Intersection of http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage and http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage

This is the set of resources that conform to both US Core Coverage Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage) and PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage).

Structure

Name	Flags	Card.	Type	Description & Constraints
Coverage	C	0..*		Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding ele-1: All FHIR elements must have a @value or children
text		0..1	Narrative	Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
extension		1..*	Extension	left: Additional content defined by implementations; right: Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	0..1	Identifier	left: Member ID and other identifiers; right: Also known as Member identifier ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes ele-1: All FHIR elements must have a @value or children
policyHolder	Σ	0..1	Reference(US Core Patient Profile | HRex Organization Profile | RelatedPerson)	Owner of the policy ele-1: All FHIR elements must have a @value or children
subscriber	Σ	0..1	Reference(US Core Patient Profile)	left: Subscriber to the policy; right: 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. ele-1: All FHIR elements must have a @value or children
subscriberId	SΣ	1..1	string	left: ID assigned to the subscriber; right: Subscriber ID ele-1: All FHIR elements must have a @value or children
beneficiary	SΣ	1..1	Reference(US Core Patient Profile | #sd-us-core-patient-hrex-patient-demographics)	Plan beneficiary ele-1: All FHIR elements must have a @value or children
dependent	SΣ	0..1	string	Dependent number ele-1: All FHIR elements must have a @value or children
relationship	S	1..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). ele-1: All FHIR elements must have a @value or children
period	SΣ	1..1	Period	Coverage start and end dates ele-1: All FHIR elements must have a @value or children
payor	SΣ	1..1	Reference(PCT Organization)	Issuer of the policy ele-1: All FHIR elements must have a @value or children
class	S	1..*	BackboneElement	Additional coverage classifications ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. ele-1: All FHIR elements must have a @value or children
value	Σ	1..1	string	Value associated with the type ele-1: All FHIR elements must have a @value or children
name	Σ	1..1	string	Human readable description of the type and value ele-1: All FHIR elements must have a @value or children
order	Σ	0..1	positiveInt	Relative order of the coverage ele-1: All FHIR elements must have a @value or children
network	Σ	0..1	string	Insurer network ele-1: All FHIR elements must have a @value or children
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	Σ	0..1	CodeableConcept	Cost category Binding: ?? (required): The types of services to which patient copayments are specified. ele-1: All FHIR elements must have a @value or children
value[x]	Σ	1..1		The amount or percentage due from the beneficiary ele-1: All FHIR elements must have a @value or children
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money(SimpleQuantity)
exception		0..*	BackboneElement	Exceptions for patient payments ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	Σ	1..1	CodeableConcept	Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. ele-1: All FHIR elements must have a @value or children
period	Σ	0..1	Period	The effective period of the exception ele-1: All FHIR elements must have a @value or children
subrogation		0..1	boolean	Reimbursement to insurer ele-1: All FHIR elements must have a @value or children
contract		0..*	Reference(Contract)	Contract details ele-1: All FHIR elements must have a @value or children
Documentation for this format