",
            "value" : "223452-2342-2435-008001"
          }
        },
        {
          "url" : "plannedPeriodOfService",
          "valueDate" : "2021-10-31"
        }],
        "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo"
      }],
      "identifier" : [{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "PLAC",
            "display" : "Placer Identifier"
          }]
        },
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "value" : "GFEProviderAssignedID0001"
      }],
      "status" : "active",
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
          "code" : "institutional",
          "display" : "Institutional"
        }]
      },
      "use" : "predetermination",
      "patient" : {
        "reference" : "Patient/patient1001"
      },
      "created" : "2021-10-05",
      "insurer" : {
        "reference" : "Organization/org1001"
      },
      "provider" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://nucc.org/provider-taxonomy",
              "code" : "2085D0003X",
              "display" : "Diagnostic Neuroimaging (Radiology) Physician"
            }]
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling",
          "valueBoolean" : true
        }],
        "reference" : "Organization/Submitter-Org-1"
      },
      "priority" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
          "code" : "normal"
        }]
      },
      "payee" : {
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/payeetype",
            "code" : "provider"
          }]
        }
      },
      "referral" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber",
          "valueString" : "REF12022002-121"
        }],
        "display" : "Referral Number"
      },
      "supportingInfo" : [{
        "sequence" : 1,
        "category" : {
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
            "code" : "typeofbill"
          }]
        },
        "code" : {
          "coding" : [{
            "system" : "https://www.nubc.org/CodeSystem/TypeOfBill",
            "code" : "011X",
            "display" : "Hospital Inpatient (Part A)"
          }]
        }
      }],
      "diagnosis" : [{
        "sequence" : 1,
        "diagnosisCodeableConcept" : {
          "coding" : [{
            "system" : "http://hl7.org/fhir/sid/icd-10-cm",
            "code" : "S06.30",
            "display" : "Unspecified focal traumatic brain injury"
          }]
        },
        "type" : [{
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
            "code" : "principal"
          }]
        }],
        "packageCode" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup",
            "code" : "400",
            "display" : "Head trauma - concussion"
          }]
        }
      }],
      "insurance" : [{
        "sequence" : 1,
        "focal" : true,
        "coverage" : {
          "reference" : "Coverage/coverage1001"
        }
      }],
      "item" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription",
          "valueString" : "Imaging"
        }],
        "sequence" : 1,
        "revenue" : {
          "coding" : [{
            "system" : "https://www.nubc.org/CodeSystem/RevenueCodes",
            "code" : "0611",
            "display" : "Magnetic Resonance Technology (MRT) - Brain/brain stem"
          }]
        },
        "productOrService" : {
          "coding" : [{
            "system" : "http://www.ama-assn.org/go/cpt",
            "code" : "70551",
            "display" : "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material"
          }]
        },
        "modifier" : [{
          "coding" : [{
            "system" : "http://www.ama-assn.org/go/cpt",
            "code" : "70551",
            "display" : "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material"
          }]
        }],
        "servicedDate" : "2021-10-31",
        "quantity" : {
          "value" : 1
        },
        "net" : {
          "value" : 200,
          "currency" : "USD"
        }
      }],
      "total" : {
        "value" : 200,
        "currency" : "USD"
      }
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Organization/Submitter-Org-1",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "Submitter-Org-1",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_Submitter-Org-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization Submitter-Org-1</b></p><a name=\"Submitter-Org-1\"> </a><a name=\"hcSubmitter-Org-1\"> </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-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: Electronic Transmitter Identification Number/ETIN-10010301</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type bus}\">Non-Healthcare Business or Corporation</span></p><p><b>name</b>: GFE Service Help INC.</p><blockquote><p><b>contact</b></p><p><b>purpose</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgContactPurposeType GFERELATED}\">GFE-related</span></p><p><b>name</b>: Clara Sender</p><p><b>telecom</b>: ph: 781-632-3209(Work), <a href=\"mailto:csender@GFEServiceHelp.com\">csender@GFEServiceHelp.com</a></p></blockquote></div>"
      },
      "identifier" : [{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "ETIN"
          }]
        },
        "value" : "ETIN-10010301"
      }],
      "active" : true,
      "type" : [{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
          "code" : "bus"
        }]
      }],
      "name" : "GFE Service Help INC.",
      "contact" : [{
        "purpose" : {
