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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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Coverage/example> a fhir:Coverage ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "example"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-coverage" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-coverage>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.div "<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>"
  ] ;
  fhir:Coverage.identifier [
     fhir:index -1 ;
     fhir:Identifier.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ] ;
         fhir:Coding.code [ fhir:value "MB" ] ;
         fhir:Coding.display [ fhir:value "Member Number" ]
       ] ;
       fhir:CodeableConcept.text [ fhir:value "Member ID" ]
     ] ;
     fhir:Identifier.system [ fhir:value "http://example.org/payer/member-ids" ] ;
     fhir:Identifier.value [ fhir:value "MB123456789" ]
  ] ;
  fhir:Coverage.status [ fhir:value "active"] ;
  fhir:Coverage.type [
     fhir:CodeableConcept.text [ fhir:value "Preferred Provider Organization (PPO)" ]
  ] ;
  fhir:Coverage.policyHolder [
     fhir:link <http://hl7.org/fhir/Patient/example> ;
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ] ;
  fhir:Coverage.subscriber [
     fhir:link <http://hl7.org/fhir/Patient/example> ;
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ] ;
  fhir:Coverage.subscriberId [ fhir:value "SUB987654321"] ;
  fhir:Coverage.beneficiary [
     fhir:link <http://hl7.org/fhir/Patient/example> ;
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ] ;
  fhir:Coverage.dependent [ fhir:value "0"] ;
  fhir:Coverage.relationship [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ] ;
       fhir:Coding.code [ fhir:value "self" ] ;
       fhir:Coding.display [ fhir:value "Self" ]
     ]
  ] ;
  fhir:Coverage.period [
     fhir:Period.start [ fhir:value "2026-01-01"^^xsd:date ] ;
     fhir:Period.end [ fhir:value "2026-12-31"^^xsd:date ]
  ] ;
  fhir:Coverage.payor [
     fhir:index -1 ;
     fhir:link <http://hl7.org/fhir/Organization/example> ;
     fhir:Reference.reference [ fhir:value "Organization/example" ]
  ] ;
  fhir:Coverage.class [
     fhir:index -1 ;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
         fhir:Coding.code [ fhir:value "group" ] ;
         fhir:Coding.display [ fhir:value "Group" ]
       ]
     ] ;
     fhir:Coverage.class.value [ fhir:value "GRP-99482" ] ;
     fhir:Coverage.class.name [ fhir:value "Example Employer Health Plan" ]
  ], [
     fhir:index -1 ;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
         fhir:Coding.code [ fhir:value "plan" ] ;
         fhir:Coding.display [ fhir:value "Plan" ]
       ]
     ] ;
     fhir:Coverage.class.value [ fhir:value "PLN-GOLD-2026" ] ;
     fhir:Coverage.class.name [ fhir:value "Example PPO Option" ]
  ] .

<http://hl7.org/fhir/Patient/example> a fhir:Patient .

<http://hl7.org/fhir/Organization/example> a fhir:Organization .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Coverage/example.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Coverage/example.ttl> .