This is the set of resources that conform to either of the profiles PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage) and PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage). E.g. what you have to deal with if you get resources conforming to one of them
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() |
|---|---|---|---|---|
![]() | C | 0..* | Insurance or medical plan or a payment agreement Constraints: hrex-cov-1 | |
![]() ![]() | 0..1 | Meta | Metadata about the resource | |
![]() ![]() | 0..1 | uri | A set of rules under which this content was created | |
![]() ![]() | 0..1 | code | Language of the resource content Binding: ?? (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 | left: Additional content defined by implementations; right: Extension | |
![]() ![]() | 0..* | Extension | Extensions that cannot be ignored | |
![]() ![]() | 0..* | Identifier | left: Also known as Member identifier; right: Member ID and other identifiers | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
![]() ![]() ![]() | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |
![]() ![]() ![]() | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |
![]() ![]() ![]() | 1..1 | string | The value that is unique within the system. Example General: 123456 | |
![]() ![]() ![]() | 0..1 | Period | Time period when id is/was valid for use | |
![]() ![]() ![]() | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | |
![]() ![]() | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |
![]() ![]() | 0..1 | CodeableConcept | left: Coverage category such as medical or accident; right: Coverage category such as medical or accident. A coverage.type of `81` (Self-pay) MAY be used to imply that the patient has no coverage or that an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs. Binding: ?? (extensible): left: The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.; right: US Public Health Data Consortium Source of Payment Codes | |
![]() ![]() | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | |
![]() ![]() | 0..1 | Reference(Patient | RelatedPerson) | Required if subscriber is a person that is not the beneficiary. When date of birth or gender are not known, omit Patient.birthDate and set Patient.gender to unknown. | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | 0..1 | string | Literal reference, Relative, internal or absolute URL | |
![]() ![]() ![]() | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |
![]() ![]() ![]() | 0..1 | Identifier | Logical reference, when literal reference is not known | |
![]() ![]() ![]() | 0..1 | string | left: Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber’s prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference.; right: Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber's prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference. | |
![]() ![]() | 1..1 | string | left: Subscriber ID; right: ID assigned to the subscriber | |
![]() ![]() ![]() | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() | 0..1 | string | Primitive value for string Max Length:1048576 | |
![]() ![]() | 1..1 | Reference(HRex Patient Demographics | #sd-24-hrex-patient-demographics-us-core-patient) | left: Plan beneficiary; right: Patient or Plan Beneficiary | |
![]() ![]() | 0..1 | string | Dependent number | |
![]() ![]() | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |
![]() ![]() | 0..1 | Period | Coverage start and end dates | |
![]() ![]() | 1..1 | Reference(PCT Organization), Reference(PCT Organization | http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0 | http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson|7.0.0) | left: Issuer of the policy; right: Issuer of the policy. For Self-pay or uninsured this should be a reference to a patient or related person resource | |
![]() ![]() | 0..* | BackboneElement | Additional coverage classifications | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. | |
![]() ![]() ![]() | 1..1 | string | Value associated with the type | |
![]() ![]() ![]() | 1..1 | string | Human readable description of the type and value | |
![]() ![]() | 0..1 | positiveInt | Relative order of the coverage | |
![]() ![]() | 0..1 | string | Insurer network | |
![]() ![]() | 0..* | BackboneElement | Patient payments for services/products | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Cost category Binding: ?? (required) | |
![]() ![]() ![]() | 1..1 | The amount or percentage due from the beneficiary | ||
![]() ![]() ![]() ![]() | Quantity(SimpleQuantity) | |||
![]() ![]() ![]() ![]() | Money | |||
![]() ![]() ![]() | 0..* | BackboneElement | Exceptions for patient payments | |
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. | |
![]() ![]() ![]() ![]() | 0..1 | Period | The effective period of the exception | |
![]() ![]() | 0..1 | boolean | Reimbursement to insurer | |
![]() ![]() | 0..* | Reference(Contract) | Contract details | |
Documentation for this format | ||||