US Quality Core Implementation Guide
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US Quality Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-quality-core/ and changes regularly. See the Directory of published versions

: Coverage example

Page standards status: Informative

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="example"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-coverage"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage example</b></p><a name="example"> </a><a name="hcexample"> </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-us-quality-core-coverage.html">US Quality Core Coverage</a></p></div><p><b>identifier</b>: Member ID/MB123456789</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:">Preferred Provider Organization (PPO)</span></p><p><b>policyHolder</b>: <a href="Patient-example.html">Example Patient  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>subscriber</b>: <a href="Patient-example.html">Example Patient  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>subscriberId</b>: SUB987654321</p><p><b>beneficiary</b>: <a href="Patient-example.html">Example Patient  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>dependent</b>: 0</p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>period</b>: 2026-01-01 --&gt; 2026-12-31</p><p><b>payor</b>: <a href="Organization-example.html">Organization Example Organization</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}">Group</span></p><p><b>value</b>: GRP-99482</p><p><b>name</b>: Example Employer Health Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}">Plan</span></p><p><b>value</b>: PLN-GOLD-2026</p><p><b>name</b>: Example PPO Option</p></blockquote></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
        <display value="Member Number"/>
      </coding>
      <text value="Member ID"/>
    </type>
    <system value="http://example.org/payer/member-ids"/>
    <value value="MB123456789"/>
  </identifier>
  <status value="active"/>
  <type>
    <text value="Preferred Provider Organization (PPO)"/>
  </type>
  <policyHolder>🔗 
    <reference value="Patient/example"/>
  </policyHolder>
  <subscriber>🔗 
    <reference value="Patient/example"/>
  </subscriber>
  <subscriberId value="SUB987654321"/>
  <beneficiary>🔗 
    <reference value="Patient/example"/>
  </beneficiary>
  <dependent value="0"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
      <display value="Self"/>
    </coding>
  </relationship>
  <period>
    <start value="2026-01-01"/>
    <end value="2026-12-31"/>
  </period>
  <payor>🔗 
    <reference value="Organization/example"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
        <display value="Group"/>
      </coding>
    </type>
    <value value="GRP-99482"/>
    <name value="Example Employer Health Plan"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
        <display value="Plan"/>
      </coding>
    </type>
    <value value="PLN-GOLD-2026"/>
    <name value="Example PPO Option"/>
  </class>
</Coverage>