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgContactPurposeType",
            "code" : "GFERELATED"
          }]
        },
        "name" : {
          "text" : "Clara Sender"
        },
        "telecom" : [{
          "system" : "phone",
          "value" : "781-632-3209",
          "use" : "work"
        },
        {
          "system" : "email",
          "value" : "csender@GFEServiceHelp.com",
          "use" : "work"
        }]
      }]
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Organization/org1001",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "org1001",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_org1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization org1001</b></p><a name=\"org1001\"> </a><a name=\"hcorg1001\"> </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-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: Electronic Transmitter Identification Number/ETIN-3200002</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type pay}\">Payer</span></p><p><b>name</b>: Umbrella Insurance Company</p><p><b>telecom</b>: ph: 860-547-5001(Work)</p><p><b>address</b>: 680 Asylum Street Hartford CT 06155 US </p></div>"
      },
      "identifier" : [{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "ETIN"
          }]
        },
        "value" : "ETIN-3200002"
      }],
      "active" : true,
      "type" : [{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
          "code" : "pay",
          "display" : "Payer"
        }]
      }],
      "name" : "Umbrella Insurance Company",
      "telecom" : [{
        "system" : "phone",
        "value" : "860-547-5001",
        "use" : "work"
      }],
      "address" : [{
        "line" : ["680 Asylum Street"],
        "city" : "Hartford",
        "state" : "CT",
        "postalCode" : "06155",
        "country" : "US"
      }]
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Patient/patient1001",
    "resource" : {
      "resourceType" : "Patient",
      "id" : "patient1001",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0"]
      },
      "text" : {
        "status" : "additional",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_patient1001\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Eve Betterhalf</b> female, DoB: 1955-07-23 ( <code>http://example.com/identifiers/patient</code>/1001)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}\">unmarried</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 781-949-4949(MOBILE)</li><li>222 Burlington Road, Bedford MA 01730</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Languages spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (United States)</span> (preferred)</td></tr></table></div>"
      },
      "identifier" : [{
        "system" : "http://example.com/identifiers/patient",
        "value" : "1001"
      }],
      "name" : [{
        "text" : "Eve Betterhalf",
        "family" : "Betterhalf",
        "given" : ["Eve"]
      }],
      "telecom" : [{
        "system" : "phone",
        "value" : "781-949-4949",
        "use" : "mobile"
      }],
      "gender" : "female",
      "birthDate" : "1955-07-23",
      "address" : [{
        "text" : "222 Burlington Road, Bedford MA 01730"
      }],
      "maritalStatus" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
          "code" : "U",
          "display" : "unmarried"
        }]
      },
      "communication" : [{
        "language" : {
          "coding" : [{
            "system" : "urn:ietf:bcp:47",
            "code" : "en-US",
            "display" : "English (United States)"
          }]
        },
        "preferred" : true
      }]
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Coverage/coverage1001",
    "resource" : {
      "resourceType" : "Coverage",
      "id" : "coverage1001",
      "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\"><a name=\"Coverage_coverage1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage coverage1001</b></p><a name=\"coverage1001\"> </a><a name=\"hccoverage1001\"> </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>: insurance</p><p><b>status</b>: Active</p><p><b>subscriberId</b>: PFP123450000</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>period</b>: 2021-01-01 --&gt; 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><h3>CostToBeneficiaries</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-copay-type copaypct}\">Copay Percentage</span></td><td>20</td></tr></table></div>"
      },
      "extension" : [{
        "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind",
        "valueCode" : "insurance"
      }],
      "status" : "active",
      "subscriberId" : "PFP123450000",
      "beneficiary" : {
        "reference" : "Patient/patient1001"
      },
      "relationship" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
          "code" : "self",
          "display" : "Self"
        }]
      },
      "period" : {
        "start" : "2021-01-01",
        "end" : "2022-01-01"
      },
      "payor" : [{
        "reference" : "Organization/org1001"
      }],
      "class" : [{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan",
            "display" : "Plan"
          }]
        },
        "value" : "Premim Family Plus",
        "name" : "Premim Family Plus Plan"
      }],
      "costToBeneficiary" : [{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
            "code" : "copaypct",
            "display" : "Copay Percentage"
          }]
        },
        "valueQuantity" : {
          "value" : 20
        }
      }]
    }
  }]
}

```
