Finance and Insurance Service (FAIS), published by IHE IT Infrastructure Technical Committee. This guide is not an authorized publication; it is the continuous build for version 1.0.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/ITI.Finance/ and changes regularly. See the Directory of published versions
: Use Case 2 - Example Coverage Eligibility Response Bundle - TTL Representation
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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 -------------------------------------------------------------------
a fhir:Bundle ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "ex-check-coverage-resp-bundle-2"] ; #
fhir:meta [
( fhir:profile [
fhir:v "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CEResponse.Bundle"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CEResponse.Bundle> ] )
] ; #
fhir:type [ fhir:v "collection"] ; #
fhir:entry ( [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/CoverageEligibilityResponse/ex-check-coverage-resp-2"^^xsd:anyURI ] ;
( fhir:resource <https://profiles.ihe.net/ITI/FAIS/CoverageEligibilityResponse/ex-check-coverage-resp-2> )
] [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1"^^xsd:anyURI ] ;
( fhir:resource <https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1> )
] [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1"^^xsd:anyURI ] ;
( fhir:resource <https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1> )
] [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1"^^xsd:anyURI ] ;
( fhir:resource <https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1> )
] ) . #
<https://profiles.ihe.net/ITI/FAIS/CoverageEligibilityResponse/ex-check-coverage-resp-2> a fhir:CoverageEligibilityResponse ;
fhir:id [ fhir:v "ex-check-coverage-resp-2"] ; #
fhir:meta [
( fhir:profile [
fhir:v "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityResponse_ex-check-coverage-resp-2\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse ex-check-coverage-resp-2</b></p><a name=\"ex-check-coverage-resp-2\"> </a><a name=\"hcex-check-coverage-resp-2\"> </a><a name=\"ex-check-coverage-resp-2-en-US\"> </a><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-06-01 15:01:00+0000</p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-ex-check-coverage-2.html\">CoverageEligibilityRequest: status = active; purpose = benefits; serviced[x] = 2024-07-01 --> 2024-12-31; created = 2024-06-01 15:00:00+0000</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Allowed</p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Coverage</b></td><td><b>Inforce</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Coverage-ex-coverage-1.html\">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --> 2024-12-31</a></td><td>true</td></tr></table></div>"
] ; #
fhir:status [ fhir:v "active"] ; #
fhir:purpose ( [ fhir:v "benefits"] ) ; #
fhir:patient [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
] ; #
fhir:created [ fhir:v "2024-06-01T15:01:00Z"^^xsd:dateTime] ; #
fhir:request [
fhir:reference [ fhir:v "CoverageEligibilityRequest/ex-check-coverage-2" ]
] ; #
fhir:outcome [ fhir:v "complete"] ; #
fhir:disposition [ fhir:v "Allowed"] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/ex-insurer-1" ]
] ; #
fhir:insurance ( [
fhir:coverage [
fhir:reference [ fhir:v "Coverage/ex-coverage-1" ] ] ;
fhir:inforce [ fhir:v "true"^^xsd:boolean ]
] ) . #
<https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1> a fhir:Organization ;
fhir:id [ fhir:v "ex-insurer-1"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_ex-insurer-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization ex-insurer-1</b></p><a name=\"ex-insurer-1\"> </a><a name=\"hcex-insurer-1\"> </a><a name=\"ex-insurer-1-en-US\"> </a><p><b>name</b>: National Health Insurance Scheme</p></div>"
] ; #
fhir:name [ fhir:v "National Health Insurance Scheme"] . #
<https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1> a fhir:Patient ;
fhir:id [ fhir:v "ex-beneficiary-1"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_ex-beneficiary-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient ex-beneficiary-1</b></p><a name=\"ex-beneficiary-1\"> </a><a name=\"hcex-beneficiary-1\"> </a><a name=\"ex-beneficiary-1-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Purity Atieno Female, DoB: 2000-05-04</p><hr/></div>"
] ; #
fhir:name ( [
fhir:family [ fhir:v "Atieno" ] ;
( fhir:given [ fhir:v "Purity" ] )
] ) ; #
fhir:gender [ fhir:v "female"] ; #
fhir:birthDate [ fhir:v "2000-05-04"^^xsd:date] . #
<https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1> a fhir:Coverage ;
fhir:id [ fhir:v "ex-coverage-1"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_ex-coverage-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage ex-coverage-1</b></p><a name=\"ex-coverage-1\"> </a><a name=\"hcex-coverage-1\"> </a><a name=\"ex-coverage-1-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PUBLICPOL}\">public healthcare</span></p><p><b>policyHolder</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>subscriber</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>subscriberId</b>: 05710b56-4448-11ef-b676-774a043da147</p><p><b>beneficiary</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2024-01-01 --> 2024-12-31</p><p><b>payor</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p></div>"
] ; #
fhir:status [ fhir:v "active"] ; #
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PUBLICPOL" ] ;
fhir:display [ fhir:v "public healthcare" ] ] )
] ; #
fhir:policyHolder [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
] ; #
fhir:subscriber [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
] ; #
fhir:subscriberId [ fhir:v "05710b56-4448-11ef-b676-774a043da147"] ; #
fhir:beneficiary [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
] ; #
fhir:relationship [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ;
fhir:code [ fhir:v "self" ] ;
fhir:display [ fhir:v "Self" ] ] )
] ; #
fhir:period [
fhir:start [ fhir:v "2024-01-01"^^xsd:date ] ;
fhir:end [ fhir:v "2024-12-31"^^xsd:date ]
] ; #
fhir:payor ( [
fhir:reference [ fhir:v "Organization/ex-insurer-1" ]
] ) . #
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